NON-PHARMACOLOGICAL MODALITIES FOR TREATING CERVICOGENIC HEADACHE: A SYSTEMATIC REVIEW

Authors

  • RAMESH CHANDRA PATRA Department of Physiotherapy, School of Physiotherapy and Paramedical Sciences, Lovely Professional University, Phagwara, Punjab, India. https://orcid.org/0000-0001-5287-8833
  • LOBSANG CHONZOM Department of Physiotherapy, School of Physiotherapy and Paramedical Sciences, Lovely Professional University, Phagwara, Punjab, India https://orcid.org/0009-0006-6853-0296
  • ARSHDEEP KAUR Department of Physiotherapy, School of Physiotherapy and Paramedical Sciences, Lovely Professional University, Phagwara, Punjab, India. https://orcid.org/0009-0003-9245-2636
  • ISHIKA Department of Physiotherapy, School of Physiotherapy and Paramedical Sciences, Lovely Professional University, Phagwara, Punjab, India

DOI:

https://doi.org/10.22159/ajpcr.2025v18i6.54395

Keywords:

Cervical spine, Cervical spine muscles, Cervicogenic headache, Dry needling, Spinal manipulation

Abstract

Objectives: This study aimed to investigate the outcomes of the non-pharmacological modalities in adult patients with cervicogenic headaches.

Methods: The systematic review, guided by the PRISMA approach, investigated 29 randomized controlled trials/randomized studies, published from 1997 to 2022, concerning the efficacy of non-pharmacological interventions for cervicogenic headache. The primary endpoints were headache duration, frequency, and intensity; however, the secondary endpoints included several clinical complications of cervicogenic headache.

Results: The findings from this study revealed a 97.5–100% satisfaction level in patients who underwent physiotherapy sessions for their cervicogenic headaches. The pooled outcomes revealed noticeable improvements in the range of motion of the cervical spine following the administration of manual therapy, apophyseal glide, trigger point-directed dry/superficial needling, spine mobilization, massage, and Graston procedure. In addition, dry needling, multimodal therapy, spinal manipulative therapy, routine physiotherapy, and other non-pharmacological approaches were found to be effective in improving the disability-level perception of patients with cervicogenic headaches. While the evidence negated the impact of non-pharmacological approaches on psychological distress and cognitive/social functioning, their positive influence on quality of life, pain perception, pressure pain thresholds, performance of neck muscles, and muscle fatigue was emphasized by most of the included studies.

Conclusion: This study emphasized the cervicogenic headache management potential of non-pharmacological modalities, including dry needling and cervical spine manipulation procedures; future studies should compare our results with pharmacological modalities to transform the treatment landscape for patients with cervicogenic headaches.

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References

Al Khalili Y, Ly N, Murphy PB. Cervicogenic headache. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2023.

Page P. Cervicogenic headaches: An evidence-led approach to clinical management. Int J Sports Phys Ther. 2011;6(3):254-66. PMID 22034615, PMCID PMC3201065

Pourahmadi M, Dommerholt J, Fernández-de-Las-Peñas C, Koes BW, Mohseni-Bandpei MA, Mansournia MA, et al. Dry needling for the treatment of tension-type, cervicogenic, or migraine headaches: A systematic review and meta-analysis. Phys Ther. 2021;101(5):pzab068. doi: 10.1093/ptj/pzab068, PMID 33609358

Chys M, De Meulemeester K, De Greef I, Murillo C, Kindt W, Kouzouz Y, et al. Clinical effectiveness of dry needling in patients with musculoskeletal pain-an umbrella review. J Clin Med. 2023;12(3):1205. doi: 10.3390/jcm12031205, PMID 36769852, PMCID PMC9917679

Bond BM, Kinslow C. Improvement in clinical outcomes after dry needling in a patient with occipital neuralgia. J Can Chiropr Assoc. 2015;59(2):101-10. PMID 26136602, PMCID PMC4486992

