Satpute K, Bedekar N, Hall T. Mulligan manual therapy added to exercise improves headache frequency, intensity and disability more than exercise alone in people with cervicogenic headache: a randomised trial. J Physiother. 2024 Jul;70(3):224-233. doi: 10.1016/j.jphys.2024.06.002. Epub 2024 Jun 19. PMID: 38902195
Questions:
+ What is the effect of a 4-week regimen of Mulligan Manual Therapy (MMT) plus Exercise compared with Exercise Only for managing cervicogenic headache (CH)?
+ Is MMT plus exercise more effective than sham MMT plus exercise?
+ Are any benefits maintained at 26 weeks of follow-up?
Conclusions:
+Adding MMT to exercise for the long-term management of CGH is effective for reducing headache frequency, intensity, and disability, but not reducing duration.
+Adding MMT effectively addresses long-term management of impairments of upper cervical ROM and sub-occipital pain pressure thresholds (which may be a factor in HA generation)
Take Home Messages:
+Immediate benefit favoring the Mulligan Manual Therapy + Exercise Group to Exercise Only Group at 4, 13, and 26 weeks for HA Frequency
+HA Disability and Upper Cervical Flexion Rotation ROM showed clinically worthwhile benefits at 4, 13, and 26 weeks.
+HA intensity and patient satisfaction showed worthwhile benefits at 13 & 26 weeks.
+Strong association with reduction in HA with increased Upper C-Spine ROM.
Potential Mechanisms Suggested for Improvement:
+Improved C1-2 motion segment motion may decrease strain on articular and periarticular mechanoreceptors, therefore reducing nociceptive signaling, resulting in new afferent input to the CNS by increasing non-nociceptive signaling.
+ Changes in mechanoreceptor input have the potential to change local muscle activity, thus optimizing muscle control in the upper cervical spine.
+Reduction in HA may be linked with an indirect hypoalgesic effect of MT and Ex causing improvement in cervical msk dysfunction and consequent reduction in nociceptive input.
+Improvement in pain pressure thresholds at local and remote sites suggest mechanisms underlying the hypoalgesic effects of MMT were similar to other MT techniques encompassing peripheral and central mechanisms