Manipulations Superior to Mobilizations for Headaches?

This 2016 RCT on patients with cervical headaches found that 6-8 sessions of upper cervical (C1-2) and upper thoracic (T1-2) manipulations, provided by PTs, were more effective than mobilizations to the same regions and deep neck flexor exercises.

Although both groups made improvements, the manipulation group had greater improvements in headache intensity, disability, headache frequency, headache duration, and medication use than the mobilization group. The benefits were seen after 4 weeks and maintained at 3 months.

Before we get too excited and start manipulating C1-2, I must mention that the mobilizations used in study were “Maitland” techniques involving PAs in prone.

Since learning about Mulligan techniques well over a decade ago I have not performed PAs on any of my patients.


Based on my anecdotal evidence, I find mobilization with movements (MWM) techniques as described by Mulligan to be more effective than any manipulation and PA mobilizations. The greatest advantage to all Mulligan techniques is that the patient is always empowered to perform the same mobilization on themselves, unlike manips and PAs.

I would love to see a study comparing upper cervical and thoracic MWMs to manipulations. Until then I prefer to empower my patients by giving them independent home exercises for their headaches.

Reference: Dunning JR 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.

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