The Somatic Connection  |   January 2017
Spinal Manipulation and Mobilization Therapy for Cervicogenic Headache
Author Notes
  • Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona, California 
Article Information
The Somatic Connection   |   January 2017
Spinal Manipulation and Mobilization Therapy for Cervicogenic Headache
The Journal of the American Osteopathic Association, January 2017, Vol. 117, 58-59. doi:
The Journal of the American Osteopathic Association, January 2017, Vol. 117, 58-59. doi:
Garcia J, Arnold S, Tetley K, Voight K, Frank RA. Mobilization and manipulation of the cervical spine in patients with cervicogenic headache: any scientific evidence? Front Neurol. 2016;7:40. doi:10.3389/fneur.2016.00040 
Osteopathic physicians often use osteopathic manipulative treatment (OMT) to alleviate headaches caused by cervical somatic dysfunction in patients.1 Spinal manipulation, involving high-velocity, low-amplitude (HVLA) maneuvers, and cervical spine mobilization are additional manual therapies used by manual practitioners to manage cervicogenic headache (CEH), but the efficacy of these management techniques is disputed. Researchers performed a systematic review of randomized controlled trials (RCTs) to examine the benefits of manual therapy on the cervical spine in managing CEH. 
The authors identified 10 studies that met the following inclusion criteria: (1) the study was an RCT that contained at least 1 intervention group that received spinal manipulation or mobilization and 1 control group that received another physical therapy intervention, (2) all participants had a diagnosis of CEH, and (3) headache pain and frequency were outcome measures. Studies were excluded if they were case reports, were not published in English or in a peer-reviewed journal, or involved patients with a headache diagnosis other than CEH. 
Seven of the 10 studies compared the effects of spinal manipulation or mobilization with an alternate intervention or a placebo on patients with CEH, and 6 of the 7 studies found that manipulation or mobilization interventions showed statistically significant improvements of symptoms in patients with CEH when compared with the control interventions. Moreover, the evidence also suggests that increasing the frequency of spinal manipulation or mobilization may increase its therapeutic benefit. Combining exercise with spinal manipulation or mobilization was found to be more effective in reducing the symptoms of CEH than either modality alone. Only 1 study compared mobilization with manipulation. The authors found that manipulation (HVLA) was more effective than mobilization plus exercise in decreasing CEH duration, frequency, and associated disability and in increasing patient-perceived improvement (P<.001). 
The authors concluded that cervical spine manipulation and mobilization are more beneficial than traditional physical therapy modalities and placebo interventions in lessening the intensity and frequency of symptoms in patients with CEH. However, it is difficult to draw general conclusions because the studies varied in terms of the SMT techniques used, the intervention or placebo used in control groups, the diagnostic criteria for CEH, and primary outcome measures. Because OMT can include HVLA manipulation and mobilization procedures, a rigorous RCT is essential to assess the effectiveness of OMT in treating patients with CEH. 
Biondi DM. Cervicogenic headache: a review of diagnostic and treatment strategies. J Am Osteopath Assoc. 2005;105(4 suppl 2):16S-22S. [PubMed]