Clinical Efficacy of the Mulligan Maneuver for Cervicogenic Headache: A Randomized Controlled Trial

Background: Cervicogenic headache is an often observed secondary headache in clinical settings, with patients who endure prolonged and persistent pain being particularly susceptible to mood changes.Currently, the Mulligan is one of the effective methods for CEH. However, there is a lack of evaluation about the strength and frequency of headaches, as well as the assessment of pain-induced emotions, in individuals with CEH using this particular procedure. Herein, we aimed to evaluate the effectiveness of the Mulligan maneuver from a multidimensional perspective of pain intensity and mood. Methods༚ A total of forty patients diagnosed with CEH who satisfied the specified inclusion criteria were recruited and allocated randomly into two groups: the control group and the treatment group, with each group consisting of twenty cases. The control group received health education, while the treatment group received the Mulligan maneuver once daily over a course of 10 treatment sessions.The clinical outcome of patients with CEH in two groups was assessed using the Visual Analog Scale (VAS), Hamilton Anxiety Scale (HAMA), and Hamilton Depression Scale (HAMD). Resting-state functional magnetic resonance imaging (fMRI) was employed to examine variations in brain function activities between the two CEH groups. Brain regions showing differences were identified as regions of interest (ROI) and subsequently correlated with clinical behavioral measures using Pearson's correlation analysis. Results The differences in VAS, HAMA and HAMD between the two groups of CEH patients were also statistically significant (P < 0.05). The brain regions that showed differences in the ReHo scores between the two groups of CEH patients included the left cerebellum, the frontal gyrus, and the middle temporal gyrus. There was a positive correlation between the left frontal gyrus and VAS, HAMA and HAMD. (R 2  = 0.48, P < 0.05; R 2  = 0.28, P < 0.05; R 2  = 0.26, P < 0.05); the left middle temporal gyrus had a negative correlation with VAS, HAMA, and HAMD. (R 2  = 0.44, P < 0.05; R 2  = 0.43, P < 0.05; R 2  = 0.25, P < 0.05); and the left cerebellum had a positive correlation with VAS correlation (R 2  = 0.27, P < 0.05). Conclusion The Mulligan maneuver may improve pain levels and have a moderating effect on pain-related negative emotions by regulating the function of relevant brain regions in CEH patients.