Bini P, Hohenschurz-Schmidt D, Masullo V, Pitt D, Draper-Rodi J. The effectiveness of manual and exercise therapy on headache intensity and frequency among patients with cervicogenic headache: A systematic review and meta-analysis. Chiropr Man Therap. 2022;30(1):49. doi: 10.1186/s12998-022-00459-9, PMID 36419164

Demont A, Lafrance S, Gaska C, Kechichian A, Bourmaud A, Desmeules F. Efficacy of physiotherapy interventions for the management of adults with cervicogenic headache: A systematic review and meta-analyses. PM R. 2023;15(5):613-28. doi: 10.1002/ pmrj.12856, PMID 35596553

Moore CS, Sibbritt DW, Adams J. A critical review of manual therapy use for headache disorders: Prevalence, profiles, motivations, communication and self-reported effectiveness. BMC Neurol. 2017;17(1):61. doi: 10.1186/s12883-017-0835-0, PMID 28340566, PMCID PMC5364599

Fernandez M, Moore C, Tan J, Lian D, Nguyen J, Bacon A, et al. Spinal manipulation for the management of cervicogenic headache: A systematic review and meta‐analysis. Eur J Pain. 2020;24(9):1687- 702. doi: 10.1002/ejp.1632, PMID 32621321

Sarkis-Onofre R, Catalá-López F, Aromataris E, Lockwood C. How to properly use the PRISMA statement. Syst Rev. 2021;10(1):117. doi: 10.1186/s13643-021-01671-z, PMID 33875004

Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019; 366:l4898. doi: 10.1136/bmj.l4898.

Rani M, Kaur J. Effectiveness of different physiotherapy interventions in the management of cervicogenic headache: A pilot randomized controlled trial. J Man Manip Ther. 2022;30(2):96-104. doi: 10.1080/10669817.2021.1962687, PMID 34374330

Youssef EF, Shanb AS. Mobilization versus massage therapy in the treatment of cervicogenic headache: A clinical study. J Back Musculoskelet Rehabil. 2013;26(1):17-24. doi: 10.3233/BMR-2012- 0344, PMID 23411644

Abdel-Aal NM, Elsayyad MM, Megahed AA. Short-term effect of adding Graston technique to exercise program in treatment of patients with cervicogenic headache: A single-blinded, randomized controlled trial. Eur J Phys Rehabil Med. 2021;57(5):758-66. doi: 10.23736/ S1973-9087.21.06595-3, PMID 33947825

Lerner-Lentz A, O’Halloran B, Donaldson M, Cleland JA. Pragmatic application of manipulation versus mobilization to the upper segments of the cervical spine plus exercise for treatment of cervicogenic headache: A randomized clinical trial. J Man Manip Ther. 2021;29(5):267-75. doi: 10.1080/10669817.2020.1834322, PMID 33148134

Mousavi-Khatir SR, Fernández-De-Las-Peñas C, Saadat P, Javanshir K, Zohrevand A. The effect of adding dry needling to physical therapy in the treatment of cervicogenic headache: A randomized controlled trial. Pain Med. 2022;23(3):579-89. doi: 10.1093/pm/pnab312, PMID 34687308

Mohamed GI, Shendy WS. Effect of natural apophyseal glides on cervicogenic headache: A randomized controlled trial. Phys Ther Rehabil. 2018;5(1):8. doi: 10.7243/2055-2386-5-8

Bodes-Pardo G, Pecos-Martín D, Gallego-Izquierdo T, Salom- Moreno J, Fernández-de-Las-Peñas C, Ortega-Santiago R. Manual treatment for cervicogenic headache and active trigger point in the sternocleidomastoid muscle: A pilot randomized clinical trial. J Manipulative Physiol Ther. 2013;36(7):403-11. doi: 10.1016/j. jmpt.2013.05.022, PMID 23845200

Hall T, Chan HT, Christensen L, Odenthal B, Wells C, Robinson K. Efficacy of a C1-C2 self-sustained natural apophyseal glide (SNAG) in the management of cervicogenic headache. J Orthop Sports Phys Ther. 2007;37(3):100-7. doi: 10.2519/jospt.2007.2379, PMID 17416124

