Effect of neck exercises on cervicogenic headache: a randomized controlled trial.
From: J Rehabil Med. 2010 Apr;42(4):344-9
This study compared the efficacy of three 12-month training programmes on headache and upper extremity pain in patients with chronic neck pain. A total of 180 female office workers, with chronic, non-specific neck pain were randomly assigned to 3 groups. The strength group performed isometric, dynamic and stretching exercises. The endurance group performed dynamic muscle and stretching exercises. The control group performed stretching exercises. Pain was assessed with a visual analogue scale. Each group was divided into 3 subgroups according to headache intensity.
At the 12-month follow-up headache had decreased by 69% in the strength group, 58% in the endurance group and 37% in the control group compared with baseline. Neck pain diminished most in the strength group with the most severe headache. In the dose analysis, one metabolic equivalent per hour of training per week accounted for a 0.6-mm decrease in headache on the visual analogue scale. Upper extremity pain decreased by 58% in the strength group, 70% in the endurance group and 21% in the control group.
All of the training methods decreased headache. However, stretching, which is often recommended for patients, was less effective alone than when combined with muscle endurance and strength training. Care must be taken in recommending the type of neck exercises to be undertaken by patients with severe cervicogenic headache.
Regarding neck pain, this is in contrast to a study in Clin Rehabil. 2008 Jul;22(7):592-600. Strength training and stretching versus stretching only in the treatment of patients with chronic neck pain: a randomized one-year follow-up study, where no statistically significant differences in neck pain and disability were observed between of a 12-month home-based combined strength training and stretching programme against stretching alone in the treatment of chronic neck pain, although this study did not evaluate headaches.
It is also not clear from the abstract, the methods used to diagnose cervicogenic headache and to distinguish from migrainous or tension-type headaches. Additionally, the abstract notes chronic non-specific neck pain and upper extremity pain without indication for method of referral. It is also noted that pecentages are given for improvement in headaches and upper extremity pain, however, the neck pain is not afforded this specific analysis, noting only that neck pain diminished most in the strength group. Additionally, the only method of quantification was the visual analog scale
