Introduction
Background
Objectives
Methods
Literature search
Eligibility criteria
Participants
Intervention(s)
Comparator(s)/control conditions
Main outcome(s)
Study design
Screening and eligibility assessment
Data extraction
Risk of bias assessment
Data synthesis
Descriptive analysis
Meta-analysis
GRADE assessment
Results
Authors | Intervention (N) | Intervention description | Comparator (N) | Primary outcome measures | Secondary outcome measures | Duration and frequency of intervention | Measurement time points |
---|---|---|---|---|---|---|---|
Bodes-Pardo et al. [51] | Trigger point therapy + stretching (10) | Passive progressive manual pressure over trigger points (hyperirritable spot within a taut band of a skeletal muscle that elicits a referred pain upon examination) | Sham trigger point therapy (10) | HI (NPRS 0–10) | Cervical ROM (degrees). Pressure pain sensitivity (analogical algometer). Deep cervical flexors motor performance (CCFT) | 3 sessions over 1 week | Baseline; 1 week |
Chaibi et al. [52] | Cervical manipulation (4) | High-velocity, low-amplitude spinal manipulation | Sham manual therapy (4); Control (4) | HI (VAS 0–10), HF (days/month) | HD (hours/day), Headache Index (HI × HF × HD) | 12 sessions over 3 months | Baseline; 3 months; 6 months; 12 months |
Dunning et al. [53] | Cervical and thoracic manipulation (58) | High-velocity, low-amplitude spinal manipulation | Cervical and thoracic mobilization and cranio-cervical flexion exercises (52) | HI (NPRS 0–10), HF (days/week) | HD (hours/week), Disability (NDI), Global Rating of Change Scale (GRCS), Medictions intake | 6–8 sessions over 4 weeks | Baseline; 1 week; 4 weeks; 3 months |
Esin et al. [54] | Kinesiotaping (34) | Application of elastic tape over the vertical and horizontal portions of the trapezius muscle | Sham taping (34); Education and autonomous rehabilitation instructions (33) | HI (VAS 0–100), HF (days/month) | Pressure pain threshold | 20 applications over 4 weeks | Baseline, 4 weeks, 8 weeks |
Haas et al. [55] | Cervical and thoracic manipulation—8 sessions (20); Cervical and thoracic manipulation—16 sessions (20) | High-velocity, low-amplitude spinal manipulation | Moist heat and light massage—8 sessions (20); Moist heat and light massage—16 sessions (20) | HI (MVK 0–100), HF (days/4 weeks) | Disability (MVK 0–10), Others headache frequency, Medications intake | 8 or 16 sessions over 8 weeks. Groups undergoing 8 sessions also had 8 sessions of discussion and manual assessment | Baseline, 4 weeks, 8 weeks, 12 weeks, 16 weeks, 20 weeks, 24 weeks |
Haas et al. [56] | Cervical and thoracic manipulation—6 sessions (65); Cervical and thoracic manipulation—12 sessions (64); Cervical and thoracic manipulation—18 sessions (63) | High-velocity, low-amplitude spinal manipulation | Sham massage (64) | HI (VAS 0–10), HF (days/4 weeks) | Disability (MVK), Drugs intake (N in the past 4 weeks), Other headache frequency (episodes in the past month) | 6, 12 or 18 sessions over 6 weeks depending on group allocation. In the remaining visits, light massage was applied to experimental groups | Baseline, 6 weeks, 12 weeks, 18 weeks, 24 weeks, 39 weeks, 42 weeks |
Hall et al. [57] | C1-2 SNAG (16) | The self-directed use of a self-SNAG strap to emphasize C1-2 rotation through passive motion | Sham SNAG (16) | Headache index (HI × HF × HD) | CROM (FRT), perceived benefit (VAS 0–10) | Daily self-administration for 12 months | Baseline, 4 weeks, 12 months |
Jafari et al. [58] | Trigger point therapy (9) | Passive progressive manual pressure over trigger points | No treatment control (10) | HI (VAS 0–10), HF (days/2 weeks) | Change in elastic modulus in trigger point area (Pa), Trigger point area (cm2), Pressure pain threshold (Algometer, VAS), CGH duration (hrs in the last 2 weeks) | 4 sessions over 8 days | Baseline, 3 weeks |
Jull et al. [59] | Spinal mobilization and manipulation (51); low load endurance exercises for cervico-scapular muscle (52); Comination of the above (49) | Spinal manipulation: High-velocity, low-amplitude spinal manipulation Spinal mobilization: low-velocity spinal mobilization Low-load endurance exercise: a program of low-load exercises to train muscle control of the cervico-scapular region | No treatment control (48) | HI (VAS 0–10), HF (days/week) | Cervical pressure pain threshold (VAS), Deep Cervical flexors performance (CCFT), Pain with neck movement (VAS 0–10), Neck pain index (Northwick Park), CGH duration (hrs in the past week), Medication intake | 8 to 12 sessions over 6 weeks | Baseline, 1 week, 3 months, 6 months, 12 months |
