Mobilization versus massage therapy in the treatment of cervicogenic headache: a clinical study. Physical examination and self-reported pain outcomes from a randomized trial on chronic cervicogenic headache. Dose response and efficacy of spinal manipulation for chronic cervicogenic headache: a pilot randomized controlled trial. Clinical tests of musculoskeletal dysfunction in the diagnosis of cervicogenic headache. Effect of Treatment of Temporomandibular Disorders (TMD) in Patients with Cervicogenic Headache: A Single-Blind, Randomized Controlled Study The Prevalence of Cervicogenic Headache in a Random Population Sample of 20–59 Year Olds Manual treatment for cervicogenic headache and active trigger point in the sternocleidomastoid muscle: a pilot randomized clinical trial. Effectiveness of manual therapies: the UK evidence report Lack of efficacy of manual therapy in children and adolescents with suspected cervicogenic headache: results of a prospective, randomized, placebo-controlled, and blinded trial. Manual therapy and exercise for neck pain: A systematic review. A randomized controlled trial of the effect of spinal manipulation in the treatment of cervicogenic headache. A Randomized Pragmatic Clinical Trial of Chiropractic Care for Headaches With and Without a Self-Acupressure Pillow. The effect of spinal manipulation in the treatment of cervicogenic headache. Effectiveness of Physical Therapy in Patients with Tension-type Headache: Literature Review. [Therapeutic manipulation of episodic tension type headache. A randomized, controlled clinical trial]. A Randomized Controlled Trial of Exercise and Manipulative Therapy for Cervicogenic Headache The flexion-rotation test and active cervical mobility--a comparative measurement study in cervicogenic headache. Multicenter prospective evaluation of proposed pediatric migraine revisions to the IHS criteria. Pediatric Headache Committee of the American Association for the Study of Headache. Efficacy of a C1-C2 self-sustained natural apophyseal glide (SNAG) in the management of cervicogenic headache. Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report Comparison of acute effects of superficial and deep dry needling into trigger points of suboccipital and upper trapezius muscles in patients with cervicogenic headache. [Comparative study on effects of manipulation treatment and transcutaneous electrical nerve stimulation on patients with cervicogenic headache]. Intertester reliability and diagnostic validity of the cervical flexion-rotation test.
BACKGROUND AND OBJECTIVE Cervicogenic headache ( CGH ) is a common problem associated with neck pain . In this study the effect of cervical mobilizations was compared with that of massage therapy in the management of CGH . DESIGN Thirty-six subjects with CGH , r and omly assigned into two groups , participated in the study . The first group was treated with spinal mobilization techniques of the upper cervical spine , while the second group was treated with massage therapy of the neck region . All subjects underwent active neck range of motion , isometric and dynamic strengthening and endurance exercises in two sessions/week for 6 weeks . Pre- and post-treatment outcomes were assessed with means and st and ard error of the means of measured headache pain intensity , frequency and duration of headache attacks as well as via the functional Neck Disability Index ( NDI ) and active neck range of motion . RESULTS The results of the study showed significant improvement in all measured variables in each treatment group . Comparison between the two groups showed significant differences in all measured variables after intervention in favor of mobilization techniques with the exception of the functional NDI . CONCLUSION Upper cervical spine mobilization demonstrated more clinical benefits than massage therapy with regard to headache pain parameters and neck mobility for CGH subjects OBJECTIVE Objective clinical measures for use as surrogate markers of cervicogenic headache ( CGH ) pain have not been established . In this analysis , we investigate relationships between objective physical examination ( PE ) measures with self-reported CGH outcomes . METHODS This is an exploratory analysis of data generated by attention control PE from an open-label r and omized clinical trial . Of 80 subjects , 40 were r and omized to 8 treatments ( spinal manipulative therapy or light massage control ) and 8 PE over 8 weeks . The remaining subjects received no PE . Physical examination included  motion palpation of the cervical and upper thoracic regions , active cervical range of motion ( ROM ) and associated pain , and algometric pain threshold evaluated over articular pillars . Self-reported outcomes included CGH and neck pain and disability , number of CGH headaches , and related disability days . Associations between PE and self-reported outcomes were evaluated using generalized linear models , adjusting for sociodemographic differences and study group . RESULTS At baseline , number of CGH and disability days were strongly associated with cervical active ROM ( P < .001 to .037 ) . Neck pain and disability were strongly associated with ROM-elicited pain ( P < .001 to .035 ) but not later in the study . After the final treatment , pain thresholds