Effects of Cervical Manual Therapy on Cervicogenic Headache
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.
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.