Malo-Urriès et al. [60] | Upper cervical mobilization (41) | Low-velocity spinal mobilization | Control (lay supine for 30') (41) | HI (VAS 0–10) | General cervical spine ROM (using CROM device), Upper cervical spine ROM (using CROM device during FRT), Cervical, suboccipital, trapezius pressure pain threshold (Algometer, Kg/cm2) | Single intervention | Baseline, immediately after treatment |
Nilsson et al. [61] | Cervical manipulation (28) | High-velocity, low-amplitude spinal manipulation | G2: Deep friction massage, trigger point therapy to upper back and neck, laser light therapy (26) | HI (VAS 0–100) | Medications intake | 6 sessions over 3 weeks | Baseline; 5 weeks |
Sedighi et al. [62] | Sub-occipital and trapezius dry needling (15) | An invasive intervention where a solid filament needle is inserted into a trigger point | Sham sub-occipital and trapezius dry needling (15) | Headache index (HI × HF) | Cervical spine ROM (4-points scale), Sub-occipital and trapezius pressure pain threshold (4-points scale, Function (FRI) | Single intervention | Baseline, post-intervention, 1 weeks |
Sharma et al. [63] | Multimodal therapy (9); G2: exercise therapy (low load and mobility exercise program for the cervical spine, postural correction intervention) (9) | Multimodal therapy: spinal mobilization, low load and mobility exercise program for the cervical spine, postural correction intervention) | Postural correction (9) | HI (MVK 0–100), HF (days/week) | Deep Cervical flexors performance (CCFT), Disability (NDI), CGH duration (hrs in the past week) | 12 sessions over 4 weeks | Baseline, 1 week, 2 weeks, 3 weeks, 4 weeks |
von Piekartz et al. [64] | Manual therapy + exercise (22) | TMJ mobilization, trigger point therapy and stretching, TMJ coordination-ROM-home exercises | Usual care (cranio-cervical manual and exercise therapy) (21) | HI (CAS 0–10) | Anamnestic questionnaire (AQ), Graded-chronic pain status (GCPS-NL, scale 1 to 4), Temporo-mandibular pressure pain threshold (Digital algometer, Kgf), Disability (NDI), TMJ noise (presence/absence of click, TMJ-related disability (GCPS), TMJ ROM (cm), Pain with TMJ opening, Mandibular deviation (presence/absence) | 6 sessions over 3–6 weeks | Baseline, 3 months, 6 months |
Yang and Kang [65] | Hot pack and low frequency therapy on trapezius + cranio cervical flexion exercises (10); Hot pack and low frequency therapy on trapezius + sub-occipital relaxation (10) | Cranio-cervical exercise: low-intensity exercise aimed at recruiting deep cervical spine flexors painlessly Sub-occipital relaxation: light, prolonged manual pressure over the suboccipital muscles | Hot pack and low frequency therapy on trapezius (10) | HI (VAS 0–100) | Muscular fatigue (Hz), Muscle tone (N/m) | 20 sessions over 4 weeks | Baseline, 2 weeks, 4 weeks |
Youssef and Shanb [66] | Cervical mobilization and exercise (20) | Low-velocity spinal mobilization | Massage and exercise (18) | HI (VAS 0–10), HF (days/4 weeks) | Cervical spine ROM (cm), Disability (NDI), HD (hours/week) | 12 sessions over 6 weeks | Baseline, 7 weeks |
Abdel et al. [67] | Exercise Therapy (stretching, isometric contractions, postural correction) + Graston technique (30) | Graston technique: an instrument-assisted soft tissue mobilization | Exercise Therapy (stretching, isometric contractions, postural correction) (30) | HI (VAS 0–100), HF (days/week) | Disability (NDI), Cervical spine ROM (CROM device), HD (hours in the past week), Medication intake | 12 sessions over 4 weeks | Baseline, 2 weeks, 4 weeks |
Dunning et al. [68] | Spinal manipulation and electrical dry needling (74) | High-velocity, low-amplitude spinal manipulation Electrical dry needling: application of needles over the cervical, occipital, temporal and oculo-frontal areas with low-frequency electrostimulation | Spinal mobilization and scapular and cranio-cervical exercise (68) | HI (NPRS 0–10), HF (days/week) | HD (hours in the past week), Disability (NDI), Global Rating of Change (GROC), Medication intake | 4 to 8 sessions over 4 weeks | Baseline, 1 week, 4 weeks, 3 months |
