The effectiveness of manipulation and mobilization on pain and disability in individuals with cervicogenic and tension-type headaches: a systematic review and meta-analysis

Abstract

Background: Cervicogenic (CGH) and tension-type (TTH) headaches are prevalent conditions that are associated with considerable pain and disability. Joint mobilization and manipulation are common interventions used by physical therapists to manage individuals with musculoskeletal conditions. However, there is controversy surrounding their effectiveness.

Objectives: To evaluate the effectiveness of mobilization and manipulation (MM) compared to other conservative treatments on reducing pain, frequency, and disability in patients with CGH and TTH.

Methods: A literature search using terms related to mobilization, manipulation, CGH, and TTH was conducted to identify randomized clinical trials comparing MM to conservative treatment in treating CGH and TTH. The overall quality of the evidence was assessed using the Cochrane risk-of-bias tool. Meta-analysis and qualitative synthesis of the evidence were performed.

Results: Nine total studies were included in the systematic review. The majority of studies scored lower than a 69% on the Cochrane risk of bias tool indicating a moderate to high risk of bias. MM were found to be equally as effective as conservative treatment in reducing pain, disability, and frequency of headache in individuals with CGH. MM had statistically significant short-term (1–4 weeks) improvements over conservative treatment for TTH on pain and disability, but not frequency. When comparing the effectiveness of MM versus conservative treatment for TTH, both groups exhibited improvement between 1–3 months in all three outcomes.

Conclusions: Manipulation and mobilization were only found to be more effective than conservative care at short-term follow up for individuals with TTH.

Keywords:

• Manipulations
• mobilization
• cervicogenic headache
• tension-type headache
• manual therapy

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Matthew Coelho

Matthew Coelho, SPT, is a third-year doctor of physical therapy student at Franklin Pierce University. Upon graduation in March 2019, he will begin his career as a physical therapist and plans to specialize in orthopedics and manual therapy.

Naomi Ela

Naomi Ela, SPT, is a third-year doctor of physical therapy student at Franklin Pierce University. Upon graduation in March 2019, she will begin her career as a physical therapist.

Allison Garvin

Allison Garvin, SPT, is a third-year doctor of physical therapy student at Franklin Pierce University. Upon graduation in March 2019, she will begin her career as a physical therapist.

Charles Cox

Charles Cox, SPT, is a third-year doctor of physical therapy student at Franklin Pierce University. Upon graduation in March 2019, he will begin his career as a physical therapist.

Wendy Sloan

Wendy Sloan, SPT, is a third-year doctor of physical therapy student at Franklin Pierce University. Upon graduation in March 2019, she will begin her career as a physical therapist.

Mary Palaima

Mary Palaima, PT, EdD, is a professor and the Program Director of the Doctor of Physical Therapy program at Franklin Pierce University. She is a physical therapist and has a specific research interests and expertise in areas of clinical education and health care education.

Joshua A. Cleland

Joshua Cleland, PT, PHD, is a professor in the Doctor of Physical Therapy program at Franklin Pierce University. He is a clinical researcher, author, and practicing clinician who has co-authored four textbooks and has over 200 publications with specific interest focused on the efficacy of manual therapy and exercise for disorders affecting the spine and extremities.