Manual Therapy and Exercise in Patients With Cervicogenic Headache

Patients with cervicogenic headache will be randomized to receive 6-8 sessions over 2-4 weeks of either: (1) upper cervical and upper thoracic thrust manipulation, or (2) upper cervical and upper thoracic non-thrust mobilization and range of motion, strength and postural exercises.

Inclusion criteria

• Diagnosis of cervicogenic headache as defined by Cervicogenic Headache International Study Group criteria
• Headache frequency of at least one per week for a minimum of 3 months
• Minimum pain score (NPRS) of 2/10 and minimum disability score (NDI) of 10/50

Exclusion criteria

• Bilateral headaches
• Presence of any of the following atherosclerotic risk factors: hypertension, diabetes, heart disease, stroke, transient ischemic attack, peripheral vascular disease, smoking, hypercholesterolemia or hyperlipidemia
• Red flags noted in the patient's Neck Medical Screening Questionnaire (i.e. tumor, fracture, metabolic diseases, RA, osteoporosis, prolonged history of steroid use, etc.)
• History of whiplash injury within the last 6 weeks
• Diagnosis of cervical spinal stenosis
• Bilateral upper extremity symptoms
• Evidence of central nervous system involvement, to include hyperreflexia, sensory disturbances in the hand, intrinsic muscle wasting of the hands, unsteadiness during walking, nystagmus, loss of visual acuity, impaired sensation of the face, altered taste, the presence of pathological reflexes (i.e. positive Hoffman's and/or Babinski reflexes)
• Two or more positive neurologic signs consistent with nerve root compression, including any two of the following:

• Muscle weakness involving a major muscle group of the upper extremity.
• Diminished upper extremity deep tendon reflex of the biceps, brachioradialis, triceps or superficial flexors
• Diminished or absent sensation to pinprick in any upper extremity dermatome
• Prior surgery to the neck or thoracic spine.
• Involvement in litigation or worker's compensation regarding their neck pain and/or headaches.
• Physical therapy or chiropractic treatment for neck pain or headache in the 3 months before baseline examination.
• Any condition that might contraindicate spinal manipulative therapy