were strongly associated with week 12 neck pain and disability and CGH disability and disability days ( P < or = .001 to .048 ) . CONCLUSIONS Cervical ROM was most associated with the baseline headache experience . However , 4 weeks after treatment , algometric pain thresholds were most associated . No one PE measure remained associated with the self-reported headache outcomes over time BACKGROUND CONTEXT Systematic review s of r and omized controlled trials suggest that spinal manipulative therapy ( SMT ) is efficacious for care of cervicogenic headache ( CGH ) . The effect of SMT dose on outcomes has not been studied . PURPOSE To compare the efficacy of two doses of SMT and two doses of light massage ( LM ) for CGH . PATIENT SAMPLE Eighty patients with chronic CGH . MAIN OUTCOME MEASURES Modified Von Korff pain and disability scales for CGH and neck pain ( minimum clinical ly important difference=10 on 100-point scale ) , number of headaches in the last 4 weeks , and medication use . Data were collected every 4 weeks for 24 weeks . The primary outcome was the CGH pain scale . METHODS Participants were r and omized to either 8 or 16 treatment sessions with either SMT or a minimal LM control . Patients were treated once or twice per week for 8 weeks . Adjusted mean differences ( AMD ) between groups were computed using generalized estimating equations for the longitudinal outcomes over all follow-up time points ( profile ) and using regression modeling for individual time points with baseline characteristics as covariates and with imputed missing data . RESULTS For the CGH pain scale , comparisons of 8 and 16 treatment sessions yielded small dose effects : |AMD|</=5.6 . There was an advantage for SMT over the control : AMD=-8.1 ( 95 % confidence interval=-13.3 to -2.8 ) for the profile , -10.3 ( -18.5 to -2.1 ) at 12 weeks , and -9.8 ( -18.7 to -1.0 ) at 24 weeks . For the higher dose patients , the advantage was greater : AMD=-11.9 ( -19.3 to -4.6 ) for the profile , -14.2 ( -25.8 to -2.6 ) at 12 weeks , and -14.4 ( -26.9 to -2.0 ) at 24 weeks . Patients receiving SMT were also more likely to achieve a 50 % improvement in pain scale : adjusted odds ratio=3.6 ( 1.6 to 8.1 ) for the profile , 3.1 ( 0.9 to 9.8 ) at 12 weeks , and 3.1 ( 0.9 to 10.3 ) at 24 weeks . Secondary outcomes showed similar trends favoring SMT . For SMT patients , the mean number of CGH was reduced by half . CONCLUSIONS Clinical ly important differences between SMT and a control intervention were observed favoring SMT . Dose effects tended to be small Persistent intermittent headache is a common disorder and is often accompanied by neck aching or stiffness , which could infer a cervical contribution to headache . However , the incidence of cervicogenic headache is estimated to be 14 - 18 % of all chronic headaches , highlighting the need for clear criterion of cervical musculoskeletal impairment to identify cervicogenic headache sufferers who may benefit from treatments such as manual therapy . This study examined the presence of cervical musculoskeletal impairment in 77 subjects , 27 with cervicogenic headache , 25 with migraine with aura and 25 control subjects . Assessment s included a  photographic measure of posture , range of movement , cervical manual examination , pressure pain thresholds , muscle length , performance in the cranio-cervical flexion test and cervical kinaesthetic sense .  The results indicated that when compared to the migraine with aura and control groups who scored similarly in the tests , the cervicogenic headache group had less range of cervical flexion/extension ( P=0.048 ) and significantly higher incidences of painful upper cervical joint dysfunction assessed by manual examination ( all P<0.05 ) and muscle tightness ( P<0.05 ) . Sternocleidomastoid normalized EMG values were higher in the latter three stages of the cranio-cervical flexion test although they failed to reach significance . There were no between group differences for other measures . A discriminant analysis revealed that manual examination could discriminate the cervicogenic headache group from the other subjects ( migraine with aura and control subjects combined ) with an 80 % sensitivity Abstract The present study was comprised of 43 patients ( 16 men ) with cervicogenic headaches for over three months , diagnosed according to the International Classification of Diagnostic Criteria of Headaches ( ICDH-ll ) . The patients were r and omly assigned to receive either manual therapy for the cervical region ( usual care group ) or additional manual therapy techniques to the temporom and ibular region to additionally influence temporom and ibular disorders ( TMD ) . All patients were assessed prior to treatment , after six sessions of treatment , and at a six-month follow-up . The outcome criteria were : intensity of headaches measured on a colored analog scale , the Neck Disability Index ( Dutch version ) , the Conti Anamnestic Question naire , noise registration at the m and ibular joint using a stethoscope , the Grade d Chronic Pain Status ( Dutch version ) , m and ibular deviation , range of mouth opening , and pressure/pain threshold of the masticatory muscles . The results indicate in the studied sample of cervicogenic headache patients , 44.1 % had TMD . The group that received additional temporom and ibular manual therapy techniques showed significantly decreased headache intensities and increased neck function after the treatment period . These improvements persisted during the treatment-free period ( follow-up ) and were not observed in the usual care group . This trend was also reflected on the question naires and the clinical temporom and ibular signs . Based on these observations , we strongly believe that treatment of the temporom and ibular region has beneficial effects for patients with cervicogenic headaches  , even in the long-term Study Design From a r and om population sample , those experiencing frequent headaches were identified . They were examined to determine how many fulfilled the 1990 international Headache Society classification criteria for cervicogenic headache . Objective To estimate the prevalence of cervicogenic headache in the general population and in the group experiencing frequent headaches . Summary of Background Data Only with the publication of the 1990 headache classification criteria did a generally accepted clinical definition of cervicogenic headache emerge . The prevaience of this form of headache has been estimated only in two highly selected in-clinic patient population s. No data exist regading the prevalence in representative unselected population s. Methods . A short question naire on headaches  was mailed to 826 r and omly selected residents of a midsized Danish town . A group of 57 individuale in the age range 20–59 years who reported having headache episodes on 5 or more days in the previous month were identified . Forty-five of the 57 were eventually interviewed and examined with respect to the IHS criteria for cervicogenic headache ( the radiological criteria were omitted on ethical grounds ) . Results Of the 45 persons examined , eight fulfilled the diagnostic criteria for cervicogenic headache , equivalent to a prevalence in the headache group of 17.8 % ( 95 % confidence interval = 8%-32 % ) . Conclusions Cervicogenic headache appears to be a relatively common form of headache , similar to migraine in prevaience OBJECTIVE The purpose of this preliminary study was to determine feasibility of a clinical trial to measure the effects of manual therapy on sternocleidomastoid active trigger points ( TrPs ) in patients with cervicogenic headache ( CeH ) . METHODS Twenty patients , 7 males and 13 females ( mean ± SD age , 39 ± 13 years ) , with a clinical diagnosis of CeH and active TrPs in the sternocleidomastoid muscle were r and omly divided into 2 groups . One group received TrP therapy ( manual pressure applied to taut b and s and passive stretching ) , and the other group received simulated TrP therapy ( after TrP localization no additional pressure was added , and inclusion of longitudinal stroking but no additional stretching ) . The primary outcome was headache intensity ( numeric pain scale ) based on the headaches experienced in the preceding week . Secondary outcomes included neck pain intensity , cervical range of motion ( CROM ) , pressure pain thresholds ( PPT ) over the upper cervical spine joints and deep cervical flexors motor performance . Outcomes were captured at baseline and 1 week after the treatment . RESULTS Patients receiving TrP therapy showed greater reduction in headache and neck pain intensity than those receiving the simulation ( P < .001 ) . Patients receiving the TrP therapy experienced greater improvements in motor performance of the deep cervical flexors , active CROM , and PPT ( all , P < .001 ) than those receiving the simulation . Between-groups effect sizes were large ( all , st and ardized mean difference , > 0.84 ) . CONCLUSION This study provides preliminary evidence that a trial of this nature is feasible . The preliminary findings show that manual therapy targeted to active TrPs in the sternocleidomastoid muscle may be effective for reducing headache and neck pain intensity and increasing motor performance of the deep cervical flexors , PPT , and active CROM in individuals with CeH showing active TrPs in this muscle . Studies including greater sample sizes and examining long-term effects are needed Background The purpose of this report is to provide a succinct but comprehensive summary of the scientific evidence regarding the effectiveness of manual treatment for the management of a variety of musculoskeletal and non-musculoskeletal conditions . Methods The conclusions are based on the results of systematic review s of r and omized clinical trials ( RCTs ) , widely accepted and primarily UK and United States evidence -based clinical guidelines , plus the results of all RCTs not yet included in the first three categories . The strength/ quality of the evidence regarding effectiveness was based on an adapted version of the grading system developed by the US Preventive Services Task Force and a study risk of bias assessment tool for the recent RCTs . Results By September 2009 , 26 categories of conditions were located containing RCT evidence for the use of manual therapy :  13 musculoskeletal conditions , four types of chronic headache and nine non-musculoskeletal conditions . We identified 49 recent relevant systematic review s and 16 evidence -based clinical guidelines plus an additional 