Effectiveness Of Mulligan Manual Therapy In Improving Headache Frequency And Intensity In Patients With Cervicogenic Headache: A Systematic Review

Abstract

Background: The Cervicogenic Headache (CGH) is rampant musculoskeletal ailment caused by postural dysfunction of cervical spine. Different cervical spine anatomic structures may be the source of the etiology of CGH. Mulligan Manual Therapy (MMT) is thought to be beneficial in improving neck pain and headaches however the existing literature lacks evidence to strengthen the results produced by MMT, hence this systematic review is done to investigate the effects of same on various indicators of Cervical Spine health and Headache frequency and intensity.

Methods: The studies were included in the present review were constrained to English Language only with study design as Randomized Controlled Trial (RCT) published between 2019- 2024 with atleast one intervention as Mulligan Manual therapy (MMT) compared with other therapeutic interventions like traditional treatment (TT), strengthening exercises, stretching or if various MMT interventions compared with themselves. Database searches were conducted using MEDLINE, PubMed, Scopus, Web of Science (WoS), and Cochrane. Data extraction was done based on eligibility criteria and risk of bias assessment using PEDRO scale for the included studies was done using the following keywords: “Cervicogenic headache and mulligan therapy”, “Cervicogenic headache and manual therapy”, “Cervicogenic headache and physical therapy”, “Cervicogenic headache and mulligan or manual therapy”, “Cervicogenic headache and SNAGs and/or NAGs”, “Headache and mulligan therapy”, “Headache and manual therapy”, “Headache and mulligan therapy or physical therapy”. The systematic review has been registered in INPLASY with the registration number INPLASY202510045.

Results & Conclusion: 5 studies out of 1575 articles after abstract screening were included for which effects were studied on various parameters like headache frequency, intensity, cervical disability, range of motion (ROM), psychological parameters like depression and anxiety, cervical muscle performance which were diversified across the included studies. The findings of present review reveals the role of MMT in improving symptoms of headache in CEH patients with reduction in neck disability, improved cervical muscle performance, lordosis angle, ROM, psychological functioning, hence emerging as one of the most beneficial approach in treatment of headaches of cervical origin.