徒手治療及運動治療介入對頸因性頭痛之效果：系統性回顧與統合分析

Efficacy of Manual Therapy and Therapeutic Exercise for Patients With Cervicogenic Headache: Systematic Reviews and Meta-Analysis

唐群凱(Chun-Kai Tang) ； 何晴華(Ching-Hua Ho) ； 江佳倚(Chia-Yi Chiang) ； 施怡芬(Yi-Fen Shih) ； 王子娟(Wendy Tzyy-Jiuan Wang)

《物理治療》 44卷3期 (2019/09) Pp. 180-191

https://doi.org/10.6215/FJPT.201909_44(3).0003

摘要

背景與目的：頸因性頭痛（cervicogenic headache）是一種次發性頭痛，其特色為與頸部姿勢或動作相關之單側頭痛症狀。先前文獻探討徒手治療與運動治療對於頸因性頭痛的效果尚未有一致結論，本研究目的為以系統性回顧與統合分析，探討徒手治療及運動治療介入對頸因性頭痛患者的療效。方法：資料蒐集的方式包含電腦化的資料庫搜尋（包含PubMed、Medline及CINAHL）和人工檢索相關文獻。研究刊登日期介於1966年至2018年4月之間。結果：共有7研究符合納入條件，分析結果顯示徒手或運動治療較對照組在頭痛強度、頻率、時間均有顯著減輕之效果（p ＜ 0.001）；徒手治療介入較對照組在頸部活動度有顯著較佳效果（p = 0.002）；徒手與運動治療介入較對照組在屈曲旋轉角度有顯著較好效果（p ＜ 0.001）。至於在頸因性頭痛患者的頸部疼痛方面，徒手治療介入較控制組，效果未達顯著（p = 0.220）。結論：徒手治療或運動治療可減輕頸因性頭痛強度、頻率與持續時間，也可改善頸部活動度。本統合分析結果提供臨床實證，支持這些介入方法的療效。

關鍵字

頸因性頭痛 ； 徒手治療 ； 運動治療 ； 系統性回顧 ； 統合分析

並列摘要

Background and Purpose: Cervicogenic headache (CGH) is a secondary headache characterized by pain over the single side and related to the cervical spine. There is no consistent conclusion on the effect of manual therapy or exercise therapy on the cervicogenic headache. The purpose of this study was to investigate the effect of manual therapy and therapeutic exercise on intensity, frequency, duration of the headache, cervical mobility, and function of the neck. Methods: We searched PubMed, Medline and CINAHL databases for journal articles in English from1966 until April 2018. Original clinical trials which met the following criteria were included: (1) subjects with cervicogenic headache; (2) using either the manual therapy or therapeutic exercise as an intervention; (3) the control group received sham treatment, placebo, or no intervention; (4) outcome measures contained the intensity, frequency, duration of headache, cervical mobility, and neck function. Results: Seven articles met the inclusion criteria and were analyzed. The results of meta-analysis showed that both manual therapy and therapeutic exercise were significantly better than the control group on headache intensity, frequency, and duration (p ＜ 0.001). Manual therapy resulted in better improvement in neck mobility than the control group (p = 0.002). Manual therapy and therapeutic exercise demonstrated a significantly better effect than the controls on upper cervical rotation mobility (p ＜ 0.001). However, manual therapy showed no better effects on reducing neck pain in patients with CGH (p = 0.220). Conclusions: Good evidence has been found, supporting the clinical effects of manual therapy and exercise on improving the headache intensity, frequency, duration, and upper cervical rotation mobility. Manual therapy can also improve the gross range of cervical motion.

並列關鍵字

Cervicogenic headache ； Manual therapy ； Therapeutic exercise ； Systematic review ； Meta-analysis