46 RCTs not yet included in systematic review s and guidelines .Additionally , brief references are made to other effective non-pharmacological , non-invasive physical treatments . Conclusions Spinal manipulation/mobilization is effective in adults for : acute , subacute , and chronic low back pain ; migraine and cervicogenic headache ; cervicogenic dizziness ;  manipulation/mobilization is effective for several extremity joint conditions ; and thoracic manipulation/mobilization is effective for acute/subacute neck pain . The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration , and for manipulation/mobilization for mid back pain , sciatica , tension-type headache , coccydynia , temporom and ibular joint disorders , fibromyalgia , premenstrual syndrome , and pneumonia in older adults . Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation , or for Stage 1 hypertension when added to an antihypertensive diet . In children , the evidence is inconclusive regarding the effectiveness for otitis media and enuresis , and it is not effective for infantile colic and asthma when compared to sham manipulation . Massage is effective in adults for  chronic low back pain and chronic neck pain . The evidence is inconclusive for knee osteoarthritis , fibromyalgia , myofascial pain syndrome , migraine headache , and premenstrual syndrome . In children , the evidence is inconclusive for asthma and infantile colic OBJECTIVE Clinical trials concerning cervical spine manipulation and mobilization in children and adolescents with cervicogenic headache are lacking . METHODS We performed a multicenter , prospect i ve , r and omized , placebo-controlled , and blinded trial in 52 children and adolescents ( 21 boys , 31 girls ) aged 7 - 15 . After prospect i ve baseline documentation for 2 months patients were either assigned to placebo or true manipulation with another 2-month follow-up . Main outcome measures were defined as : percentage of days with headache , total duration of headache , days with school absence due to headache , consume of analgesics , intensity of headache . RESULTS We did not find a significant difference comparing the groups with placebo and true manipulation with respect to the defined main outcome measures . CONCLUSIONS We were not able to show an efficacy of cervical spine manipulation in 52 children and adolescents Manual therapy is often used with exercise to treat neck pain . This cervical overview group systematic review up date assesses if manual therapy , including manipulation or mobilisation , combined with exercise improves pain , function/disability , quality of life , global perceived effect , and patient satisfaction for adults with neck pain with or without cervicogenic headache or radiculopathy . Computerized search es were performed to July 2009 . Two or more authors independently selected studies , abstract ed data , and assessed method ological quality . Pooled relative risk ( pRR ) and st and ardized mean differences ( pSMD ) were calculated . Of 17 r and omized controlled trials included , 29 % had a low risk of bias . Low quality evidence suggests clinical ly important long-term improvements in pain ( pSMD-0.87(95 % CI:-1.69,-0.06 ) ) , function/disability , and global perceived effect when manual therapy and exercise are compared to no treatment . High quality evidence suggests greater short-term pain relief [ pSMD-0.50(95 % CI:-0.76,-0.24 ) ] than exercise alone , but no long-term differences across multiple outcomes for (sub)acute/chronic neck pain with or without cervicogenic headache . Moderate quality evidence supports this treatment combination for pain reduction and improved quality of life over manual therapy alone for chronic neck pain ; and suggests greater short-term pain reduction when compared to traditional care for acute whiplash . Evidence regarding radiculopathy was sparse . Specific research recommendations are made PURPOSE To determine whether the isolated intervention of high-velocity , low-amplitude spinal manipulation in the cervical spine has any effect on cervicogenic headache . DESIGN R and omized controlled trial with a blind observer . SETTING Ambulatory outpatient facility in an independent NHS-funded chiropractic research institution . PARTICIPANTS Thirty-nine subjects suffering from frequent headaches who fulfilled the IHS criteria for cervicogenic headache ( excluding radiological criteria ) . These subjects were recruited from among some 400 headache sufferers who responded to newspaper advertisements . INTERVENTION Half of the group received high-velocity , low-amplitude cervical manipulation twice/wk for 3 wk . The other half received low-level laser in the upper cervical region and deep friction massage ( including trigger points ) in the lower cervical/upper thoracic region , also twice/wk for 3 wk . MAIN OUTCOME MEASURE The change from week 2 to week 6 in analgesics use per day , headache intensity per episode and number of headache hr per day . RESULTS Despite a significant reduction in the manipulation group on all three outcome measures , differences between the two treatment groups failed to reach statistical significance . CONCLUSION The results suggest a possible effect of manipulation on cervicogenic headache , but because of method ological