Tuina Combined with Acupuncture and Other Therapies for Treating Cervicogenic Headache: A Network Meta-Analysis Based on Randomized Controlled Trials

Objective: To systematically evaluate the therapeutic effect of tuina combined with different methods in the treatment of cervicogenic headache, so as to provide evidence-based basis for clinical selection of the optimal combined treatment. Methods: Randomized controlled trials of tuina combined with other therapies for cervicogenic headache published in English and Chinese databases from the establishment of databases to November 11, 2025 were searched by computer. The Cochrane bias risk assessment tool was used to evaluate the quality of the literature. Stata 16.0 and R 4.2.0 softwares were used for network meta-analysis to compare the efficacy and visual analogue scale of different combined treatment methods, and the SUCRA was ranked. Results: A total of 25 studies were included, involving 2559 patients and 11 combined treatment regimens. The analysis of the evidence volume showed that the number of studies on Acupuncture and Tuina was relatively large, and the evidence base was relatively solid; while the Blade needle and Tuina, Instrument-assisted soft tissue mobilization and Tuina schemes only had one study supporting them, and the evidence base was weak. The SUCRA ranking results showed that in terms of efficacy, Blade needle and Tuina, Acupotomy and Tuina, and acupuncture combined with Tuina ranked high; in terms of VAS scores, Blade needle and Tuina, Acupuncture and Tuina, and acupuncture combined with Tuina ranked high. However, since the ranking results are mostly based on small samples or single studies, and the evidence network lacks closed loops and the assumption of transferability faces challenges, the ranking results should be regarded as exploratory findings. Conclusion: Acupuncture and Tuina is currently a combined treatment regimen with a relatively solid evidence base and can be used as a preliminary reference in clinical practice. Although Blade needle and Tuina performed well in the ranking, it was based on only one study, and the evidence strength was insufficient. It should not be regarded as a definitive recommendation. The main value of this study lies in systematically reviewing the current research status of Tuina combined treatment for cervicogenic headache, revealing the differences in evidence volume among different regimens, and indicating the direction for future research - priority should be given to conducting more high-quality studies on schemes with weak evidence bases but potential, and strengthening direct comparisons between different combined treatment regimens. Keywords: cervicogenic headache, tuina, network meta-analysis, randomized controlled trial, combination therapy