Short-term effect of adding Graston technique to exercise program in treatment of patients with cervicogenic headache: a single-blinded, randomized controlled trial.

Abstract

Physical therapists may use the Graston technique to relieve soft-tissue restrictions and pain in the upper cervical region. However, no studies have tested the efficacy of the Graston technique in patients with cervicogenic headache. The aim of the study was to investigate the effect of adding the Graston technique to an exercise program on pain intensity, neck disability, cervical range of motion, headache frequency and duration, and medication intake in subjects with cervicogenic headache. The design of this study was a single-blinded (assessor), randomized controlled trial. The setting was outpatient rehabilitation clinic. Sixty patients, from 35 to 50 years old, with cervicogenic headache have participated in the study. Patients were recruited from the outpatient clinics of Tala general hospital in Menoufia governorate. Patients were assigned randomly into two groups. Patients in the study group received the Graston technique in addition to an exercise program, while patients in the control group received the exercise program only. All patients received 3 sessions a week for 4 weeks. The primary outcome measure was the Visual Analogue Scale (VAS), while the secondary outcome measures were Neck Disability Index (NDI), Cervical Range of Motion (CROM), headache frequency and duration, and medication intake. All outcomes were measured at baseline, after 2 weeks as well as after 4 weeks of intervention. After 2 weeks of the treatment, statistically significant differences were found in all the measured outcomes (P<0.05) in favor of the Graston group except for neck extension (P=0.08). After 4 weeks of the intervention, statistically significant differences were found in all the measured outcomes (P<0.05) in favor of the Graston group. Short-term effect of using the Graston technique in combination with an exercise program can reduce pain, decrease headache frequency and duration, and medication intake more than the exercise program alone in the medium-term. Although the study results for NDI and neck ROM were statistically significant, it is neither clinically relevant change nor clearly outside the range of measurement error.