problems , such an effect could not be unequivocally demonstrated OBJECTIVE The purpose of this study was to determine if the addition of a self-acupressure pillow ( SAP ) to typical chiropractic treatment results in significantly greater improvement in tension-type and cervicogenic headache sufferers . METHODS A pragmatic r and omized clinical trial was conducted in a chiropractic college teaching clinic . Thirty-four subjects , including tension-type and cervicogenic headache sufferers , 21 to 60 years of age , male or female , completed the study . Group A ( n = 15 ) received typical chiropractic care only ( manual therapy and exercises ) , and group B ( n = 19 ) received typical chiropractic care with daily home use of the SAP . The intervention period was 4 weeks . The main outcome measure was headache frequency . Satisfaction and relief scores were obtained from subjects in the SAP group . Analysis of variance was used to analyze the intergroup comparisons . RESULTS Owing to failure of r and omization to produce group equivalence on weekly headache frequency , analysis of covariance was performed showing a trend ( P = .07 ) favoring the chiropractic-only group ; however , this was not statistically significant . Group A obtained a 46 % reduction of weekly headache frequency ( t = 3.1 , P = .002 ; d = 1.22 ) . The number of subjects in group A achieving a reduction in headaches greater than 40 % was 71 % , while for group B , this was 28 % . The mean benefit score ( 0 - 3 ) in group B of the use of the SAP was 1.2 ( .86 ) . The mean satisfaction rating of users of the SAP was 10.4 ( 2.7 ) out of 15 ( 63 % ) . CONCLUSION This study suggests that chiropractic care may reduce frequency of headaches in patients with chronic tension-type and cervicogenic headache . The use of a self-acupressure pillow ( Dr Zaxx device ) may help those with headache and headache pain relief as well as producing moderately high satisfaction with use PURPOSE To study whether the isolated intervention of high-speed , low-amplitude spinal manipulation in the cervical spine has any effect on cervicogenic headache . DESIGN Prospect i ve r and omized controlled trial with a blinded observer . SETTING Ambulatory outpatient facility in an independent research institution . PARTICIPANTS Fifty-three subjects suffering from frequent headaches who fulfilled the International Headache Society criteria for cervicogenic headache ( excluding radiological criteria ) . These subjects were recruited from 450 headache sufferers who responded to newspaper advertisements . INTERVENTION After r and omization , 28 of the group received high-velocity , low-amplitude cervical manipulation twice a week for 3 wk . The remaining 25 received low-level laser in the upper cervical region and deep friction massage ( including trigger points ) in the lower cervical/upper thoracic region , also twice a week for 3 wk . MAIN OUTCOME MEASURES The change from week 1 to week 5 in analgesic use per day , in headache intensity per episode and in number of headache hours per day , as registered in a headache diary . RESULTS The use of analgesics decreased by 36 % in the manipulation group , but was unchanged in the soft-tissue group ; this difference was statistically significant ( p = .04 , chi 2 for trend ) . The number of headache hours per day decreased by 69 % in the manipulation group , compared with 37 % in the soft-tissue group ; this was significant at p = .03 ( Mann-Whitney ) . Finally , headache intensity per episode decreased by 36 % in the manipulation group , compared with 17 % in the soft-tissue group ; this was significant at p = .04 ( Mann-Whitney ) . CONCLUSION Spinal manipulation has a significant positive effect in cases of cervicogenic headache BACKGROUND  Tension-type headache ( TTH ) is a disease with a great incidence on quality of life and with a significant socioeconomic impact . OBJECTIVES The aim of this review is to determine the effectiveness of physical therapy by using manual therapy ( MT ) for the relief of TTH . DATA SOURCES A review was done identifying r and omized controlled trials through search es in MEDLINE , PEDro , Cochrane and CINAHL ( January 2002 - April 2012 ) . STUDY SELECTION English- language studies , with adult patients and number of subjects not under 11 , diagnosed with episodic tension-type headache ( ETTH ) and chronic tension-type headache ( CTTH ) were included . DATA EXTRACTION Initial search was undertaken with the words Effectiveness , Tension-type headache , and Manual therapy ( 39 studies ) . In addition , a search which included terms related to treatments such as physiotherapy , physical therapy , spinal manipulation was performed ( 25 studies ) . RESULTS From the two search es 9 studies met the inclusion criteria and were analysed finding statistically significant results : 1 ) myofascial release , cervical traction , neck muscles trigger points in cervical thoracic muscles and stretching ; 2 ) Superficial heat and massage , connective tissue manipulation and vertebral Cyriax mobilization ; 3 ) cervical or thoracic spinal manipulation and cervical chin-occipital manual traction ; 4 ) massage , progressive relaxation and gentle stretching , program of active exercises of shoulder , neck and pericranial muscles ; 