Osteopathic Care Combined With Physiotherapy and Pain Education for Cervicogenic Headache

Introduction: Cervicogenic headache (CH) is a secondary headache associated withnon‐traumatic dysfunctions of the cervical region. Osteopathic Care (OC) has shownpromising results in reducing pain and disability in patients with migraine, tension‐typeheadaches and CH, but the effectiveness of OC remains scarce, and the studies has lowcertainty of evidence. Objective: To investigate the effectiveness of the OC in themanagement of headache‐related disability in patients with CH 6 weeks and 24 weeks afterthe intervention compared with sham and control group. Methods: This is a three‐arm,pragmatic, randomized controlled trial. A total of 120 adult participants with chronic CHwill be recruited. Participants must report episodic headache for at least 3 months,occurring at least once per week, present cervical mobility less than 44° on the cervicalflexion‐rotation test, and exhibit headache during provocative tests at C0, C1, C2,and/or C3. After randomization, the experimental group will receive OC plus Physiotherapy(specific exercises for the cervical spine and Mulligan´s manual therapy) and a paineducation booklet. The control group will receive the same Physiotherapy and paineducation intervention. The sham group will receive the OC sham combined withPhysiotherapy and pain education. Primary outcome will be headache‐related disability,assessed by Headache Impact Test (HIT‐6). Secondary outcomes will be pain intensity (VAS)and the Perceived Changes Questionnaire (PCQ). Outcome assessment will be carried out atbaseline, 6 weeks after the intervention and 24 weeks follow up with anintention‐to‐treat framework. Expected Results: OC combined with Physiotherapy and paineducation would be effectiveness in reducing headache‐related disability compared to thesham and control groups, 6 weeks after the intervention.