Spinal manipulative therapy (SMT) may be associated with greater reductions in cervicogenic headache days compared with light massage, according to an open-label randomized controlled trial published in Spine Journal.
In this study, investigators randomly assigned 256 adult patients with chronic cervicogenic headache to undergo 0 (n=64), 6 (n=65), 12 (n=64), or 18 (n=63) sessions of SMT during a 6-week period.
Study participants received treatment 3 times per week, and on sessions without SMT, they were given a focused light-massage control. The SMT sessions included manual, low-amplitude, and high-velocity thrust manipulation focused on the upper thoracic and cervical spine regions.
Light massage consisted of kneading and gliding of the muscles in the shoulders and neck. At 12 and 24 weeks after treatment, the number of cervicogenic headache days in the prior 4 weeks, as well as disability, pain intensity, perceived improvement, patient satisfaction, and medication use, were assessed.
Overall, reductions of approximately 1 cervicogenic headache day per month were observed with each additional 6 SMT sessions, indicating a linear dose-response effect of SMT (P <.05). For the most effective dose of 18 SMT sessions, the number of cervicogenic headache days per month was reduced from approximately 16 to 8 days. In this cohort, the average differences in cervicogenic headache days per month between 18 SMT visits and control were −3.3 at 12 weeks (P =.004) and −2.9 at 24 weeks (P =.017).
At the 24-week follow-up, more than half of participants in each group achieved a 30% reduction in cervicogenic headache days. Participants receiving up to 18 SMT sessions also demonstrated greater improvements in cervicogenic headache-related disability than those in the control group at 24 weeks (adjusted mean difference, −3.1; 95% CI, −5.5 to −0.7).
The findings from this trial may be limited to this cohort and may not generalize to participants receiving care in other clinical settings. In addition, because of the absence of a sham or no-treatment control, this study did provide evidence for the superiority of SMT over no intervention.
Investigators note that the “the absence of a significant plateau in the dose-response curves over the range of SMT visits” creates difficulty in determining an optimal dose to recommend for clinical practice.
Haas M, Bronfort G, Evans R, et al. Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial [published online February 23, 2018]. Spine J. doi: 10.1016/j.spinee.2018.02.019