5 ) massage , passive rhythmic mobilization techniques , cervical , thoracic and lumbopelvic postural correction and cranio-cervical exercises ; 6 ) progressive muscular relaxation combined with joint mobilization , functional , muscle energy , and strain/counterstrain techniques , and cranial osteopathic treatment ; 7 ) massage focused on relieving myofascial trigger point activity ; 8) pressure release and muscle energy in suboccipital muscles ; 9 ) combination of mobilizations of the cervical and thoracic spine , exercises and postural correction . All studies used a combination of different techniques and none analyzed treatments separately , also all the studies have assessed aspects related to TTH beyond frequency and intensity of pain . CONCLUSIONS The findings from these studies showed evidence that physiotherapy with articulatory MT , combined with cervical muscle stretching and massage are effective for this disease in different aspects related with TTH . No evidence was found of the effectiveness of the techniques applied separately In a r and omized controlled clinical trial , 75 subjects fulfilling the IHS criteria for episodic tension-type headache were treated for four weeks . One group received spinal manipulation plus soft tissue therapy in the neck , the other received soft tissue therapy plus low-power laser therapy to the same region . In the three month follow-up period both groups showed significant improvement , but there were no differences between the groups . Thus , spinal manipulation had no effect on episodic tension-type headache , in contrast to the significant effect of spinal manipulation which has previously been demonstrated in cases of cervicogenic headache . These two headaches should therefore be diagnostically differentiated in the future Study Design . A multicenter , r and omized controlled trial with unblinded treatment and blinded outcome assessment was conducted . The treatment period was 6 weeks with follow-up assessment after treatment , then at 3 , 6 , and 12 months . Objectives . To determine the effectiveness of manipulative therapy and a low-load exercise program for cervicogenic headache when used alone and in combination , as compared with a control group . Summary of Background Data . Headaches arising from cervical musculoskeletal disorders are common . Conservative therapies are recommended as the first treatment of choice . Evidence for the effectiveness of manipulative therapy is inconclusive and available only for the short term . There is no evidence for exercise , and no study has investigated the effect of combined therapies for cervicogenic headache . Methods . In this study , 200 participants who met the diagnostic criteria for cervicogenic headache were r and omized into four groups : manipulative therapy group , exercise therapy group , combined therapy group , and a control group . The primary outcome was a change in headache frequency . Other outcomes included changes in headache intensity and duration , the Northwick Park Neck Pain Index , medication intake , and patient satisfaction . Physical outcomes included pain on neck movement , upper cervical joint tenderness , a craniocervical flexion muscle test , and a photographic measure of posture . Results . There were no differences in headache-related and demographic characteristics between the groups at baseline . The loss to follow-up evaluation was 3.5 % . At the 12-month follow-up assessment , both manipulative therapy and specific exercise had significantly reduced headache frequency and intensity , and the neck pain and effects were maintained ( P < 0.05 for all ) . The combined therapies was not significantly superior to either therapy alone , but 10 % more patients gained relief with the combination . Effect sizes were at least moderate and clinical ly relevant . Conclusion . Manipulative therapy and exercise can reduce the symptoms of cervicogenic headache , and the effects are maintained A single blind , age and gender matched , comparative measurement study was design ed to assess  active range of cervical motion  and  passive range of rotation in cervical flexion  in asymptomatic and cervicogenic headache subjects . Both procedures are commonly used in clinical practice to evaluate patients with cervicogenic headache .  We studied 20 women and eight men with side dominant cervicogenic headache ( mean age 43.3 years ) matched with 28 asymptomatic subjects . Two experienced manipulative therapists , who were blind to each other 's measurement , noted active ranges of cervical motion  and passive cervical rotation  performed in the flexion-rotation test using the Cervical Range of Motion Device .  