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QUESTION: In patients with cervicogenic headache, does manipulative therapy and/or specific low load exercise reduce headaches?
Design
Randomised (allocation concealed*), blinded (outcome assessors),* controlled trial with follow up immediately after treatment and at 12 months.
Setting
5 centres in Australia.
Patients
200 patients (mean age 37 y, 70% women) with cervicogenic headache, defined as unilateral (or unilateral dominant-side consistent) headache associated with neck pain and aggravated by neck postures or movement, joint tenderness in ≥1 of the upper 3 cervical joints, and headache frequency of ≥1 per week over a period of 2 months to 10 years. Exclusion criteria were bilateral headaches, features suggestive of migraine, contraindications to manipulative therapy, involvement in litigation or workers’ compensation, and physiotherapy or chiropractic treatment for headache in the previous 12 months. Follow up at 12 months was 97%.
Intervention
51 patients were allocated to manipulative therapy (MT), which included low velocity cervical joint mobilisation and high velocity manipulation. 52 patients were allocated to therapeutic exercise (ExT), which used …
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