Sedighi A, Nakhostin Ansari N, Naghdi S. Comparison of acute effects of superficial and deep dry needling into trigger points of suboccipital and upper trapezius muscles in patients with cervicogenic headache. J Bodyw Mov Ther. 2017;21(4):810-4. doi: 10.1016/j. jbmt.2017.01.002, PMID 29037632

McDevitt AW, Cleland JA, Rhon DI, Altic RA, Courtney DJ, Glynn PE, et al. Thoracic spine thrust manipulation for individuals with cervicogenic headache: A crossover randomized clinical trial. J Man Manip Ther. 2022;30(2):78-95. doi: 10.1080/10669817.2021.1947663, PMID 34269160

Daher A, Carel RS, Tzipi K, Esther H, Dar G. The effectiveness of an aerobic exercise training on patients with neck pain during a short- and long-term follow-up: A prospective double-blind randomized controlled trial. Clin Rehabil. 2020;34(5):617-29. doi: 10.1177/0269215520912000, PMID 32183555

Dunning JR, Butts R, Mourad F, Young I, Fernandez-De-Las Peñas C, Hagins M, 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;17(1):64. doi: 10.1186/s12891-016-0912-3, PMID 26852024

Haas M, Spegman A, Peterson D, Aickin M, Vavrek D. Dose response and efficacy of spinal manipulation for chronic cervicogenic headache: A pilot randomized controlled trial. Spine J. 2010;10(2):117-28. doi: 10.1016/j.spinee.2009.09.002, PMID 19837005

Haas M, Bronfort G, Evans R, Schulz C, Vavrek D, Takaki L, et al. Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: A dual-center randomized controlled trial. Spine J. 2018;18(10):1741-54. doi: 10.1016/j.spinee.2018.02.019, PMID 29481979

Sharma A, Hameed UA, Grover S. Multimodal therapy in cervicogenic headache- a randomized controlled trial. Indian J Physiother Occup Int J. 2011;5:9-13.

Von Piekartz H, Lüdtke K. Effect of treatment of temporomandibular disorders (TMD) in patients with cervicogenic headache: A single-blind, randomized controlled study. Cranio. 2011;29(1):43-56. doi: 10.1179/ crn.2011.008, PMID 21370769

Dunning J, Butts R, Zacharko N, Fandry K, Young I, Wheeler K, et al. Spinal manipulation and perineural electrical dry needling in patientswith cervicogenic headache: A multicenter randomized clinical trial. Spine J. 2021;21(2):284-95. doi: 10.1016/j.spinee.2020.10.008, PMID 33065273

Moustafa IM, Diab A, Shousha T, Harrison DE. Does restoration of sagittal cervical alignment improve cervicogenic headache pain and disability: A 2-year pilot randomized controlled trial. Heliyon. 2021;7(3):e06467. doi: 10.1016/j.heliyon.2021.e06467, PMID 33786392

Ylinen J, Nikander R, Nykänen M, Kautiainen H, Häkkinen A. Effect of neck exercises on cervicogenic headache: A randomized controlled trial. J Rehabil Med. 2010;42(4):344-9. doi: 10.2340/16501977-0527, PMID 20461336

Gildir S, Tüzün EH, Eroğlu G, Eker L. A randomized trial of trigger point dry needling versus sham needling for chronic tension-type headache. Medicine (Baltimore). 2019;98(8):e14520. doi: 10.1097/ MD.0000000000014520, PMID 30813155

Rodríguez-Sanz J, Malo-Urriés M, Corral-De-Toro J, Lucha-López MO, López-De-Celis C, Pérez-Bellmunt A, et al. Short- and medium-term effects of manual therapy on the upper cervical spine combined with exercise vs isolated exercise in patients with cervicogenic headache. A randomized controlled trial. Int J Osteopath Med. 2022;43:5-15. doi: 10.1016/j.ijosm.2022.04.006

