SYSTEMATIC REVIEW article
Front. Neurol.
Sec. Headache and Neurogenic Pain
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1566764
Comparative Safety and Efficacy of Manual Therapy Interventions for Cervicogenic Headache: A Systematic Review and Network Meta-Analysis
Provisionally accepted
Xueliang Xu1
Yan Ling2*- 1Third Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
- 2Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Objective: To evaluate and compare the safety and efficacy of spinal manipulation, mobilization, and massage for the management of cervicogenic headache (CGH) using meta-analytic techniques.Methods: Comprehensive searches were conducted in Cochrane, Embase, PubMed, and ClinicalTrials.gov to identify studies investigating the effects of manipulation, mobilization, and massage on pain, disability, and physical function in patients with CGH. Key outcomes included pain severity (visual analog scale, VAS), Neck Disability Index (NDI), Flexion-Rotation Test (FRT), and Headache Disability Inventory (HDI) at various follow-up timepoints.Results: Fourteen studies totaling 1,297 CGH patients were included. Standard pairwise meta-analysis revealed that sustained natural apophyseal glides (SNAG) mobilization produced significantly greater improvements compared to non-SNAG interventions in VAS (MD=1.73, 95%CI: 1.05, 2.40), NDI (MD=8.55, 95%CI: 2.73, 14.37), FRT (MD=-7.22, 95%CI: -9.38, -5.07), and HDI (MD=9.29, 95%CI: 3.64, 14.95), with benefits maintained over time. Network meta-analysis showed that for VAS improvement, the surface under the cumulative ranking curve (SUCRA) probabilities were: cervical spine manipulation (CSM, 98.9%), mobilization (67.3%), exercise (21.0%), and massage (12.8%). For NDI, the SUCRA scores were: CSM (82.2%), mobilization (57.2%), exercise (6.7%), and massage (53.9%). CSM exhibited significantly greater VAS reductions compared to exercise, massage, and mobilization, while mobilization was superior to exercise and massage for VAS. For NDI, CSM was significantly better than exercise, but no other between-group differences were observed.Conclusions: In patients with CGH, SNAG mobilization can significantly improve pain and function, with benefits maintained in the long-term. Additionally, CSM may be the most effective short-term intervention for reducing pain and disability compared to mobilization, massage, and exercise, although clinician expertise appears to be an important factor.
Keywords: Cervicogenic Headache, Neck disability index, Flexion-rotation test, manual therapy, Meta-analysis
Received: 25 Jan 2025; Accepted: 22 Apr 2025.
Copyright: © 2025 Xu and Ling. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yan Ling, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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