Thoracic Spine Thrust Manipulation for Cervicogenic Headaches: A Randomized Clinical Trial
Condition: Headache Disorders, Secondary
MeSH terms: Post-Traumatic Headache; Headache Disorders; Headache Disorders, Secondary; Headache
Study type: Interventional

Summary: 
      Headaches have been listed as 1 of the 10 most disabling conditions worldwide. (Stovner et
      al., 2007) and cervicogenic headaches (CeHs) comprise 15% of the individuals with these
      complaints. (Nillsson, 1995); (Fernandez de-las-penas et al., 2005) The current best approach
      to the conservative care of this condition has yet to be determined. The primary aim of this
      study is to determine whether individuals with CeHs will respond to a program of thoracic
      spine thrust manipulation in isolation. This may further the current body of evidence by
      offering an alternative, potentially safer approach to the conservative care of individuals
      with this condition. Additionally, results of this study may serve to drive a larger scale
      Randomized Clinical Trial (RCT) by offering information regarding feasibility of recruitment
      of individuals with chronic CeHs as well as timing and dosing of the intervention.
    

Detailed description: 
      Headaches have been listed as 1 of the 10 most disabling conditions worldwide. (Stovner et
      al., 2007) and cervicogenic headaches (CeHs) comprise 15% of the individuals with these
      complaints. (Nillsson, 1995); (Fernandez de-las-penas et al., 2005) The current best approach
      to the conservative care of this condition has yet to be determined. Evidence suggests that
      manipulative therapy aimed at the cervical spine in combination with exercise is helpful in
      alleviating these symptoms. (Jull et al., 2002) The risk of injury from cervical spine
      manipulative techniques has been documented to be remote (Haldeman et al., 2002; DiFabio
      1999), however the potential consequences can be severe. Therefore with inherently lower
      risks, thoracic spine manipulations may be a suitable alternative as the evidence is
      accumulating for its influence on the cervical spine. (Mintken et al., 2010; Boyles et al.,
      2009; Cleland et al., 2005 & 2007 A & B, 2010; Flynn et al., 2001; Fernandez-de-las-penas et
      al., 2004; Piva et al., 2000; Browder et al., 2004) The primary aim of this study is to
      determine whether individuals with CeHs will respond to a program of thoracic spine thrust
      manipulation in isolation. This may further the current body of evidence by offering an
      alternative, potentially safer approach to the conservative care of individuals with this
      condition. Additionally, results of this study may serve to drive a larger scale RCT by
      offering information regarding feasibility of recruitment of individuals with chronic CeHs as
      well as timing and dosing of the intervention.
    

Intervention name(s): Thoracic manipulation (Manipulation Group); Thoracic Manipulation (Control wait-list)
Intervention type(s): Procedure; Procedure
Intervention description(s): Manipulation techniques will include: CT junction manipulation seated and supine, upper thoracic manipulation, middle thoracic spine manipulation in seated and supine, middle thoracic spine manipulation in prone, thoracic active range of motion exercise and instruction to maintain usual activity level within the limits of pain.; Manipulation techniques will include: CT junction manipulation seated and supine, upper thoracic manipulation, middle thoracic spine manipulation in seated and supine, middle thoracic spine manipulation in prone, thoracic active range of motion exercise and instruction to maintain usual activity level within the limits of pain.
Other intervention name(s): Manual therapy to thoracic spine; Manual therapy to thoracic spine
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Treatment