Lerner-Lentz et al. [69] | Spinal manipulation, cranio-cervical and scapular exercise (24) | Spinal manipulation: High-velocity, low-amplitude spinal manipulation | Spinal mobilization and scapular and cranio-cervical exercise (21) | HI (NPRS 0–10) | Disability (NDI, HIT-6), GRC, Patient Acceptable Symptoms Scale (PASS) | Two sessions, uncertain timing | Baseline, 2 days, 1 week, 1 month |
Moustafa et al. [70] | Myofascial release, spinal mobilization, cranio-cervical and scapular exercise, Dennerol cervical extension traction (30) | Dennerol cervical traction: the use of an orthotic device in supine position creating cervical spine traction | Myofascial release, spinal mobilization, cranio-cervical and scapular exercise (30) | HF (days/2 weeks) | Disability (HIT-6; HDI), Radiographic cervical alignment variables, Daily Defined Dose (DDD) | 30 sessions over 10 weeks | Baseline, 10 weeks, 1 year, 2 years |
Risk of Bias
Study authors | 1. Was the method of randomization adequate? | 2. Was the treatment allocation concealed? | 3. Was the patient blinded to the intervention? | 4. Was the care provider blinded to the intervention? | 5. Was the outcome assessor blinded to the intervention? | 6. Was the drop out rate described and acceptable? | 7. Were all randomized participants analyzed in the group to which they were allocated? | 8. Are reports of the study free of suggestion of selective outcome reporting? | 9. Were groups similar at regarding the most important prognostic indicators? | 10. Were co-interventions avoided or similar? | 11. Was the compliance acceptable in all groups? | 12. Was the timing of the outcome assessment similar in all groups? | 13. Are other sources of bias unlikely? | Overall risk of bias |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Bodes-Pardo et al. [51] | Yes | Unsure | Unsure | No | Unsure | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Unsure |
Chaibi et al. [52] | Yes | Yes | No | No | No | No | Yes | Yes | No | Yes | Unsure | Yes | Yes | High |
Dunning et al. [53] | Yes | Yes | No | No | No | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Low |
Esin et al. [54] | Yes | Unsure | Unsure | No | No | No | Unsure | Yes | Yes | Unsure | Unsure | Yes | Unsure | High |
Haas et al. [55] | Yes | Yes | No | No | No | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Low |
Haas et al. [56] | Yes | Yes | No | No | No | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Low |
Hall et al. [57] | Yes | Unsure | Yes | No | Yes | Yes | Yes | Yes | Yes | No | Unsure | Yes | Yes | High |
Jafari et al. [58] | Yes | Unsure | No | No | No | Yes | Yes | Yes | Yes | Yes | Unsure | Yes | Yes | Unsure |
Jull et al. [59] | Yes | Unsure | No | No | No | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | High |
Malo-Urriès et al. [60] | Yes | Yes | No | No | No | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Low |
Nilsson et al. [61] | Yes | Yes | No | No | No | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Low |
Sedighi et al. [62] | Unsure | Unsure | No | No | No | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Unsure |
Sharma et al. [63] | Yes | Unsure | No | No | No | Yes | Unsure | Yes | Unsure | Unsure | Unsure | Yes | Unsure | Unsure |
von Piekartz et al. 2011 [64] | Yes | Yes | No | No | No | Yes | Yes | Yes | Yes | Unsure | Yes | Yes | Yes | Unsure |
Yang and Kang [65] | Unsure | Unsure | No | No | No | No | Unsure | Yes | Unsure | Unsure | Unsure | Yes | Unsure | High |
Youssef and Shanb [66] | Yes | Yes | No | No | No | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Low |
Abdel et al. [67] | Yes | Yes | No | No | No | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Low |
Dunning et al. [68] | Yes | Yes | No | No | No | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Low |
Lerner-Lentz et al. [69] | Yes | Yes | No | No | No | Yes | Yes | Yes | Yes | Yes | Yes | Unsure | Yes | Unsure |
Moustafa et al. [70] | Yes | Yes | No | No | No | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | High |
Descriptive analysis: primary outcome measures