Chaibi A, Knackstedt H, Tuchin PJ, Russell MB. Chiropractic spinal manipulative therapy for cervicogenic headache: A single-blinded, placebo, randomized controlled trial. BMC Res Notes. 2017;10(1):310. doi: 10.1186/s13104-017-2651-4, PMID 28738895

Esin OR, Khairullin IK, Esin RG. Efficiency of kinesio taping in adolescents with cervicogenic headache: A blind placebo-controlled study. BioNanoScience. 2018;8(1):412-7. doi: 10.1007/s12668-018- 0506-7

Direkvand-Moghadam A, Sayehmiri K, Delpisheh A, Sattar K. Epidemiology of premenstrual syndrome (PMS)-A systematic review and meta-analysis study. J Clin Diagn Res. 2014;8(2):106- 9. doi: 10.7860/JCDR/2014/8024.4021, PMID 24701496, PMCID PMC3972521

Jafari M, Bahrpeyma F, Togha M. Effect of ischemic compression for cervicogenic headache and elastic behavior of active trigger point in the sternocleidomastoid muscle using ultrasound imaging. J Bodyw Mov Ther. 2017;21(4):933-9. doi: 10.1016/j.jbmt.2017.01.001, PMID 29037651

Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine (Phila Pa 1976). 2002;27(17):1835-43. doi: 10.1097/00007632-200209010-00004, PMID 12221344

Malo-Urriés M, Tricás-Moreno JM, Estébanez-de-Miguel E, Hidalgo- García C, Carrasco-Uribarren A, Cabanillas-Barea S. Immediate effects of upper cervical translatoric mobilization on cervical mobility and pressure pain threshold in patients with cervicogenic headache: A randomized controlled trial. J Manipulative Physiol Ther. 2017;40(9):649-58. doi: 10.1016/j.jmpt.2017.07.007, PMID 29229055

Nilsson N, Christensen HW, Hartvigsen J. The effect of spinal manipulation in the treatment of cervicogenic headache. J Manipulative Physiol Ther. 1997;20(5):326-30. PMID 9200048

Yang DJ, Kang DH. Comparison of muscular fatigue and tone of neck according to craniocervical flexion exercise and suboccipital relaxation in cervicogenic headache patients. J Phys Ther Sci. 2017;29(5):869-73. doi: 10.1589/jpts.29.869, PMID 28603362

Patra RC, Mohanty P, Gautam AP. Effectiveness of C1-C2 sustained natural apophyseal glide combined with dry needling on pressure point threshold and headache disability in cervicogenic headache. Asian J Pharm Clin Res. 2018;11(1):171-4. doi: 10.22159/ajpcr.2018. v11i1.22349

Xiao H, Peng BG, Ma K, Huang D, Liu XG, Lv Y, et al. Expert panel’s guideline on cervicogenic headache: The Chinese association for the study of pain recommendation. World J Clin Cases. 2021;9(9):2027-36. doi: 10.12998/wjcc.v9.i9.2027, PMID 33850922

Fernández-De-Las-Peñas C, Courtney CA. Clinical reasoning for manual therapy management of tension type and cervicogenic headache. J Man Manip Ther. 2013;22(1):45-51. doi: 10.1179/2042618613y.0000000050

Lv Q, Wu F, Gan X, Yang X, Zhou L, Chen J, et al. The involvement of descending pain inhibitory system in electroacupuncture-induced analgesia. Front Integr Neurosci. 2019;13:38. doi: 10.3389/ fnint.2019.00038, PMID 31496944, PMCID PMC6712431

Published

07-06-2025

How to Cite

RAMESH CHANDRA PATRA, et al. “NON-PHARMACOLOGICAL MODALITIES FOR TREATING CERVICOGENIC HEADACHE: A SYSTEMATIC REVIEW”. Asian Journal of Pharmaceutical and Clinical Research, vol. 18, no. 6, June 2025, pp. 54-67, doi:10.22159/ajpcr.2025v18i6.54395.

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Section

Review Article(s)