Effectiveness of manipulation and mobilisation for headaches: an evidence-based systematic review.

Objectives of the Systematic Review The objective of this systematic review is to determine the efficacy of manipulation and mobilisation for headaches. Questions The specific questions to be addressed are: - Is spinal mobilisation and manipulation effective in the treatment of tension- type headache, migraine and cervicogenic headache? - What type mobilisation and or manipulation used in tension-type headache, migraine or cervicogenic headache is the most effective; -in reducing headache and promoting comfort -in reducing headache intensity -in reducing headache frequency -in reducing headache duration Inclusion criteria Participants Adult age>18) with headache(s) who are currently receiving or have received manipulation and/or mobilisation as the main part of their treatment. Excluded are participants reporting of: headache due to neurologic compromises, headache due to medical conditions, headache caused by other factors such as tumours Interventions Any type of cervical spine mobilisation and manipulation with a specific physiotherapy background Excluded interventions are: Chiropractic intervention, Acupuncture, Craniosacral therapy, Osteopathy. These interventions are not physiotherapy specific and require specialised skills by the practitioner and hence will be excluded. Comparators The most appropriate comparator would be no manipulation or mobilisation for headaches or other alternative treatment strategies. Outcomes Primary outcome measures:Subjective changes in headache reporting (headache diary) Secondary outcome measures: Other clinical findings which are often reported in combination with headache such as altered range of motion, associated pain symptoms, changes to cervical musculature etc