Study | Intervention (N) | Comparator (N) | HI scale | HI: MCID reached for Intervention group (Mean change at short term) | HI: MCID reached for Intervention group (Mean change at long term) | HF scale | HF: MCID reached for Intervention group (Mean change at short term) | HF: MCID reached for Intervention group (Mean change at long term) | P value between-groups | RoB |
---|---|---|---|---|---|---|---|---|---|---|
Bodes-Pardo et al. [51] | Trigger point therapy + stretching (10) | Sham trigger point therapy (10) | NPRS 0–10 | MCID reached (− 5.4/10 at 1 week) | P < .001 | Unsure | ||||
Chaibi et al. [52] | Cervical manipulation (4) | Sham manual therapy (4); Control (4) | VAS 0–10 | MCID unknown (− 2.3 at 3 months) | Days/month | − 6 at 3 months | P values not calculated due to small sample size | High | ||
Dunning et al. [53] | Cervical and thoracic manipulation (58) | Cervical and thoracic mobilization and cranio-cervical flexion exercises (52) | NPRS 0–10 | MCID reached (− 4.5/10 at 4 weeks) | MCID reached (− 4.3/10 at 3 months) | P < .001 at all time points | Low | |||
Esin et al. [54] | Kinesiotaping (34) | Sham taping (34); Education and autonomous rehabilitation instructions (33) | VAS 0–100 | MCID unknown (− 2.3/100 at 4 weeks, − 29.5/100 at 8 weeks) | Days/month | MCID reached (− 8 at 4 weeks, − 9.7 at 8 weeks) | P < .01 for both comparisons at long term, and for HF at short term. P > 0.05 for HI at short term | High | ||
Haas et al. [55] | Cervical and thoracic manipulation—8 sessions (20) | Moist heat and light massage—8 sessions (20) | MVK 0–100 | MCID unknown (− 21/100 at 12 weeks) | MCID unknown (− 18/100 at 24 weeks) | Days/4 weeks | MCID reached (− 9 at 12 weeks) | MCID reched (− 7.6 at 24 weeks) | Analysis comparing both intervention groups ot both control groups found P < .05 for all outcomes at all time points, besides P > .05 for HF at 24 weeks | Low |
Cervical and thoracic manipulation—16 sessions (20) | Moist heat and light massage—16 sessions (20) | MVK 0–100 | MCID unknown (− 21/100 at 12 weeks) | MCID unknown (− 23/100 at 24 weeks) | Days/4 weeks | MCID reached (− 9.6 at 12 weeks | MCID reched (− 9.4 at 24 weeks) | |||
Haas et al. [56] | Cervical and thoracic manipulation—6 sessions (65) | Sham massage (64) | VAS 0–10 | MCID unknown (− .5/10 at 6 weeks) | MCID unknown (− .6/10 at 24 weeks) | Days/4 weeks | MCID not reached (− 3 at 6 weeks) | MCID not reached (− 5.2 at 24 weeks) | P > .05 at all time points | Low |
Cervical and thoracic manipulation—12 sessions (64) | Sham massage (64) | VAS 0–10 | MCID unknown (− .7/10 at 6 weeks) | MCID unknown (− .7/10 at 24 weeks) | Days/4 weeks | MCID not reached (− 5 at 6 weeks) | MCID not reached (− 5.5 at 24 weeks) | P > .05 at all time points | ||
Cervical and thoracic manipulation—18 sessions (63) | Sham massage (64) | VAS 0–10 | MCID unknown (− .9/10 at 6 weeks) | MCID unknown (− .6/10 at 24 weeks) | Days/4 weeks | MCID not reached (− 7.7 at 6 weeks) | MCID not reached (− 7.2 at 24 weeks) | P < .05 at all time points for HF. P < .05 at 6 and 52 weeks for HI | ||
Hall et al. [57] | C1-2 SNAG (16) | Sham SNAG (16) | CGH index | MCID unknown (− 21/100 at 4 weeks) | MCID unknown (− 28/100 at 24 weeks) | CGH index | MCID unknown (− 21/100 at 4 weeks) | MCID unknown (− 28/100 at 12 months) | P < .001 at 4 weeks and 12 months | High |
Jafari et al. [58] | Trigger point therapy (9) | No treatment control (10) | VAS 0–10 | MCID unknown (− 2.4/10 at 3 weeks) | Days/2 weeks | MCID reached (− 1.8 at 3 weeks) | P < .05 at 3 weeks | Unsure | ||
Jull et al. [59] | Spinal mobilization and manipulation (51) | No treatment control (48) | VAS 0–10 | MCID unknown (− 3 at 7 weeks) | MCID unknown (− 2.3/10 at 12 months) | Days/week | MCID reached (− 2 at 7 weeks) | MCID reached (− 2.2 at 12 months) | P < .001 at 7 weeks for both outcomes, P < .05 at 12 months for HI and P < .01 for HF | High |
Low load endurance exercises for cervico-scapular muscle (52) | No treatment control (48) | VAS 0–10 | MCID unknown (− 3.3 at 7 weeks) | MCID unknown (− 2.8/10 at 12 months) | Days/week | MCID reached (− 2.4 at 7 weeks) | MCID reched (− 2.5 at 12 months) | P < .001 for HF at all time points, P < .05 at 7 weeks and P < .01 at 12 months for HI | ||
