European Journal of Pain
Matthew Fernandez Craig Moore Jinghan Tan Derrick Lian Jeremy Nguyen Andrew Bacon Brie Christie Isabella Shen Thomas Waldie Danielle Simonet André Bussières
First published: 04 July 2020 https://doi.org/10.1002/ejp.1632
Abstract
Background
Spinal manipulative therapy (SMT) is frequently used to manage cervicogenic headache (CGHA). No meta‐analysis has investigated the effectiveness of SMT exclusively for CGHA.
Objective
Evaluate the effectiveness of SMT for CGHA.
Databases and Data Treatment
Five databases identified randomized controlled trials comparing SMT with other manual therapies. The PEDro scale assessed the risk‐of‐bias. Pain and disability data were extracted and converted to a common scale. A random effects model was used for several follow‐up periods. GRADE described the quality of evidence.
Results
Seven trials were eligible. At short‐term follow‐up, there was a significant, small effect favouring SMT for pain intensity (mean difference [MD] ‐10.88 [95% CI, ‐17.94, ‐3.82]) and small effects for pain frequency (standardized mean difference [SMD] ‐0.35 [95%CI, ‐0.66, ‐0.04]). There was no effect for pain duration (SMD ‐0.08 [95%CI, ‐0.47, 0.32]). There was a significant, small effect favoring SMT for disability (MD ‐13.31 [95% CI, ‐18.07, ‐8.56]). At intermediate follow‐up, there was no significant effects for pain intensity (MD ‐9.77 [‐24.21 to 4.68]) and a significant, small effect favoring SMT for pain frequency (SMD ‐0.32 [‐0.63 to ‐0.00]). At long‐term follow‐up, there was no significant effects for pain intensity (MD ‐0.76 [‐5.89 to 4.37]) and for pain frequency (SMD ‐0.37 [‐0.84 to 0.10]).
Conclusion
For CGHA, SMT provides small, superior short‐term benefits for pain intensity, frequency and disability but not pain duration, however, high‐quality evidence in this field is lacking. The long‐term impact is not significant.