Xu Xueliang, Ling Yan
Department of Rehabilitation III, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Department of Pediatrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Front Neurol. 2025 May 16;16:1566764. doi: 10.3389/fneur.2025.1566764. eCollection 2025.
To evaluate and compare the safety and efficacy of spinal manipulation, mobilization, and massage for the management of cervicogenic headache (CGH) using meta-analytic techniques.
Comprehensive searches were conducted in Cochrane, Embase, PubMed, and ClinicalTrials.gov to identify studies investigating the effects of manipulation, mobilization, and massage on pain, disability, and physical function in patients with CGH. Key outcomes included pain severity (visual analog scale, VAS), Neck Disability Index (NDI), Flexion-Rotation Test (FRT), and Headache Disability Inventory (HDI) at various follow-up timepoints.
Fourteen studies totaling 1,297 CGH patients were included. Standard pairwise meta-analysis revealed that sustained natural apophyseal glides (SNAG) mobilization produced significantly greater improvements compared to non-SNAG interventions in VAS (MD = 1.73, 95%CI: 1.05, 2.40), NDI (MD = 8.55, 95%CI: 2.73, 14.37), FRT (MD = -7.22, 95%CI: -9.38, -5.07), and HDI (MD = 9.29, 95%CI: 3.64, 14.95), with benefits maintained over time. Network meta-analysis showed that for VAS improvement, the surface under the cumulative ranking curve (SUCRA) probabilities were: cervical spine manipulation (CSM, 98.9%), mobilization (67.3%), exercise (21.0%), and massage (12.8%). For NDI, the SUCRA scores were: CSM (82.2%), mobilization (57.2%), exercise (6.7%), and massage (53.9%). CSM exhibited significantly greater VAS reductions compared to exercise, massage, and mobilization, while mobilization was superior to exercise and massage for VAS. For NDI, CSM was significantly better than exercise, but no other between-group differences were observed.
In patients with CGH, SNAG mobilization can significantly improve pain and function, with benefits maintained in the long-term. Additionally, CSM may be the most effective short-term intervention for reducing pain and disability compared to mobilization, massage, and exercise, although clinician expertise appears to be an important factor.
DOI: 10.37766/inplasy2025.3.0079.
运用荟萃分析技术评估和比较脊柱推拿、松动术及按摩治疗颈源性头痛（CGH）的安全性和有效性。
在Cochrane、Embase、PubMed及ClinicalTrials.gov进行全面检索，以确定研究推拿、松动术及按摩对CGH患者疼痛、功能障碍及身体功能影响的研究。关键结局包括在不同随访时间点的疼痛严重程度（视觉模拟量表，VAS）、颈部功能障碍指数（NDI）、屈伸旋转试验（FRT）及头痛功能障碍量表（HDI）。
纳入14项研究，共1297例CGH患者。标准成对荟萃分析显示，与非持续自然关节突滑动（SNAG）干预相比，持续自然关节突滑动（SNAG）松动术在VAS（MD = 1.73，95%CI：1.05，2.40）、NDI（MD = 8.55，95%CI：2.73，14.37）、FRT（MD = -7.22，95%CI：-9.38，-5.07）及HDI（MD = 9.29，95%CI：3.64，14.95）方面产生了显著更大的改善，且随着时间推移益处得以维持。网状荟萃分析表明，对于VAS改善，累积排序曲线下面积（SUCRA）概率为：颈椎推拿（CSM，98.9%）、松动术（67.3%）、运动（21.0%）及按摩（12.8%）。对于NDI，SUCRA分数为：CSM（82.2%）、松动术（57.2%）运动（6.7%）及按摩（53.9%）。与运动、按摩及松动术相比，CSM在VAS降低方面表现出显著更大的效果，而对于VAS，松动术优于运动和按摩。对于NDI，CSM显著优于运动，但未观察到其他组间差异。
在CGH患者中，SNAG松动术可显著改善疼痛和功能，且长期受益。此外，与松动术、按摩及运动相比，CSM可能是减轻疼痛和功能障碍最有效的短期干预措施，尽管临床医生的专业技能似乎是一个重要因素。
DOI：10.37766/inplasy2025.3.0079
