Effectiveness of Manual Therapy for Cervicogenic Headache
- Dr. Shawn Thistle
Patients often consult chiropractors with headaches and in many cases, a reasonable trial of chiropractic care is warranted once red flags have been ruled out and a diagnosis has been reached. Cervicogenic headaches are relatively common, but in my experience can overlap with other headache phenotypes, such as tension headaches. When a patient presents with the characteristic headache pain pattern and you discover cervical joint issues, spinal manipulation (SMT) is the treatment of choice. This week’s Review brings us up to date on what the evidence tells us about the effectiveness of SMT and other manual therapies for cervicogenic headache…
Cervicogenic headache (CGH) is a secondary headache which emanates from bone, disc, and/or soft tissue(s) in the cervical spine. The pain follows a topographic course, typically extending from the cervical region to the oculo-fronto-temporal area and it is generally worsened by sustained neck positions and/or pressure over the occipital area. From 2.2% to 4.1% of the general population suffer from CGH and the condition affects women 4 times more than in men.
Established diagnostic criteria for CGH are: 1) clinical and/or imaging evidence of a disorder or lesion within the cervical spine or soft tissues of the neck which have been shown to cause headache; and 2) evidence of causation demonstrated by at least 2 of the following: (i) onset of headache in temporal relation to the development of a cervical disorder/lesion, (ii) headache significantly improved along with improvement or resolution of the cervical disorder/lesion, (iii) reduced cervical range of motion and headache is significantly worsened by provocative maneuvers, and/or (iv) headache is eliminated following diagnostic blockade of a cervical structure or its nerve supply.
Conservative interventions, like manual therapy (MT) techniques and exercise, have become preferred treatments and have been shown to provide long-term relief of CGH symptomatology. Nevertheless, there are a variety of MT techniques (including spinal manipulation and mobilization) but no consensus as to which are the most effective. The aim of this study was to investigate the MT methods and techniques that have been evaluated for the treatment of CGH and their effectiveness.
THIS WEEK'S RESEARCH REVIEW: “Effectiveness of Manual Therapy for Cervicogenic Headache”
This paper was published in Headache (2022) and this Review is posted in Recent Reviews, Headache - Cervicogenic and the 2022 Archive.