Effectiveness of physiotherapy interventions on pain in patients of cervicogenic headache: a systematic review and meta analysis

Pain due to cervicogenic headache reduces the work productivity and functional efficiency. This results in increased burden on the society.

To summarize the effect of physiotherapy interventions on pain in cervicogenic headache and present meta-analysis irrespective of heterogeneity and number of studies.

Design: Systematic Review and Meta-Analysis. Data sources: Pub Med, Cochrane, and PEDro. Study eligibility criteria: Randomized controlled trial published in English language with at least one arm should contain physiotherapy interventions and compared with control group. Subject/Population: Patients with cervicogenic headache. Outcome measure: Headache intensity. Study appraisal: Study quality was assessed by PEDro, Cochrane collaboration risk of bias tool. Data extraction: Descriptive data was represented as mean, 95% confidence interval for headache intensity at baseline and post intervention was collected. Statistical methods: meta-analysis was performed using review manager 5.3 software.

10 studies with 953 patients were included in present review. Meta analysis of all studies indicates a mean reduction of 1.24 (95% CI -2.09 to -0.39; p=0.004) on 0–10 scale in manipulation group, -1.45 (95% CI-1.95 to -0.95; p<0.001) in mobilization group, -3.81 (95% CI-7.05 to -0.58; p=0.02) in massage group and -1.46 (95% CI -1.98 to -0.94; p<0.001) in exercise group.

Our moderate to high quality studies concluded that all physiotherapy interventions are effective in managing CGH pain intensity as compared to control group. However, meta-analysis showed clinically important pain reduction for only three interventions i.e. mobilization, exercise and massage.