Combination of the above (49) | No treatment control (48) | VAS 0–10 | MCID unknown (− 3.4 at 7 weeks) | MCID unknown (− 2.7/10 at 12 months) | Days/week | MCID reached (− 2 at 7 weeks) | MCID reched (− 2.1 at 12 months) | P < .001 at all time points | ||
Malo-Urriès et al. [60] | Upper cervical mobilization (41) | No treatment control (41) | VAS 0–10 | MCID unknown (− .6 post TTT) | P < .05 | Low | ||||
Nilsson et al. [61] | Cervical manipulation (28) | G2: Deep friction massage, trigger point therapy to upper back and neck, laser light therapy (26) | VAS 0–100 | MCID unknown (− 16/100 at 5 weeks) | P < .05 | Low | ||||
Sedighi et al. [62] | Sub-occipital and trapezius dry needling (15) | Sham sub-occipital and trapezius dry needling (15) | CGH index | MCID unknown (− 8.4 At 1 week) | CGH index | MCID unknown (− 8.4 At 1 week) | P > .05 | Unsure | ||
Sharma et al. [63] | Multimodal therapy (spinal mobilization, low load and mobility exercise program for the cervical spine, postural correction intervention) (9) | Postural correction (9) | VAS 0–100 | MCID unknown (− 71 at 4 weeks) | Days/week | MCID reached (− 5.2 at 4 weeks) | P < .05 for both outcome measures | Unsure | ||
Exercise therapy (low load and mobility exercise program for the cervical spine, postural correction intervention) (9) | Postural correction (9) | VAS 0–100 | MCID unknown (− 71 at 4 weeks) | Days/week | MCID reached (− 5.2 at 4 weeks) | P < .05 for HI, P > .05 for HF | ||||
von Piekartz et al. [64] | Manual therapy + exercise (TMJ manual therapy, TMJ coordination and ROM exercises) (22) | Usual care (cranio-cervical manual and exercise therapy) (21) | CAS 0–10 | MCID unknown (− 3,9 at 3 months, − 4.9 at 6 months) | P < .001 at all time points | Unsure | ||||
Yang and Kang [65] | Hot pack and low frequency therapy on trapezius + cranio cervical flexion exercises (10) | Hot pack and low frequency therapy on trapezius (10) | VAS 0–100 | MCID unknown (unclear results at 4 weeks) | P < .05 reported despite wrong results reported at weel 4 | High | ||||
Hot pack and low frequency therapy on trapezius + sub-occipital relaxation (10) | Hot pack and low frequency therapy on trapezius (10) | VAS 0–100 | MCID unknown (wrong 4 weeks measure | P < .05 reported despite wrong results reported at weel 4 | ||||||
Youssef and Shanb [66] | Cervical mobilization and exercise (20) | Massage and exercise (18) | VAS 0–10 | MCID unknown (− 4.9 at 7 weeks) | Days/4 weeks | MCID reached (− 4.1 at 7 weeks) | P < .05 for both outcome measures | Low | ||
Abdel et al. [67] | Exercise Therapy (stretching, isometric contractions, postural correction) + Graston technique (30) | Exercise Therapy (stretching, isometric contractions, postural correction) (30) | VAS 0–100 | MCID unknown (MD = 36.7/100 at 4 weeks) | Days/week | Values expressed in median, difference of median for the Intervention group reaching MCID (− 80% from baseline) | P = 0.0001 for HI, P = 0.001 for HF | Low | ||
Dunning et al. [68] | Spinal manipulation and electrical dry needling (74) | Spinal mobilization and scapular and cranio-cervical exercise (68) | NPRS 0–10 | MCID reached (MD = 3.9 at 4 weeks) | MCID reached (MD = 4.9 at 3 months) | Days/week | MCID reached (MD = 2.9 at 4 weeks) | MCID reached (MD = 3.5 at 3 months) | P < 0.001 at 4 weeks and 3 months for HI and HF | Low |
Lerner-Lentz et al. [69] | Spinal manipulation, cranio-cervical and scapular exercise (21) | Spinal mobilization and scapular and cranio-cervical exercise (24) | NPRS 0–10 | MCID reached (MD = 4.3 at 1 month) | P > 0.05 at all time points. Within-group P < 0.05 for both groups at all timepoints | Unsure | ||||
Moustafa et al. [70] | Myofascial release, spinal mobilization, cranio-cervical and scapular exercise, Dennerol cervical extension traction (30) | Myofascial release, spinal mobilization, cranio-cervical and scapular exercise (30) | Days/2 weeks | MCID reached (MD = 5.5 at 10 weeks) | MCID reached (MD = 10.4 at 1 year) | P < 0.001 at all time points for HF | High |
Study | Adverse events |
---|---|
Bodes-Pardo et al. [51] | Not reported |
Chaibi et al. [52] | No severe or serious adverse effects |
Dunning et al. [53] | No severe or serious adverse effects |
