Effects of Cervical Manual Therapy on Cervicogenic Headache

The effects of cervical spine manual therapy, including mobilization and manipulation, on cervical spine range of motion, joint position sense, and balance is unknown among individuals with cervicogenic headache. Previous studies have indicated improved frequency of headache, decreased perceived disability, and demonstrated improved neuromuscular function following upper cervical manipulation. Other authors report improved cervical spine range of motion, joint position sense, and balance following cervical spine manual therapy for individuals with cervicogenic dizziness. Through an experimental design, this study aims to determine the effects of cervical spine manual therapy on variables such as cervical spine range motion, joint position sense, and balance among individuals with headache of a cervical spine origin.

A convenience sample will be utilized to obtain subjects who suffer from cervicogenic headaches, as defined by the International Headache Classification. Subjects will be given an online medical screening questionnaire to differentiate and screen additional types of headache symptoms (migraine, cluster, tension-type, for example) and identify possible contraindications for manual therapy treatment techniques and exclude individuals if necessary. Subjects will be randomized into one of three groups (upper cervical mobilization, upper cervical manipulation, or control) and be tested with the Cervical Flexion Rotation Test, Joint Position Error testing, and sensorimotor balance testing via NeuroCom Balance Master. Subjects with cervicogenic headaches will receive their assigned intervention and dependent variables will be reassessed immediately, as well as 4-weeks after initial intervention. Individuals in either intervention group (mobilization or manipulation) will also complete a specific home-exercise program, which has been reported to improve upper cervical range of motion, to the C1/2 segment.

Eligibility Criteria:
Inclusion Criteria:

* Over the age of 18
* Signs and symptoms consistent with cervicogenic headache (including unilateral headache, headache that improves or resolves as cervical disorder or lesion improves or resolves, headache that is made worse with cervical movement or sustained painful neck positions, reduced cervical range of motion
* Headache frequency of at least once a week for 3 months

Exclusion Criteria:

* Bilateral headaches
* Non-musculoskeletal red flags
* Two or more positive neurologic signs indicative of nerve root compression
* Diagnosed with cervical spinal stenosis
* Bilateral upper extremity symptoms
* Symptoms indicative of central nervous system lesion
* History of whiplash injury within the previous 6 weeks
* Prior head or neck surgery
* Has received treatment for head or neck pain from any practitioner within the previous month
* Has received physical therapy or chiropractic treatment for head or neck pain within the previous 3 months
* Having a known vestibular or balance dysfunction (BPPV, unilateral vestibular loss, etc.)
* Other headaches that do not originate from the cervical spine, primarily migraine, vascular (cervical artery dysfunction), and tension-type headache.