Treatment of patients with cervicogenic headache
Cervicogenic headache (CH) can be recognized as a headache caused by a disorder of the cervical spine and its components. Unilateral headache, neck pain including limited range of motion, elicitation of pain, with external pressure over the ipsilateral upper neck and sustained neck movements are dominant features of CH.
Treatments such as spinal manipulation, mobilization and exercise in management of CH are frequently performed, however it is unclear what is the most effective treatment. The current study compared spinal manipulation with mobilization and exercises, and concluded that spinal manipulation was more effective.
110 patients suffering from cervicogenic headache were randomly allocated to two groups, receiving either manipulation of the cervical and thoracic spine, or mobilisation and exercises. Outcome measures included an NPRS, the NDI (Neck Disability Index), the GRC (Global Rating of Change), headache frequency, headache duration and medication intake.
The selection of the segments to treat in the manipulation group was left to the discretion of the treating therapist. The same accounted for the selection of segments to treat in the mobilization/ exercise group, except that therapists were instructed to mobilize one cervical segment and one thoracic segment or rib on each treatment session to avoid a contact or attention effect.
A significant difference was present between the manipulation group and the mobilisation/ exercise group. Statistical analyses show that patients in the upper cervical and upper thoracic manipulation group experienced less frequent headaches.
It has been suggested that high-velocity displacement of vertebrae with impulse durations of less than 200 ms may alter afferent discharge rates by stimulating mechanoreceptors and proprioceptors, thereby changing alpha motorneuron excitability levels and subsequent muscle activity. On top of that, there also might be a change of stimulation of receptors in the deep paraspinal muscles. More research is necessary in order to define the effectiveness of different types and dosages of manipulation.
> From: Dunning et al., BMC Musculoskelet Disord 17 (2016) 64(Epub ahead of print). All rights reserved to The Author(s). Click here for the Pubmed summary.