What works for neck related headaches

A recent study examined the effectiveness of several treatments for neck related headaches (also known as cervicogenic headaches).

The study was a systematic review and meta analysis. This means the researchers searched multiple research databases and collected studies related to this topic.

This study only included randomised controlled trials, which are generally considered the gold standard for evaluating treatment effectiveness.

In total, the review included 41 studies involving 1,922 participants.

Overall, 4 treatment approaches showed the strongest effects in the following order:

1. Dry needling combined with exercise showed a large reduction in average pain intensity and reduced headache frequency.
   

2. Dry needling in combination with manual therapy. Large reduction in average pain intensity. Less frequent headache occurrence.
   

3. Manual therapy in combination with exercise. Moderate-Large reduction in average pain intensity. Lower disability.
   

4. Manual therapy. Moderate reduction in average pain intensity.

Limitations

• The study was only done on adults so we have to be careful in applying this to people under 18.
  

• As noted several times in the paper, the included studies used different diagnostic criteria.
  

• Only 2 studies examining medication were included. As highlighted in the discussion, this does not mean medications are ineffective, but rather that this area requires further research.
  

• The duration of symptoms was not clearly described. It is unclear whether participants had recent (acute) headaches or longer term (chronic) symptoms.
  

• Although the average effects were quite large for several treatments, there was significant variation between studies, meaning the certainty of the evidence remains low.

Conclusions / Opinion

• Overall, this was a reasonably well conducted review. It included good studies and the risk of bias was considered to have some concern.
  

• It is important to note that the review only examined short to moderate term outcomes - with the longest follow ups being 3 months. Which means that we don’t know if the effects would be any longer. In many conditions, treatment effects often appear smaller when examined over longer follow up periods.
  

• Most of the included studies examined manual therapy or exercise. There were very few trials investigating medical treatments. In this review, pharmacological approaches appeared less

  effective than multimodal physical therapies, although the evidence base was smaller and less connected. This may be encouraging for some patients, as these approaches are generally lower risk and accessible.
  

• We don’t know if the effects are the same for recent onset (acute) headaches or for longer term (chronic) headaches.

Manual therapy is generally considered relatively safe when performed appropriately. Exercise is considered safe. Both appear capable of reducing pain and disability in the short term, although longer term effects remain less certain. In combination they appeared to produce the strongest average effects. Like with everything the effects varied significantly for people in these studies and results are based on averages responses. This means individual responses may vary and it is not possible to predict how well any treatment will work for a specific person.

Written by

Samuel Bulten

Exercise Physiologist | Masters in Medicine (Pain Management)

Director, Adapt Movement

Disclaimer

This information is for educational purposes only and is not a substitute for personal medical advice. These blogs are written by Sam Bulten and represent his opinions and insights and are based on his experience and interpretation of the research. As Sam is a human, these opinions and insights are not absolute truths.