Dose response and efficacy of spinal manipulation for chronic cervicogenic headache: a pilot randomized controlled trial.

The purpose of this study was to compare the efficacy of two doses of SMT and two doses of light massage (LM) for CGH. Eighty patients with chronic CGH were randomized to either 8 or 16 treatment sessions with either SMT or a minimal LM control. Patients were treated once or twice per week for 8 weeks. Adjusted mean differences (AMD) between groups were computed using generalized estimating equations for the longitudinal outcomes over all follow-up time points (profile) and using regression modeling for individual time points with baseline characteristics as covariates and with imputed missing data. For the CGH pain scale, comparisons of 8 and 16 treatment sessions yielded small dose effects. There was an advantage for SMT over the control at 12 weeks and at 24 weeks. For the higher dose patients, the advantage was greater at 12 weeks and at 24 weeks. Patients receiving SMT were also more likely to achieve a 50% improvement in pain scale. Secondary outcomes showed similar trends favouring SMT. For SMT patients, the mean number of CGH was reduced by half.

Clinically important differences between SMT and a control intervention were observed favoring SMT. Dose effects tended to be small.

Haas M, Spegman A, Peterson D, et al. Dose response and efficacy of spinal manipulation for chronic cervicogenic headache: a pilot randomized controlled trial. Spine J. 2010 Feb;10(2):117-28

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