Esin et al. [54] | Not reported |
Haas et al. [55] | Not reported |
Haas et al. [56] | No severe or serious adverse effects |
Hall et al. [57] | Not reported |
Jafari et al. [58] | Not reported |
Jull et al. [59] | No severe or serious adverse effects. 6.7% of total headaches experienced by participants during the trial were reported to be caused by the treatment |
Malo-Urriès et al. [60] | No severe or serious adverse effects |
Nilsson et al. [61] | Not reported |
Sedighi et al. [62] | Not reported |
Sharma et al. [63] | Not reported |
von Piekartz et al. [64] | No severe or serious adverse effects. 3 patients dropped out after the second follow up due to worsening of their symptoms |
Yang and Kang [65] | Not reported |
Youssef and Shanb [66] | Not reported |
Abdel et al. [67] | Not reported |
Dunning et al. [68] | No severe or serious adverse effects. 60% of participants in the dry needling group experienced localized soreness, and 24% localized ecchymosis, resolved withing 48 h. 4% experienced drowsiness or nausea, resolved within several hours |
Lerner-Lentz et al. [69] | Not reported |
Moustafa et al. [70] | No severe or serious adverse effects |
Spinal manipulation
Spinal mobilization
Myofascial trigger point therapy
Dry needling
Temporo-mandibular joint (TMJ) treatment
Kinesio-taping
Therapeutic exercise
Self-sustained Natural Apophyseal Glide (SNAG)
Graston technique
Dennerol cervical extension traction
Descriptive analysis: secondary outcome measures
Study | Intervention (N) | Comparator (N) | Secondary outcome measures | Key findings |
---|---|---|---|---|
Bodes-Pardo et al. [51] | Trigger point therapy + stretching (10) | Sham trigger point therapy (10) | Neck pain intensity (VAS), Cervical spine ROM (CROM device), Cervical pressure pain threshold (algometer), Deep Cervical flexors performance (CCFT) | P < 0.001 for neck pain intensity, CCFT, pressure pain thresholds and CROM at 1 week. MCID reached for CROM (MD = 8.2–13.6°) |
Chaibi et al. [52] | Cervical manipulation (4) | Sham manual therapy (4); Control (4) | CGH duration (hrs/day) | P values not calculated due to small sample size |
Dunning et al. [53] | Cervical and thoracic manipulation (58) | Cervical and thoracic mobilization and cranio-cervical flexion exercises (52) | CGH duration (hrs in the last week), Disability (NDI), Global Rating of Change scale (GRC), Drugs intake | P < 0.001 for NDI and GRC at 1, 4 weeks and 3 months. P < 0.05 for headache duration at 1 week and 3 months. P < 0.001 for medication intake at 3 months. MCID proposed by the study for NDI were reached (MD = − 11,6 at 4 weeks) |
Esin et al. [54] | Kinesiotaping (34) | Sham taping (34); Education and autonomous rehabilitation instructions (33) | Pressure pain threshold (cervical, sub-occipital, trapezius muscles) | P < 0.01 for pressure pain threshold at 4 and 8 weeks |
Haas et al. [55] | Cervical and thoracic manipulation—8 sessions (20) | Moist heat and light massage—8 sessions (20) | Disability (MVK), Drugs intake (N in the past 4 weeks), Other headache frequency (episodes in the past month) | Intervention main effect: P < 0.05 for other headache frequency and medication intake at 24 weeks. P < 0.05 for Disability at 12 weeks |
Cervical and thoracic manipulation—16 sessions (20) | Moist heat and light massage—16 sessions (20) | Disability (MVK), Drugs intake (N in the past 4 weeks), Other headache frequency (episodes in the past month) | Intervention main effect: P < 0.05 for other headache frequency and medication intake at 24 weeks. P < 0.05 for Disability at 12 weeks | |
Haas et al. [56] | Cervical and thoracic manipulation—6 sessions (65) | Sham massage (64) | Disability (HIT-6), Perceived change (0-points scale), Quality of life (VAS 0–100), Subjective CGH improvement (20-points scale), satisfaction (7-points Likert scale), neck pain frequency | P < 0.05 for Disability at 6 and 24 weeks |
Cervical and thoracic manipulation—12 sessions (64) | Sham massage (64) | Disability (HIT-6), Perceived change (0-points scale), Quality of life (VAS 0–100), Subjective CGH improvement (20-points scale), satisfaction (7-points Likert scale), neck pain frequency | P < 0.05 for Disability, neck pain frequency and intensity at 6 weeks. P < 0.05 for perceived change at 6 and 24 weeks | |
