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

BACKGROUND

The efficacy of commonly used medication and physical interventions for cervicogenic headache (CGH) in adults remains insufficiently assessed.

OBJECTIVE

To evaluate the efficacy of nonsurgical interventions for managing adults with CGH.

METHODS

A comprehensive search was conducted across 6 databases through September 2025, identifying randomized controlled trials (RCTs) that examined the efficacy of nonsurgical interventions in reducing CGH-related outcomes, including headache frequency, intensity, duration, neck disability, medication intake, and quality of life. 2 reviewers independently extracted data using a standardized form. Risk of bias was assessed with the Cochrane RoB 2.0 tool, and certainty of evidence with the GRADE approach. Meta-analyses were conducted for trials with similar interventions, comparators, and outcomes. Standardized mean differences (SMD) with 95 % confidence intervals were calculated using a random-effects model and the inverse-variance method. Heterogeneity was assessed using χ² and I² statistics. Effect sizes were interpreted according to Cohen's thresholds. For RCTs not eligible for meta-analysis, a structured narrative synthesis was conducted.

RESULTS

29 RCTs were included. Low-certainty evidence suggests that manual therapy reduced headache intensity compared with sham at 0-2 weeks post-intervention (SMD -1.60; 95 %CI -2.40 to -0.79; 5 RCTs; n = 144), but not at 12 months (SMD 0.09; 95 %CI -0.59 to 0,76; 2 RCTs; n = 265). Low-certainty evidence indicates that exercise therapy alone may reduce headache compared with usual care, but the difference was not statistically significant at 1-3 months (SMD -1.30; 95 %CI -2.61 to 0.02; 2 RCTs; n = 116) and at 12 months (SMD -1.25; 95 %CI -2.35 to -0.14; 2 RCTs; n = 116). Evidence is uncertain regarding the efficacy of both manual therapy and the combination of manual therapy and exercise therapy compared with usual care.

CONCLUSIONS

Manual therapy may offer short-term relief for adults with CGH. However, the long-term effects and added benefits of combined approaches remain unclear. TRIAL REGISTRATION PROSPERO: #CRD42023390280.