title: Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial.
abstract: BACKGROUND
  Although commonly utilized interventions, no studies have directly compared the effectiveness of cervical and thoracic manipulation to mobilization and exercise in individuals with cervicogenic headache (CH). The purpose of this study was to compare the effects of manipulation to mobilization and exercise in individuals with CH.
  
  
  METHODS
  One hundred and ten participants (n = 110) with CH were randomized to receive both cervical and thoracic manipulation (n = 58) or mobilization and exercise (n = 52). The primary outcome was headache intensity as measured by the Numeric Pain Rating Scale (NPRS). Secondary outcomes included headache frequency, headache duration, disability as measured by the Neck Disability Index (NDI), medication intake, and the Global Rating of Change (GRC). The treatment period was 4 weeks with follow-up assessment at 1 week, 4 weeks, and 3 months after initial treatment session. The primary aim was examined with a 2-way mixed-model analysis of variance (ANOVA), with treatment group (manipulation versus mobilization and exercise) as the between subjects variable and time (baseline, 1 week, 4 weeks and 3 months) as the within subjects variable.
  
  
  RESULTS
  The 2X4 ANOVA demonstrated that individuals with CH who received both cervical and thoracic manipulation experienced significantly greater reductions in headache intensity (p < 0.001) and disability (p < 0.001) than those who received mobilization and exercise at a 3-month follow-up. Individuals in the upper cervical and upper thoracic manipulation group also experienced less frequent headaches and shorter duration of headaches at each follow-up period (p < 0.001 for all). Additionally, patient perceived improvement was significantly greater at 1 and 4-week follow-up periods in favor of the manipulation group (p < 0.001).
  
  
  CONCLUSIONS
  Six to eight sessions of upper cervical and upper thoracic manipulation were shown to be more effective than mobilization and exercise in patients with CH, and the effects were maintained at 3 months.
  
  
  BACKGROUND
  NCT01580280 April 16, 2012.
authors: Alabama Physical Therapy & Acupuncture, Montgomery, AL, USA. jamesdunning@hotmail.com.|Nova Southeastern University, Ft. Lauderdale, FL, USA. jamesdunning@hotmail.com.|AAMT Fellowship in Orthopaedic Manual Physical Therapy, Columbia, SC, USA. jamesdunning@hotmail.com.
authors: James R
authors: JR
authors: Dunning
authors: Research Physical Therapy Specialists, Columbia, SC, USA. buttsraymond@yahoo.com.
authors: Raymond
authors: R
authors: Butts
authors: Universidad Rey Juan Carlos, Alcorcón, Spain. firas.mourad@me.com.
authors: Firas
authors: F
authors: Mourad
authors: Spine and Sport, Savannah, GA, USA. youngian@spinesport.org.
authors: Ian
authors: I
authors: Young
authors: Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain. cesarfdlp@yahoo.es.
authors: Cesar
authors: C
authors: Fernandez-de-Las Peñas
authors: Department of Physical Therapy, Long Island University, Brooklyn, NY, USA. marshall.hagins@liu.edu.
authors: Marshall
authors: M
authors: Hagins
authors: Back to Health, Brooklyn, NY, USA. thomas.stanislawski@gmail.com.
authors: Thomas
authors: T
authors: Stanislawski
authors: Research Physical Therapy Specialists, Columbia, SC, USA. jonathan.donley@palmettohealth.org.
authors: Jonathan
authors: J
authors: Donley
authors: Cutting Edge Orthopedics, Gilbert, AZ, USA. dustinbuck@hotmail.com.
authors: Dustin
authors: D
authors: Buck
authors: Champion Sports Medicine, Birmingham, AL, USA. trhooks@hotmail.com.
authors: Todd R
authors: TR
authors: Hooks
authors: Department of Physical Therapy, Franklin Pierce University, Manchester, NH, USA. joshcleland@comcast.net.
authors: Joshua A
authors: JA
authors: Cleland
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D008875:Middle Aged; D019547:Neck Pain / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D051298:Post-Traumatic Headache / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D013904:Thoracic Vertebrae; D016896:Treatment Outcome