Cervical and thoracic manipulation—18 sessions (63) | Sham massage (64) | Disability (HIT-6), Perceived change (0-points scale), Quality of life (VAS 0–100), Subjective CGH improvement (20-points scale), satisfaction (7-points Likert scale), neck pain frequency | P < 0.05 for Disability, perceived change and neck pain frequency at 6 and 24 weeks. P < 0.05 for neck pain intensity at 6 weeks | |
Hall et al. [57] | C1-2 SNAG (16) | Sham SNAG (16) | Cervical spine ROM (CROM device during FRT) | P < 0.001 for CROM (FRT), MCID reached (MD = 11–20°) after 1st intervention |
Jafari et al. [58] | Trigger point therapy (9) | No treatment control (10) | Change in elastic modulus in trigger point area (Pa), Trigger point area (cm2), Pressure pain threshold (Algometer, VAS), CGH duration (hrs in the last 2 weeks) | P < 0.05 for headache duration, pressure pain threshold, TrP area at 3 weeks |
Jull et al. [59] | Spinal mobilization and manipulation (51) | No treatment control (48) | Cervical pressure pain threshold (VAS), Deep Cervical flexors performance (CCFT), Pain with neck movement (VAS), Neck pain index (Northwick Park), CGH duration (hrs in the past week), Medication intake | P < 0.05 for neck pain index, headache duration and pain on palpation at 7 weeks and 12 months. P < 0.05 for pain with neck movements at 7 weeks. P < 0.015 for medication intake at 12 months. P > 0.05 for CCFT at 7 weeks and 12 months |
Low load endurance exercises for cervico-scapular muscle (52) | No treatment control (48) | Cervical pressure pain threshold (VAS), Deep Cervical flexors performance (CCFT), Pain with neck movement (VAS), Neck pain index (Northwick Park), CGH duration (hrs in the past week) | P < 0.05 for neck pain index and pain with neck movement at 7 weeks and 12 months. P < 0.05 for pain on palpation at 7 weeks. P < 0.015 for medication intake at 12 months. P < 0.001 for CCFT at 7 weeks and 12 months | |
Combination of the above (49) | No treatment control (48) | Cervical pressure pain threshold (VAS), Deep Cervical flexors performance (CCFT), Pain with neck movement (VAS), Neck pain index (Northwick Park), CGH duration (hrs in the past week) | P < 0.05 for neck pain index, headache duration and pain on palpation at 7 weeks and 12 months. P < 0.05 for pain with neck movements at 7 weeks. P < 0.015 for medication intake at 12 months. P < 0.001 for CCFT at 7 weeks, P < 0.01 at 12 months | |
Malo-Urriès et al. [60] | Upper cervical mobilization (41) | No treatment control (41) | General cervical spine ROM (using CROM device), Upper cervical spine ROM (using CROM device during FRT), Cervical, suboccipital, trapezius pressure pain threshold (Algometer, Kg/cm2) | P > 0.05 for pressure pain thresholds. P < 0.05 for general cervical ROM (flexion, left rotation), P = 0.006 for right FRT and P < 0.001 for left FRT post intervention. MCIDs for FRT were reached (MD + 5.4° to 7.4°) |
Nilsson et al. [61] | Cervical manipulation (28) | G2: Deep friction massage, trigger point therapy to upper back and neck, laser light therapy (26) | Medication intake (N/day) | P = 0.14 at week 5, with P < 0.05 after X2 test for type-2 error. Within-group changes saw P < 0.0001 in the experimental group |
Sedighi et al. [62] | Sub-occipital and trapezius dry needling (15) | Sham sub-occipital and trapezius dry needling (15) | Cervical spine ROM (4-points scale), Sub-occipital and trapezius pressure pain threshold (4-points scale), Function (FRI) | P < 0.01 for FRI at 1 week. Within-group changes only were provided for other outcomes, with P < 0.05 for ROM and P < 0.001 for trigger point tenderness in the MT group at 1 week |
Sharma et al. [63] | Multimodal therapy (spinal mobilization, low load and mobility exercise program for the cervical spine, postural correction intervention) (9) | Postural correction (9) | Deep Cervical flexors performance (CCFT), Disability (NDI), CGH duration (hrs in the past week) | P = 0.001 for all outcome measures at 4 weeks. NDI MCID cannot be assessed due to absence of raw data |
Exercise therapy (low load and mobility exercise program for the cervical spine, postural correction intervention) (9) | Postural correction (9) | Deep Cervical flexors performance (CCFT), Disability (NDI), CGH duration (hrs in the past week) | P = 0.001 for all outcome measures at 4 weeks. NDI MCID cannot be assessed due to absence of raw data | |
