Esta entrada ha sido elaborada bajo mi supervisión por los estudiantes de fisioterapia de la Universidad Europea de Valencia, Dolz D, Ferrari A, y publicada bajo su consentimiento en el presente espacio. Enhorabuena a ambos, gran trabajo.
Espero que os guste, un placer compartir.
The article of Chaibi A, Russell MB, entitled Manual therapies for cervicogenic headache: a systematic review does an overview of the literature with randomized clinical trials (RCTs) of manual therapy for cervicogenic headache (CEH). To do this, seven studies were chosen, six of them about cervical spinal manipulation therapy and one about applied physiotherapy and mobilization techniques.
The CEH is a type of secondary headache unilateral whose symptoms also involve the neck and head. The pathogenesis of CEH may originate from various anatomic structures in the cervical spine, for example in the convergence of afferents of the trigeminal and upper three cervical spinal nerves onto the second-order neurons in the trigeminal-cervical nucleus in the upper cervical spinal cord is likely to lead to the headache.
Despite the recognition given to this disorder in the medical field, cervicogenic headache continues to stir controversy among the various experts, discussing the pathophysiology, various treatments to be carried out and the differential diagnosis with other headaches.
However, about the diagnosis, some authors argue that one of the characteristics to differentiate CEH from other headache diagnosis is easy, for example with a exploratory test, according to Torres the criteria to diagnose should be: that headache has been triggered because movements or positions held by the neck or the external pressure in the suboccipital or posterior cervical region, should pursue reduced homolateral cervical mobility and must be pain in the cervical spine, shoulder or arm.
In the article reviewed, RCTs suggest that physical therapy and spinal manipulative therapy may be effective in the treatment of CEH, but with due caution, since studies are inconclusive about. In the first place, because only one study included a control group that received no treatment. Secondly, because the majority of patients were suffering from intermittent headache, however, the CEH is characterized by a continuous headache. And thirdly, because we still lack a validated clinical diagnosis of CEH.
Furthermore, due to muscle tenderness and possibly not yet identified local factor in the cervical spine, it might be that manual therapies can alleviate CEH , along with blockage of the greater occipital nerve (GON) which is the only effective invasive treatment.
Among the seven studies, four were performed by chiropractors, two per physical therapists and one by a physician. In search of literature studies, massage therapy, osteopathy and spinal mobilization were not identified.
In the study of the Netherlands conventional physiotherapy was used, selecting the treatment and exercises that were considered most beneficial for each participant. Accessory movements of the temporomandibular region, treatment trigger points and muscle stretching were used. Also active and passive kinesiotherapy, and coordination exercises. The PTs could also opt for neuromusculoskeletal treatment for the cervical region. The group showed a reduction of pain intensity.
In the other studies, spinal manipulative therapy was used, performed by chiropractors, physical therapists and a doctor. In such studies obtained good results in reducing the duration and intensity of the headache. In addition to the spinal manipulative therapy, soft tissue work, trigger points therapy and heat was included.
Regarding methodology, mentioning that all studies have conducted clinical interviews, which is considered the best method to establish an accurate diagnosis of CEH. On the other hand, must be performed studies with a larger number of participants. Another weakness of the studies is that it did not respect a period of 3 months of intervention established by the IHS for experiments with chronic headaches. As we mentioned at the beginning, only one study included a control group, in which the placebo effect was high. This should be included in future studies, although this type of studies with adult participants, blinding is extremely complicated.
In all studies, good results are obtained, based primarily on the manipulation of the cervical and myofascial treatment for trigger points. Medication is ineffective in CEH.
Much remains to be done and there are major challenges to overcome regarding the diagnosis and treatment of CEH, but the literature reviewed suggests that physical therapy and spinal manipulative therapy may be an effective treatment in the management of cervicogenic headache.
Chaibi A, Russell MB. Manual therapies for cervicogenic headache: a systematic review. J Headache Pain. 2012 Jul;13(5):351-9. doi: 10.1007/s10194-012-0436-7. Epub 2012 Mar 30. Review.
Robert Gates, V. Diagnóstico y tratamiento manipulativo de la cefalea cervicogénica. Revisión bibliográfica. Fisioterapia. 2003, 25(3), 137-149.
Torres Cueco R. Cefalea cervicogénica. Criterios diagnósticos, exploración física y aproximación terapéutica. En: Padrós E, editor. Bases diagnósticas, terapéuticas y posturales del funcionalismo craneofacial. Madrid: Ripano; 2006. p.736-58.
Other recent studies about CEH:
1. Manual treatment for cervicogenic headache and active trigger point in the sternocleidomastoid muscle: a pilot randomized clinical trial. Bodes-Pardo G, Pecos-Martín D, Gallego-Izquierdo T, Salom-Moreno J, Fernández-de-Las-Peñas C, Ortega-Santiago R.
J Manipulative Physiol Ther. 2013 Sep; 36(7):403-11. doi:
10.1016/j.jmpt.2013.05.022. Epub 2013 Jul 8.
2. What are the clinical criteria justifying spinal manipulative therapy for neck pain?- a systematic review of randomized controlled trials.Smith J, Bolton PS.Pain Med. 2013 Apr;14(4):460-8. doi: 10.1111/pme.12041. Epub 2013 Feb 22. Review.
3. Orofacial manual therapy improves cervical movement impairment associated with headache and features of temporomandibular dysfunction: a randomized controlled trial.von Piekartz H, Hall T.Man Ther. 2013 Aug;18(4):345-50. doi: 10.1016/j.math.2012.12.005. Epub 2013 Feb 14.
4. Mobilization versus massage therapy in the treatment of cervicogenic headache: a clinical study.Youssef EF, Shanb AS.J Back Musculoskelet Rehabil. 2013;26(1):17-24. doi: 10.3233/BMR-2012-0344.
5. Diagnostic work-up of an elderly patient with unilateral head and neck pain. A case report.De Hertogh W, Vaes P, Versijpt J. Man Ther. 2013 Dec;18(6):598-601. doi: 10.1016/j.math.2012.08.008. Epub 2012 Oct 2.
6. Immediate effects of ischemic compression on neck function in patients with cervicogenic cephalic syndrome.Lin YC, Lai CH, Chang WH, Tu LW, Lin JC, Chou SW. J Manipulative Physiol Ther. 2012 May;35(4):301-7. doi: 10.1016/j.jmpt.2012.04.009.