Université Paris Cité, Inserm, ECEVE, Paris, France.
Physiotherapy School, University of Orleans, Orleans, France.
PM R. 2023 May;15(5):613-628. doi: 10.1002/pmrj.12856. Epub 2022 Aug 4.
To update and appraise the efficacy of physiotherapy for adults with cervicogenic headache.
Bibliographic searches were conducted up to October 2021 for randomized controlled trials (RCTs), assessing the efficacy of physiotherapy interventions for adults with cervicogenic headache, in five databases: CINAHL, Physiotherapy Evidence Database (PEDro), PubMed, Sage Journals, and Wiley Online Library.
Data extraction of included trials was conducted by two reviewers according to a standardized extraction form. The PEDro tool and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach were used for grading evidence. Results from trials with similar interventions and with similar outcome measures were pooled into separate meta-analyses. A qualitative synthesis was performed for studies that were not pooled into meta-analyses.
Fourteen trials were included. Moderate-certainty evidence indicates that manual therapy significantly reduces headache frequency (mean difference [MD]: -0.93 episodes/week; 95% confidence interval [CI]: -1.40 to -0.46; 2 RCTs; n = 265) compared to sham manual therapy, and headache frequency (MD: -1.23 episodes/week; 95% CI: -1.55 to -0.91; 3 RCTs; n = 126) and intensity (MD: -1.63/10; 95% CI: -2.15 to -1.10; 4 RCTs; n = 208) compared to no treatment in the short term. At 12-month follow-up, moderate-certainty evidence indicates that manual therapy did not lead to greater reduction in headache intensity (MD Visual Analog Scale 0-10: -0.12; 95% CI: -0.49 to 0.26; 2 RCTs; n = 265) or frequency (MD: -0.32 episodes/week; 95% CI: -0.91 to 0.28; 2 RCTs; n = 265) when compared to a sham manual therapy. In the long-term, in one high quality trial, neck exercise significantly reduced headache intensity compared to no treatment (MD: -1.51/10; 95% CI: -2.52 to -0.50; n = 100) or to aerobic exercises in another trial of moderate quality (MD: -1.15/10; 95% CI: -2.1 to -0.20; n = 180).
Manual therapy in the short term and neck exercise in the long term may be efficacious to treat adults with cervicogenic headache. More high-quality evidence is needed and future results may change the current conclusions. Trial Registration Prospero: #CRD42019135858.
更新并评估物理疗法治疗颈源性头痛成人的疗效。
截至 2021 年 10 月，我们对五个数据库（CINAHL、物理治疗证据数据库（PEDro）、PubMed、Sage 期刊和 Wiley Online Library）中的随机对照试验（RCT）进行了文献检索，评估了物理疗法干预治疗颈源性头痛成人的疗效。
两名评审员根据标准化提取表对纳入试验的数据进行提取。PEDro 工具和推荐分级、评估、制定与评价（GRADE）方法用于分级证据。具有类似干预措施和类似结局测量的试验结果被汇总到单独的荟萃分析中。对于未进行荟萃分析的研究进行定性综合分析。
纳入了 14 项试验。中等确定性证据表明，与假手疗法相比，手法治疗可显著减少头痛发作频率（平均差异 [MD]：-0.93 次/周；95%置信区间 [CI]：-1.40 至-0.46；2 项 RCT；n=265），与无治疗相比，头痛发作频率（MD：-1.23 次/周；95% CI：-1.55 至-0.91；3 项 RCT；n=126）和强度（MD：-1.63/10；95% CI：-2.15 至-1.10；4 项 RCT；n=208）也有显著改善。在 12 个月随访时，中等确定性证据表明，与假手疗法相比，手法治疗并不能更显著地降低头痛强度（视觉模拟量表 0-10 评分 MD：-0.12；95% CI：-0.49 至 0.26；2 项 RCT；n=265）或频率（MD：-0.32 次/周；95% CI：-0.91 至 0.28；2 项 RCT；n=265）。在长期随访中，一项高质量试验表明，颈部运动与无治疗相比（MD：-1.51/10；95% CI：-2.52 至-0.50；n=100）或与另一项中等质量试验中的有氧运动（MD：-1.15/10；95% CI：-2.1 至-0.20；n=180）相比，可显著降低头痛强度。
短期手法治疗和长期颈部运动可能对治疗颈源性头痛成人有效。需要更多高质量的证据，未来的研究结果可能会改变目前的结论。试验注册 Prospero：#CRD42019135858。
