The Comparative Efficacy of Treatments for Cervicogenic Headache: A Systematic Review and Network Meta-Analysis of...

Cervicogenic headache lacks comprehensive evidence comparing all available treatments. This study aimed to evaluate the relative efficacy of interventions for reducing headache intensity, frequency and headache-related disability in cervicogenic headache.

We conducted a systematic search for randomised controlled trials (RCTs) evaluating pharmacological and non-pharmacological interventions in adults diagnosed with cervicogenic headache. Searches were performed across multiple electronic databases, including PubMed, Scopus, Cochrane Central Register of Controlled Trials, PEDro, ClinicalTrials.gov, and Google Scholar. The primary outcomes were headache intensity and frequency. The secondary outcome was the Headache Impact Test (HIT-6). Data was synthesised using random-effects network meta-analysis, with risk of bias assessed via the Cochrane RoB 2 tool. Treatment hierarchies were established using P-scores.

The review included 41 RCTs involving 1922 participants, with 37 studies contributing to network meta-analysis. Multimodal non-pharmacological approaches demonstrated superior short-term efficacy compared to single-modality and pharmacological interventions. The highest-ranked interventions for both intensity and frequency reduction included manual therapy combined with dry needling (intensity: mean difference [MD] = -5.98, 95% CI: -10.43 to -1.53; frequency: MD = -15.29, 95% CI: -20.99 to -9.59). The combination of manual therapy, exercise, and orthosis demonstrated the greatest reduction in HIT-6 scores (MD = -18.69, 95% CI: -28.62 to -8.76). In contrast, isolated passive treatments such as massage and pharmacological interventions including pregabalin and botulinum toxin demonstrated limited effectiveness.

Multimodal non-pharmacological approaches are superior to single-modality treatments and pharmacological interventions in the short-term management of cervicogenic headache, effectively reducing headache intensity, frequency and headache-related disability.

This network meta-analysis demonstrates that multimodal non-pharmacological approaches are superior to single-modality treatments and pharmacological interventions in the short-term management of cervicogenic headache, effectively reducing headache intensity, frequency and headache-related disability.