Mobilization Versus Manipulation for the Treatment of Cervicogenic Headaches
Mobilization Versus Manipulation for the Treatment of Cervicogenic Headaches
There is currently a gap within the literature as to the effects of a thrust versus
 non-thrust mobilizations techniques specifically to the upper cervical spine C0-C3 along with
 home exercise program to help reduce frequency and intensity of cervicogenic headaches.
 Therefore, the purpose of this study is to examine the effectiveness of in treating headaches
 using non-thrust or thrust mobilizations in addition to postural corrective exercises on
 patient outcomes measures.
Cervicogenic headaches are classified as secondary headaches and typically rise from a
 musculoskeletal, cervical spine, disc, or soft tissue elements and are accompanied by neck
 pain. Dominant features of cervicogenic headache include unilateral head pain, external
 pressure over the ipsilateral upper neck, limited cervical range of motion, and trigger
 attacks by various neck motions. Cervicogenic headaches typically originate from the
 atlanto-occipital and upper 3 segments of the cervical spine and can radiate to the head or
 face region. Physical therapist have for some time been treating cervicogenic headaches with
 a variety of different treatment techniques ranging from conservative therapy, passive and
 active range of motion, stretching for cervical, strengthening exercises for the upper
 extremity, and manual therapy. However, little is known about the effects of thrust and
 non-thrust manipulative physical therapy treatments along with exercises to help reduce
 cervicogenic headaches. The purpose of this study is to assess the effectiveness of physical
 therapy in treating headaches using non-thrust to the upper 3 segments of the cervical spine
 or thrust mobilizations to the upper 3 segments, plus the addition of postural corrective
 exercises in treating cervicogenic headaches.
Inclusion Criteria:

 1. Patient must be English-speaking and have appropriate medical literacy to participate
 in the study

 2. The physical examination must yield a reproducible familiar/concordant neck, head, jaw
 symptom or dysfunction

 3. Pain reports of at least 2/10 for a headache or neck pain intensity

 4. Neck Disability reports of at least a 20% or greater impact

 5. Patients that report having at least two headaches within one month

 Exclusion Criteria:

 1. The presence of any know red flags (i.e., tumor, metabolic diseases, RA, osteoporosis,
 prolonged history of steroid use, etc.)

 2. Patients who exhibit any red flag symptoms: positive upper or lower motor neuron
 testing. Signs or symptoms consistent cervical myelopathy or radiculopathy with nerve
 root compression (muscle weakness involving a major muscle group of the upper
 extremity, diminished upper extremity muscle stretch reflex, or diminished or absent
 sensation to pinprick in any upper extremity dermatome

 3. Patients who exhibit any red flag symptoms of cervical instability tests, or have a
 positive VBI or CAD testing, showing signs of the 5 D's (dizziness, drop attacks,
 dysarthria, dysphagia, diplopia) or patient who have signs of 3 N's (Nystagmus,
 nausea, other neurological symptoms).

 4. Prior surgery to the cervical spine or head (including cerebral shunts)

 5. Women who are pregnant in their third trimester