Cervical Manip vs. Mobs for Headaches
This RCT compared the effects of thoracic and upper cervical manipulations to mobilizations and exercise in patients with cervical headaches (not migraines). The patients attended physiotherapy twice a week for 4 weeks for treatments.
They found that individuals in the manipulation group had significantly better outcomes with respect to headache intensity, frequency and associated disability at 1 month and at 3 month follow-up.
The weakness of this study was that manipulation was not compared to mobilizations with movements (MWM), but compared to Maitland PAs with the patient in prone lying. The patients received 30 seconds of unilateral PA mobs on each side of C1-2 and 30 seconds of central PA on T1-2
Personal comment: This is actually the second RCT demonstrating the same results but I am still not convinced that C1-2 manipulations are the only way of helping my patients with cervical headaches. Many years ago I made the decision to no longer do cervical manipulations as I personally did not feel comfortable warning my patients regarding the “very small risk of stroke or death”.
In addition, once I discovered Mulligan’s MWM and the evidence supporting them, I’ve never looked back.
Reference: Dunning JR et al Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC Musculoskelet Disord. 2016 Feb 6;17:64.