Headache severity was assessed by a question naire . Additionally , one therapist prior to neck motion assessment determined the dominant symptomatic cervical motion segment . Active cervical motion in each direction was identical between the cervicogenic and control groups . In contrast , average rotation in flexion was 44 degrees to each side in the asymptomatic group and 28 degrees towards the headache side in the symptomatic group . C1 - 2 was deemed to be the dominant segmental level of headache origin in 24 of 28 subjects . In those 24 subjects range of rotation during the flexion-rotation test was inversely correlated to headache severity Eighty-eight children and adolescents were prospect ively evaluated at eight specialty clinics comparing the diagnostic criteria of the International Headache Society ( IHS ) and the proposed revised ( IHS-R ) classification to the clinical diagnosis . The proposed revisions to the IHS classification for pediatric migraine include : duration -1 hour to 48 hours ; location -- bifrontal/bitemporal or unilateral ; and symptoms -- to include photophobia or phonophobia . A comparison of the diagnostic rates of pediatric migraine with and without aura of the total sample revealed IHS ( 66 % ) versus IHS-R ( 93 % ) and comparison of a subset of those patients less than 12 years of age ( n = 39 ) revealed IHS ( 49 % ) versus IHS-R ( 87 % ) . Significant improvement in the diagnostic sensitivity of migraine in the pediatric population was obtained by specific modifications to the IHS criteria pertaining to duration , location , and the symptoms of photophobia and phonophobia in an ongoing multicenter prospect i ve study . These revisions may help to form the basis for future research guidelines and for further modifications to improve the diagnostic sensitivity of pediatric migraine maintaining the IHS model STUDY DESIGN R and omized , double-blind , placebo controlled trial . OBJECTIVES To determine the effect of a C1-C2 self-sustained natural apophyseal glide ( SNAG ) on cervicogenic headache . BACKGROUND Cervicogenic headache is a common condition causing significant disability . Recent studies have shown a high incidence of C1-C2 dysfunction , evaluated by the flexion-rotation test ( FRT ) , in subjects with cervicogenic headache . To manage this dysfunction , Mulligan has described a C1-C2 self-SNAG , though no studies have investigated the efficacy of this intervention approach . METHODS A sample of 32 subjects ( mean _ SD age , 36 + /- 3 years ) with cervicogenic headache and FRT limitation were r and omized into a C1-C2 self-SNAG or placebo group . After an initial instruction and practice visit in the clinic , interventions consisted of exercises applied independently by the subject twice daily at home on a continual basis . FRT range was measured twice , before and immediately after the instruction and practice visit . Headache symptoms were determined by a headache index over time , assessed by question naire preintervention , at 4 weeks postintervention , and at 12 months postintervention . RESULTS No differences were found in baseline measures between groups . Immediately after the initial instruction and practice visit performed with the supervision of the therapist , FRT range increased by 15 degrees ( SD , 9 ) for the C1-C2 self-SNAG group ( P < .001 ) , which was significantly more than 5 degrees ( SD , 5 ) for the placebo intervention ( P < .001 ) . There was also a significant interaction for the variable headache index between group and time ( P < .001 ) , indicating that group difference was dependent on time . There was no difference in headache index scores at baseline between groups . Headache index scores were substantially less in the C1-C2 self-SNAG group ( mean + /- SD points at 4 weeks , 31 + /- 9 ; mean + /- SD points at 12 months , 24 + /- 9 ) compared to the placebo group ( mean + /- SD points at 4 weeks , 51 + /- 15 ; mean + /- SD points at 12 months , 44 + /- 13 ) at 4 weeks ( P < .001 ) and 12 months ( P < .001 ) , with an overall ( + /-SD ) reduction of 54 % ( + /-17 % ) for the individuals in the C1-C2 self-SNAG group . CONCLUSIONS These results provide evidence for the efficacy of the C1-C2 self-SNAG technique in the management of individuals with cervicogenic headache Background This systematic review up date d and extended the " UK evidence report " by Bronfort et al. ( Chiropr Osteopath 18:3 , 2010 ) with respect to conditions/ interventions that received an ' inconclusive ’ or ' negative ’ evidence rating or were not covered in the report . Methods A literature search of more than 10 general medical and specialised data bases was conducted in August 2011 and up date d in March 2013 . Systematic review s , primary comparative studies and qualitative studies of patients with musculoskeletal or non-musculoskeletal conditions treated with manual therapy and reporting clinical outcomes were included . Study quality was assessed using st and ardised instruments , studies were summarised , and the results were compared against the evidence ratings of Bronfort . These were either confirmed , up date d , or new categories not assessed by Bronfort were added . Results 25,539 records were found ; 178 new and additional studies were identified , of which 72 were systematic review s , 96 were r and omised controlled trials , and 10 were non-r and omised primary studies . Most ' inconclusive ’ or ' moderate ’ evidence ratings of the UK evidence report were confirmed . Evidence ratings changed in a positive direction from inconclusive to moderate evidence ratings in only three cases ( manipulation/mobilisation [ with exercise ] for rotator cuff disorder ; spinal mobilisation for cervicogenic headache ; and mobilisation for miscellaneous headache ) . In addition , evidence was identified on a large number of non-musculoskeletal conditions not previously