Abstract：
OBJECTIVE: What is the effect of a 4-week regimen of Mulligan manual therapy (MMT) plus exercise compared with exercise alone for managing cervicogenic headache? Is MMT plus exercise more effective than sham MMT plus exercise? Are any benefits maintained at 26 weeks of follow-up?
METHODS: A three-armed, parallel-group, randomised clinical trial with concealed allocation, blinded assessment of some outcomes and intention-to-treat analysis.
METHODS: Ninety-nine people with cervicogenic headache as per International Classification of Headache Disorders (ICHD-3).
METHODS: Participants were randomly allocated to 4 weeks of: MMT with exercise, sham MMT with exercise or exercise alone.
METHODS: The primary outcome was headache frequency. Secondary outcomes were headache intensity, headache duration, medication intake, headache-related disability, upper cervical rotation range of motion, pressure pain thresholds and patient satisfaction. Outcome measures were collected at baseline and at 4, 13 and 26 weeks.
RESULTS: MMT plus exercise reduced headache frequency more than exercise alone immediately after the intervention (MD between groups in change from baseline: 2 days/month, 95% CI 2 to 3) and this effect was still evident at 26 weeks (MD 4 days, 95% CI 3 to 4). There were also benefits across all time points in several secondary outcomes: headache intensity, headache duration, headache-related disability, upper cervical rotation and patient satisfaction. Pressure pain thresholds showed benefits at all time points at the zygapophyseal joint and suboccipital areas but not at the upper trapezius. The outcomes in the sham MMT with exercise group were very similar to those of the exercise alone group.
CONCLUSIONS: In people with cervicogenic headache, adding MMT to exercise improved: headache frequency, intensity and duration; headache-related disability; upper cervical rotation; and patient satisfaction. These benefits were not due to placebo effects.
BACKGROUND: CTRI/2019/06/019506.
METHODS: A three-armed, parallel-group, randomised clinical trial with concealed allocation, blinded assessment of some outcomes and intention-to-treat analysis.
METHODS: Ninety-nine people with cervicogenic headache as per International Classification of Headache Disorders (ICHD-3).
METHODS: Participants were randomly allocated to 4 weeks of: MMT with exercise, sham MMT with exercise or exercise alone.
METHODS: The primary outcome was headache frequency. Secondary outcomes were headache intensity, headache duration, medication intake, headache-related disability, upper cervical rotation range of motion, pressure pain thresholds and patient satisfaction. Outcome measures were collected at baseline and at 4, 13 and 26 weeks.
RESULTS: MMT plus exercise reduced headache frequency more than exercise alone immediately after the intervention (MD between groups in change from baseline: 2 days/month, 95% CI 2 to 3) and this effect was still evident at 26 weeks (MD 4 days, 95% CI 3 to 4). There were also benefits across all time points in several secondary outcomes: headache intensity, headache duration, headache-related disability, upper cervical rotation and patient satisfaction. Pressure pain thresholds showed benefits at all time points at the zygapophyseal joint and suboccipital areas but not at the upper trapezius. The outcomes in the sham MMT with exercise group were very similar to those of the exercise alone group.
CONCLUSIONS: In people with cervicogenic headache, adding MMT to exercise improved: headache frequency, intensity and duration; headache-related disability; upper cervical rotation; and patient satisfaction. These benefits were not due to placebo effects.
BACKGROUND: CTRI/2019/06/019506.
摘要：
目的：与单纯运动相比，4周的Mulligan手法治疗（MMT）加运动治疗颈源性头痛的效果如何？MMT加运动是否比假MMT加运动更有效？在26周的随访中是否有任何益处？
方法：三臂，平行组，隐蔽分配的随机临床试验，对某些结果进行盲化评估和意向治疗分析。
方法：根据国际头痛疾病分类（ICHD-3），九十九人患有颈源性头痛。
方法：参与者被随机分配到4周：MMT和锻炼，假MMT与运动或单独运动。
方法：主要结果是头痛频率。次要结果是头痛强度，头痛持续时间,药物摄入量，头痛相关的残疾，上颈椎旋转的活动范围，压力疼痛阈值和患者满意度。在基线和第4、13和26周收集结果测量值。
结果：MMT加运动在干预后立即比单独运动减少了头痛频率（两组之间的MD从基线变化：2天/月，95%CI2至3)，这种效果在26周时仍然很明显(MD4天，95%CI3至4)。在几个次要结果的所有时间点也有益处：头痛强度，头痛持续时间,头痛相关的残疾，上颈椎旋转和患者满意度。压力疼痛阈值在所有时间点均显示出zygapophyseal关节和枕下区域的益处，但在上斜方肌则没有。假MMT运动组的结果与单纯运动组的结果非常相似。
结论：在宫颈源性头痛患者中，增加MMT锻炼改善：头痛频率，强度和持续时间；头痛相关残疾；上颈椎旋转；和患者满意度。这些益处不是由于安慰剂效应。
背景：CTRI/2019/06/019506。
方法：三臂，平行组，隐蔽分配的随机临床试验，对某些结果进行盲化评估和意向治疗分析。
方法：根据国际头痛疾病分类（ICHD-3），九十九人患有颈源性头痛。
方法：参与者被随机分配到4周：MMT和锻炼，假MMT与运动或单独运动。
方法：主要结果是头痛频率。次要结果是头痛强度，头痛持续时间,药物摄入量，头痛相关的残疾，上颈椎旋转的活动范围，压力疼痛阈值和患者满意度。在基线和第4、13和26周收集结果测量值。
结果：MMT加运动在干预后立即比单独运动减少了头痛频率（两组之间的MD从基线变化：2天/月，95%CI2至3)，这种效果在26周时仍然很明显(MD4天，95%CI3至4)。在几个次要结果的所有时间点也有益处：头痛强度，头痛持续时间,头痛相关的残疾，上颈椎旋转和患者满意度。压力疼痛阈值在所有时间点均显示出zygapophyseal关节和枕下区域的益处，但在上斜方肌则没有。假MMT运动组的结果与单纯运动组的结果非常相似。
结论：在宫颈源性头痛患者中，增加MMT锻炼改善：头痛频率，强度和持续时间；头痛相关残疾；上颈椎旋转；和患者满意度。这些益处不是由于安慰剂效应。
背景：CTRI/2019/06/019506。
