Clinical trial NCT03385889: Effects of Cervical Manual Therapy on Cervicogenic Headache
Official title: Effects of Cervical Spine Manual Therapy on Range of Motion, Joint Position Sense, and Balance in Participants With Cervicogenic Headache
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Unilateral Headache
Musculoskeletal Neck Pain
Keywords: Cervicogenic Headache
Manual Therapy
Joint Position Sense
Balance
Lead sponsor: Shenandoah University
Sponsor class: OTHER
First posted: 2017-12-29
Enrollment: 35
Sex: ALL
Minimum age (years): 18
Maximum age (years): 70
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Pre-test, Post-test, control group design 3 groups - mobilization, manipulation, control
Primary purpose: TREATMENT

Brief summary: 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.

Detailed description: 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.

Primary outcomes:
measure: Change in Cervical Flexion Rotation Test (CFRT)
timeFrame: Post-Intervention, 4-weeks
Secondary outcomes:
measure: Change in Joint Position Error
timeFrame: Post-Intervention, 4-weeks
measure: Change in Balance as measured by NeuroCom Balance Master
timeFrame: Post-Intervention, 4-weeks
Other outcomes:
Locations:
city: Winchester
country: United States
facility: Shenandoah University
state: Virginia
Study officials:
affiliation: Shenandoah University
name: Karen Abraham, PhD, PT
role: STUDY_DIRECTOR
References:
citation: Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013 Jul;33(9):629-808. doi: 10.1177/0333102413485658. No abstract available.
citation: Dunning JR, Butts R, Mourad F, Young I, Fernandez-de-Las Penas C, Hagins M, Stanislawski T, Donley J, Buck D, Hooks TR, Cleland JA. Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC Musculoskelet Disord. 2016 Feb 6;17:64. doi: 10.1186/s12891-016-0912-3.
citation: Reid SA, Callister R, Katekar MG, Rivett DA. Effects of cervical spine manual therapy on range of motion, head repositioning, and balance in participants with cervicogenic dizziness: a randomized controlled trial. Arch Phys Med Rehabil. 2014 Sep;95(9):1603-12. doi: 10.1016/j.apmr.2014.04.009. Epub 2014 May 2.
citation: Kristjansson E, Treleaven J. Sensorimotor function and dizziness in neck pain: implications for assessment and management. J Orthop Sports Phys Ther. 2009 May;39(5):364-77. doi: 10.2519/jospt.2009.2834.
citation: de Vries J, Ischebeck BK, Voogt LP, van der Geest JN, Janssen M, Frens MA, Kleinrensink GJ. Joint position sense error in people with neck pain: A systematic review. Man Ther. 2015 Dec;20(6):736-44. doi: 10.1016/j.math.2015.04.015. Epub 2015 May 2.