Effectiveness of Craniocervical Training and Manipulative Therapy in Patients with Cervicogenic Headache A Randomized Controlled Trail

Abstract

ABSTRACT newlineBACKGROUND AND OBJECTIVES newlineCervicogenic headache, accounting for 4%-22% of all the clinical headaches, is newlineassociated with considerable disability and decline in the quality of life. The newlinesuccessful management of cervicogenic headache needs a multifaceted newlineapproach involving pharmacologic, non-pharmacologic, manipulative, anesthetic, newlineand occasionally surgical interventions. Physical and manual modes of therapy newlinehave been validated as important therapeutic modalities for the acute newlinerehabilitation of cervicogenic headache. Though certain studies have suggested newlinethe beneficial effects of combining craniocervical training program and newlinemanipulative therapy for the long-term prevention and control of headaches, newlinethere is no conclusive evidence to validate the findings. The present study was newlineaimed at evaluating the effectiveness of craniocervical training and manipulative newlinetherapy in patients with cervicogenic headache as individual and combined newlinemanagement strategies. newlineSTUDY DESIGN newlineMulti-center, randomized prospective comparative study newlineMETHODOLOGY newlineThe study was conducted by dividing the enrolled subjects into four groups newlinebased on the clinical interventions used. The study, conducted at multiple newlinecenters based in Karnataka, India, recruited subjects between the age of 25 to newline40, based on the Cervicogenic Headache International Study Group diagnostic newlinecriteria, and other inclusion and exclusion criteria. The 120 selected subjects newlineviii newlinewere randomly allocated into 4 groups, comprising of 30 participants, as given newlinebelow: Group 1: Patients receiving craniocervical training program for newlinecervicogenic headache, Group 2: Patients undergoing a manipulative therapy, newlineGroup 3: Patients undergoing a combination of craniocervical training and newlinemanipulative therapy, and Group 4: Subjects (control group) not receiving any newlinetreatment. The subjects were assessed for pain intensity using VAS scale, newlinedisability using the neck disability index, and headache intensity using the Henry newlineFord Headache Disability Inventory. newlineRESULTS newlineOut of the 107 patients selected, 59 were males and 48 were females. A newlinesignificant difference in the pre-, post- and one-month post training mean VAS newlinescores was noted for the subjects who had undergone both craniocervical newlinetraining and manipulative therapy [f (1.38, 37.47) = 279.9, Plt 0.001]. The newlinecomparison of the pre-training VAS scores for all the study groups showed that newlinethe control/no training group had the highest mean VAS score. The highest newlinemean one-month post-training VAS score was noted in the group who had newlinemanipulative therapy, compared to all other groups. The patients who had both newlinecraniocervical training and manipulative therapy demonstrated more reduced newlineHDI post training (37.214) and one-month post training (33.93) than the other newlinegroups. Subject who received both craniocervical training and manipulative newlinetherapy, and only manipulative therapy had reduced NDI post training. However, newlineit was comparatively higher than those who received only craniocervical training. newlineix newlineCONCLUSION newlineCraniocervical training, manipulative therapy, and both craniocervical training newlineand manipulative therapy program are effective for the long-term management of newlinecervicogenic headache. Combined therapy group demonstrated good and newlineexcellent patient-reported outcomes with respect to the three scores- VAS, NDI newlineand HDI. newline