Effect of Mulligan upper cervical manual traction in the treatment of cervicogenic headache: a randomized controlled trial

Introduction Cervicogenic headache (CGH) is a serious condition manifested by upper cervical facet joints dysfunction. Mulligan upper cervical sustained natural apophyseal glide was noted to be effective in CGH but Mulligan upper cervical manual traction (MUCMT) has not yet been investigated. The purpose of the study was to compare the effect of MUCMT vs. traditional treatment (TT) in patients with CGH. Methods A randomized controlled prospective parallel single-blind trial was performed. Overall, 30 patients with CGH aged 30–55 years were randomly and equally allocated into the MUCMT group (A) and TT group (B) by using permuted block randomization. Group A participants were treated by TT and MUCMT while group B received hot packs, transcutaneous electrical nerve stimulation, and deep cervical flexors strengthening exercise. Patients gained 3 sessions every week for 3 weeks followed by home exercise for 3 months. Pre-treatment, post-treatment, and follow-up values for all outcome measures were recorded. The primary outcome was headache intensity. Secondary outcomes involved headache frequency, headache duration, neck disability index, and upper cervical rotation range of motion. Results Within groups, statistical analysis revealed a significant difference in the comparison of pre- vs. post-treatment and post-treatment vs. follow-up mean values of all outcomes. Between groups, no statistical significance was observed in post-treatment and follow-up data, with 1 exception regarding upper cervical range of motion in favour of MUCMT. Conclusions MUCMT is an effective treatment in patients with CGH, mainly with regard to upper cervical rotation range of motion.