von Piekartz et al. [64] | Manual therapy + exercise (TMJ manual therapy, TMJ coordination and ROM exercises) (22) | Usual care (cranio-cervical manual and exercise therapy) (21) | Anamnestic questionnaire (AQ), Graded-chronic pain status (GCPS-NL, scale 1 to 4), Temporo-mandibular pressure pain threshold (Digital algometer, Kgf), Disability (NDI), TMJ noise (presence/absence of click), TMJ-related disability (GCPS), TMJ ROM (cm), Pain with TMJ opening, Mandibular deviation (presence/absence) | Between-group P < 0.05 for all outcomes at 3 months. P < 0.05 for AQ, GCPS, pressure pain thresholds, TMJ noise, pain with TMJ opening at 6 months. MCID proposed by the study reached for NDI (− 6.5 at 3 months), not for mouth opening ROM at both timepoints |
Yang and Shanb [65] | Hot pack and low frequency therapy on trapezius + cranio cervical flexion exercises (10) | Hot pack and low frequency therapy on trapezius (10) | Muscular fatigue (Hz), Muscle tone (N/m) | P < 0.05 for change in muscle fatigue for SCM and UFT muscles at 2 and 4 weeks. P < 0.05 for change in muscle tone at left UT and bilateral SCM at 2 and 4 weeks |
Hot pack and low frequency therapy on trapezius + sub-occipital relaxation (10) | Hot pack and low frequency therapy on trapezius (10) | Muscular fatigue (Hz), Muscle tone (N/m) | P < 0.05 for change in muscle fatigue for SCM and UFT muscles at 2 and 4 weeks. P < 0.05 for change in muscle tone at left UT and bilateral SCM at 2 and 4 weeks | |
Youssef and Shanb [66] | Cervical mobilization and exercise (20) | Massage and exercise (18) | Cervical spine ROM (cm), Disability (NDI), CGH duration (hours/week) | P < 0.05 for all ROM directions and CGH duration at 7 weeks. Between-group P = 0.26 for NDI at 7 weeks, but within-group P < 0.001 and MCID were reached (− 27.2 at 7 weeks) |
Abdel et al. [67] | Exercise Therapy (stretching, isometric contractions, postural correction) + Graston technique (30) | Exercise Therapy (stretching, isometric contractions, postural correction) (30) | Disability (NDI), Cervical spine ROM (CROM device), HD (hours in the past week), Medication intake | Within-group P < 0.05 for flexion, left lateral flexion and right lateral flexion CROM at 2 weeks in the conrol group; P < 0.0001 for all other outcomes at all timepoints in both groups, and for between-groups differences at 4 weeks favouring Graston technique. MCIDs reached for NDI (MD = 11.1 at 4 weeks) |
Dunning et al. [68] | Spinal manipulation and electrical dry needling (74) | Spinal mobilization and scapular and cranio-cervical exercise (68) | HD (hours in the past week), Disability (NDI), Global Rating of Change (GROC), Medication intake | Between-group P < 0.001 for HD at all timepoints, for GRC and Medication intake at 3 months. MCIDs reached for NDI (MD = 14.4 at 4 weeks and 16.9 at 3 months) and between-group P < 0.001 at all timepoints |
Lerner-Lentz et al. [69] | Spinal manipulation, cranio-cervical and scapular exercise (21) | Spinal mobilization and scapular and cranio-cervical exercise (24) | Disability (NDI), Headache Impact Test (HIT-6), Globale Rate of Change (GRC), Patient Acceptable Symptoms Scale (PASS) | MCIDs reached for NDI in both groups (MD = 13.9 for manipulation and MD = 12.8 for mobilization group at 1 month). Within-group P < 0.05 at all timepoionts for all groups for all secondary outcomes. Between-groups P > 0.05 at all time points |
Moustafa et al. [70] | Myofascial release, spinal mobilization, cranio-cervical and scapular exercise, Dennerol cervical extension traction (30) | Myofascial release, spinal mobilization, cranio-cervical and scapular exercise (30) | Disability (HIT-6; HDI), Radiographic cervical alignment variables, Daily Defined Dose (DDD) | Within-group P < 0.001 for HIT-6, HDI, DDD at 10 weeks for the control group, and at all time points for the intervention group. Between group P > 0.05 at 10 weeks for HIT-6, HDI, DDD. Between group P < 0.001 at all timepoints favouring the experimental group for Radiographic variables, and for all other outcome measures at 1 and 2-years follow ups |