PAIN+ CPN

Jung A, Carvalho GF, Szikszay TM, et al. Physical Therapist Interventions to Reduce Headache Intensity, Frequency, and Duration in Patients With Cervicogenic Headache: A Systematic Review and Network Meta-Analysis. Phys Ther. 2024 Feb 1;104(2):pzad154. doi: 10.1093/ptj/pzad154. (Systematic review)
Abstract

OBJECTIVE: The aim of this study was to assess the efficacy of physical therapist interventions on the intensity, frequency, and duration of headaches, as well as on the quality of life of patients with cervicogenic headache.

METHODS: The following databases were searched up to October 2022: Physiotherapy Evidence Database, Web of Science, Pubmed, and Cochrane Library. Randomized controlled trials assessing the effect of physical therapist interventions on adults with cervicogenic headache were included. Quality appraisal was conducted using the Cochrane risk of bias 2.0 tool and the Confidence in Network Meta-analysis web app. Synthesis methods were conducted in accordance with the Cochrane Handbook.

RESULTS: Of the 28 identified reports, 23 were included in the quantitative synthesis. Manipulation plus dry needling was the highest-ranked intervention to reduce the short-term headache intensity (mean difference [MD] = -4.87; 95% CI = -8.51 to -1.24) and frequency (MD = -3.09; 95% CI = -4.93 to -1.25) when compared to a control intervention. Other high-ranked and clinically effective interventions (when compared to a control intervention) were muscle-energy technique plus exercise (MD = 4.37; 95% CI = -8.01 to -0.74), as well as soft tissue techniques plus exercise (MD = -3.01; 95% CI = -5.1 to -0.92) to reduce short-term headache intensity, and dry needling plus exercise (MD = -2.92; 95% CI = -4.73 to -1.11) to reduce short-term headache frequency. These results were based on a low certainty of evidence.

CONCLUSION: The 4 most highly ranked interventions can be considered in clinical practice. However, no conclusive recommendation can be made due to the low certainty of evidence.

IMPACT: Combined interventions such as spinal joint manipulation plus dry needling and muscle-energy technique or soft tissue techniques or dry needling plus exercises seem to be the best interventions to reduce short-term cervicogenic headache intensity and/or frequency.

Ratings
Discipline Area Score
Physician 6 / 7
Rehab Clinician (OT/PT) 6 / 7
Show me more articles about:
  Headache   Neck Pain and Injury
Comments from MORE raters

Physician rater

According to this study, among the treatment options for patients with cervicogenic headache, 4 different combinations of physical therapist interventions have been identified as the most clinically effective in reducing short-term headache intensity and/or frequency when compared to a control intervention. These interventions include spinal joint manipulation plus dry needling, and muscle-energy technique or soft tissue techniques or dry needling plus exercise. However, due to the low-certainty evidence, no conclusive recommendation can be made. Combining interventions are more effective than using single intervention techniques in improving headache symptoms. This study did not statistically evaluate adverse effects of treatments. Despite these limitations, clinicians can use these therapeutic options to customize treatment plans for patients.

Rehab Clinician (OT/PT) rater

I think this is an interesting study. Unfortunately, while the results of the analysis seems to provide some useful information, the confidence intervals never exceed the meaningful clinically important difference (except for dry needling in terms of frequency), making the results questionable for real clinical utility. Moreover, the MD decrease in pain frequency reported for mobilization is not included in the CI intervals reported, and this is very strange.

Rehab Clinician (OT/PT) rater

The most important finding of this study is that the combination of physical therapy interventions is more effective than a single physical therapy intervention in improving headache in patients with cervicogenic headache.

Rehab Clinician (OT/PT) rater

It is useful to know PT is effective for cervicogenic headache and that commonly used interventions are effective.

Rehab Clinician (OT/PT) rater

A comprehensive conclusion is provided showing that the combination of spinal joint manipulation plus dry needling might be the most effective physical therapist intervention to reduce short-term headache intensity and frequency. Other combinations of interventions such as muscle–energy technique plus exercise, soft tissue techniques plus exercise, and dry needling plus exercise were also high ranked and effective in reducing short-term headache intensity or frequency. All 4 combinations of interventions reached statistically significant and clinically meaningful effect sizes (all with a low certainty of evidence). Although no conclusive recommendation can be made due to the low certainty of evidence, the results of the present study should be considered by clinicians while considering the intervention options for patients with CGH.
Comments from PAIN+ CPN subscribers

No subscriber has commented on this article yet.