Efficacy of physiotherapy interventions for the management of adults with cervicogenic headache: A systematic review and meta-analyses.

Cervicogenic headache, which arises from problems in the neck, is often treated with physiotherapy, but how much that actually helps has been unclear. This systematic review pooled results from fourteen randomized controlled trials testing interventions like manual therapy and neck exercise against sham treatment, no treatment, or other exercise approaches. In the short term, manual therapy reduced how often headaches occurred and how intense they felt compared with sham treatment or no treatment at all, with moderate-certainty evidence supporting this.

However, those benefits did not hold up at twelve months, when manual therapy no longer showed a statistically significant advantage over sham treatment. Separately, neck exercise showed longer-term reductions in headache intensity compared to no treatment or aerobic exercise, though this rested on individual trials rather than pooled evidence. Overall, the evidence base remains modest in size, and the authors note that future research could still change these conclusions.

If you experience cervicogenic headache, meaning headaches linked to a problem in your neck, you might wonder whether physiotherapy treatments like hands-on manual therapy or neck exercises can actually help. This review combined findings from fourteen clinical trials to look at exactly that question.

In the short term, manual therapy appeared to reduce both how often headaches happened and how strong they felt, compared with a fake version of the treatment or no treatment at all. That's a meaningful early result, but it didn't last: by twelve months, manual therapy no longer showed a clear edge over the sham treatment. Neck exercise told a different story.

In separate trials, it was linked to less intense headaches over the longer term compared with no treatment or with general aerobic exercise. Still, this comes from individual studies rather than a large combined dataset, so it's an early signal rather than a settled answer.

Across the review, the total number of trials and participants was relatively small, and the authors themselves say more high-quality research is needed before firmer conclusions can be drawn.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This systematic review and meta-analysis pooled fourteen randomized controlled trials evaluating physiotherapy interventions for cervicogenic headache, using PEDro and GRADE to appraise quality and certainty. Moderate-certainty pooled evidence found manual therapy reduced headache frequency compared with sham manual therapy (mean difference -0.93 episodes/week; 95% CI -1.40 to -0.46; two RCTs, n=265), and reduced both frequency (MD -1.23 episodes/week; 95% CI -1.55 to -0.91; three RCTs, n=126) and intensity (MD -1.63/10; 95% CI -2.15 to -1.10; four RCTs, n=208) versus no treatment in the short term.

At twelve-month follow-up, moderate-certainty evidence showed no statistically significant between-group difference in intensity (MD -0.12; 95% CI -0.49 to 0.26) or frequency (MD -0.32 episodes/week; 95% CI -0.91 to 0.28) for manual therapy versus sham, from two RCTs (n=265). Neck exercise showed longer-term reductions in headache intensity versus no treatment (MD -1.51/10; 95% CI -2.52 to -0.50; n=100, one trial) and versus aerobic exercise (MD -1.15/10; 95% CI -2.1 to -0.20; n=180, one trial), each from a single trial rather than pooled data. The evidence base remains limited in scale, and the authors caution that emerging results could still shift these conclusions.