Osteopathic manipulative treatment and cervicogenic headache: a randomized controlled trial

Abstract Context Cervicogenic headache (CeH) is a common secondary headache type arising from a disorder or lesion of the cervical spine and its soft tissues. Objectives This study aimed to evaluate the effect of osteopathic manipulative treatment (OMT) in patients with CeH. Methods A total of 413 patients with CeH were treated by 30 osteopaths and allocated by block randomization to an OMT group (n=226) or a placebo group (n=187). The primary outcome was the Neck Disability Index (NDI) score; the secondary outcome was upper cervical rotation measured with the Flexion-Rotation Test (FRT) utilizing a cervical range of motion (CROM) device. Patients received two treatments over 4 weeks (standardized sham vs. findings-based OMT). Two-factor analyses of variance (ANOVAs) were utilized for the NDI score and CROM_FRT_sum, and Cohen’s d was calculated for all clinical outcomes. A severity-based subgroup analysis of the NDI was performed. Results The NDI improved by 5.9 points (11.8 %) in the OMT group and by 2.5 points (5.1 %) in the placebo group from baseline to final follow-up. Only the OMT group reached the established minimal clinically important difference (MCID) of 5.5 points. Effect sizes in the OMT group were large (Cohen’s d =0.74 short-term and 0.87 at follow-up). Conclusions OMT reduces pain and improves functional disability in patients with CeH in a clinically meaningful way. Patients with higher initial NDI scores benefit more from OMT than others.