considered ; most of this evidence was rated as inconclusive . Conclusions Overall , there was limited high quality evidence for the effectiveness of manual therapy . Most review ed evidence was of low to moderate quality and inconsistent due to substantial method ological and clinical diversity . Areas requiring further research are highlighted OBJECTIVE The purpose of this study was to compare the acute effects of superficial and deep dry needling into trigger points of suboccipital and upper trapezius muscles in patients with cervicogenic headache . METHODS Thirty participants ( 8 men , 22 women ) aged 19 - 60 years ( mean age ± SD , 39 ± 10 y ) with a clinical diagnosis of cervicogenic headache were r and omly divided into superficial and deep groups . Headache index , trigger points tenderness , cervical range of motion ( CROM ) , functional rating index was assessed at baseline , immediate and 1 week after the treatment . RESULTS Two approaches of dry needling showed reduction in headache index and trigger points tenderness .  Deep dry needling showed greater improvement of cervical range of motion ( p < 0.001 ) and functional rating index ( p < 0.01 ) . CONCLUSION The application of dry needling into trigger points of suboccipital and upper trapezius muscles induces significant improvement of headache index , trigger points tenderness , functional rating index and range of motion in patients with cervicogenic headache . Deep dry needling had greater effects on CROM and function OBJECTIVE To compare the effects of manipulation treatment and transcutaneous electrical nerve stimulation ( TENS ) on patients with cervicogenic headache . METHODS Seventy patients with cervicogenic headache were r and omly allocated to receive manipulation treatment and TENS treatment , which were given every other day respectively for total 40 days . The headache degree ( numeric rating scale , NRS ) , frequency , lasting time and the range of motion ( ROM ) of the cervical spine 2 weeks before treatment and 4 weeks after treatment , were compared . RESULTS Before treatment , there were no significant differences in the headache NRS scores , frequency , lasting time and the ROM scores between the two groups ( P>0.05 ) . After treatment , the headache NRS score , frequency , lasting time in the manipulation group decreased significantly ( P<0.01 ) , while in the TENS group just the headache NRS score decreased significantly ( P<0.05 ) . The ROM scores in both groups showed no significant changes ( P>0.05 ) . The response rate of manipulation treatment is 94.5 % , significantly higher than 64.5 % of TENS treatment ( P<0.05 ) . CONCLUSION The manipulation treatment is an effective method for patients with cervicogenic headache OBJECTIVE This article evaluates reliability and diagnostic validity of the cervical flexion-rotation test ( FRT ) to discriminate subjects with headache because of C1/2 dysfunction . In addition , this study evaluates agreement between experienced and inexperienced examiners . METHODS These were 2 single blind comparative measurement study design s. In study 1 , 2 experienced blinded examiners evaluated the FRT in 10 asymptomatic controls , 20 subjects with cervicogenic headache ( CeH ) where C1/2 was the primary dysfunctional level , and 10 subjects with CeH but without C1/2 as the primary dysfunctional level . In study 2 , 2 inexperienced and 1 experienced blinded examiners  evaluated the  FRT  in 12 subjects with CeH and 12 asymptomatic controls . Examiners were required to state whether the FRT was positive and also to determine range of rotation using a goniometer . An analysis of variance with planned orthogonal comparison , single measure intraclass correlation coefficient ( 2,1 ) , and Bl and -Altman plot were used to analyze FRT range of rotation between the examiners . Sensitivity , specificity , and examiner agreement for test interpretation were analyzed using cross tabulation and kappa . RESULTS In study 1 , sensitivity and specificity of the FRT was 90 % and 88 % with 92 % agreement for experienced examiners ( P < .001 ) . Overall diagnostic accuracy was 89 % ( P < .001 ) and kappa = 0.85 . In study 2 , for inexperienced examiners , FRT mobility was significantly greater than for experienced examiners , but sensitivity , specificity , agreement , and kappa values were all within clinical ly acceptable levels . CONCLUSIONS The FRT can be used accurately and reliably by inexperienced examiners and may be a useful aid in CeH evaluation
Conclusions : Despite low levels of evidence , manual examination of the cervical spine appears to aid the diagnostic process related to CGH and can be implemented by both experienced and inexperienced examiners
Objective : To evaluate the diagnostic validity of manual examination techniques used to diagnose  cervicogenic headache ( CGH ) .
Background : Cervicogenic headache is a specific type of headache that originates from the cervical spine and is typically chronic in nature .
Diagnostic criteria for CGH have been established by the International Headache Society ( IHS ) and are cited extensively in the literature .
Diagnosis of CGH through manual examination is a more recent practice .
To our knowledge , no systematic review of manual diagnosis of CGH has been performed .