Mobilization versus massage therapy in the treatment of cervicogenic headache: a clinical study. Physical examination and self-reported pain outcomes from a randomized trial on chronic cervicogenic headache. Dose response and efficacy of spinal manipulation for chronic cervicogenic headache: a pilot randomized controlled trial. Clinical tests of musculoskeletal dysfunction in the diagnosis of cervicogenic headache. Effect of Treatment of Temporomandibular Disorders (TMD) in Patients with Cervicogenic Headache: A Single-Blind, Randomized Controlled Study
BACKGROUND AND OBJECTIVE Cervicogenic headache ( CGH ) is a common problem associated with neck pain . In this study the effect of cervical mobilizations was compared with that of massage therapy in the management of CGH . DESIGN Thirty-six subjects with CGH , r and omly assigned into two groups , participated in the study . The first group was treated with spinal mobilization techniques of the upper cervical spine , while the second group was treated with massage therapy of the neck region . All subjects underwent active neck range of motion , isometric and dynamic strengthening and endurance exercises in two sessions/week for 6 weeks . Pre- and post-treatment outcomes were assessed with means and st and ard error of the means of measured headache pain intensity , frequency and duration of headache attacks as well as via the functional Neck Disability Index ( NDI ) and active neck range of motion . RESULTS The results of the study showed significant improvement in all measured variables in each treatment group . Comparison between the two groups showed significant differences in all measured variables after intervention in favor of mobilization techniques with the exception of the functional NDI . CONCLUSION Upper cervical spine mobilization demonstrated more clinical benefits than massage therapy with regard to headache pain parameters and neck mobility for CGH subjects OBJECTIVE Objective clinical measures for use as surrogate markers of cervicogenic headache ( CGH ) pain have not been established . In this analysis , we investigate relationships between objective physical examination ( PE ) measures with self-reported CGH outcomes . METHODS This is an exploratory analysis of data generated by attention control PE from an open-label r and omized clinical trial . Of 80 subjects , 40 were r and omized to 8 treatments ( spinal manipulative therapy or light massage control ) and 8 PE over 8 weeks . The remaining subjects received no PE . Physical examination included  motion palpation of the cervical and upper thoracic regions , active cervical range of motion ( ROM ) and associated pain , and algometric pain threshold evaluated over articular pillars . Self-reported outcomes included CGH and neck pain and disability , number of CGH headaches , and related disability days . Associations between PE and self-reported outcomes were evaluated using generalized linear models , adjusting for sociodemographic differences and study group . RESULTS At baseline , number of CGH and disability days were strongly associated with cervical active ROM ( P < .001 to .037 ) . Neck pain and disability were strongly associated with ROM-elicited pain ( P < .001 to .035 ) but not later in the study . After the final treatment , pain thresholds were strongly associated with week 12 neck pain and disability and CGH disability and disability days ( P < or = .001 to .048 ) . CONCLUSIONS Cervical ROM was most associated with the baseline headache experience . However , 4 weeks after treatment , algometric pain thresholds were most associated . No one PE measure remained associated with the self-reported headache outcomes over time BACKGROUND CONTEXT Systematic review s of r and omized controlled trials suggest that spinal manipulative therapy ( SMT ) is efficacious for care of cervicogenic headache ( CGH ) . The effect of SMT dose on outcomes has not been studied . PURPOSE To compare the efficacy of two doses of SMT and two doses of light massage ( LM ) for CGH . PATIENT SAMPLE Eighty patients with chronic CGH . MAIN OUTCOME MEASURES Modified Von Korff pain and disability scales for CGH and neck pain ( minimum clinical ly important difference=10 on 100-point scale ) , number of headaches in the last 4 weeks , and medication use . Data were collected every 4 weeks for 24 weeks . The primary outcome was the CGH pain scale . METHODS Participants were r and omized to either 8 or 16 treatment sessions with either SMT or a minimal LM control . Patients were treated once or twice per week for 8 weeks . Adjusted mean differences ( AMD ) between groups were computed using generalized estimating equations for the longitudinal outcomes over all follow-up time points ( profile ) and using regression modeling for individual time points with baseline characteristics as covariates and with imputed missing data . RESULTS For the CGH pain scale , comparisons of 8 and 16 treatment sessions yielded small dose effects : |AMD|</=5.6 . There was an advantage for SMT over the control : AMD=-8.1 ( 95 % confidence interval=-13.3 to -2.8 ) for the profile , -10.3 ( -18.5 to -2.1 ) at 12 weeks , and -9.8 ( -18.7 to -1.0 ) at 24 weeks . For the higher dose patients , the advantage was greater : AMD=-11.9 ( -19.3 to -4.6 ) for the profile , -14.2 ( -25.8 to -2.6 ) at 12 weeks , and -14.4 ( -26.9 to -2.0 ) at 24 weeks . Patients receiving SMT were also more likely to achieve a 50 % improvement in pain scale : adjusted odds ratio=3.6 ( 1.6 to 8.1 ) for the profile , 3.1 ( 0.9 to 9.8 ) at 12 weeks , and 3.1 ( 0.9 to 10.3 ) at 24 weeks . Secondary outcomes showed similar trends favoring SMT . For SMT patients , the mean number of CGH was reduced by half . CONCLUSIONS Clinical ly important differences between SMT and a control intervention were observed favoring SMT . Dose effects tended to be small Persistent intermittent headache is a common disorder and is often accompanied by neck aching or stiffness , which could infer a cervical contribution to headache . However , the incidence of cervicogenic headache is estimated to be 14 - 18 % of all chronic headaches , highlighting the need for clear criterion of cervical musculoskeletal impairment to identify cervicogenic headache sufferers who may benefit from treatments such as manual therapy . This study examined the presence of cervical musculoskeletal impairment in 77 subjects , 27 with cervicogenic headache , 25 with migraine with aura and 25 control subjects . Assessment s included a  photographic measure of posture , range of movement , cervical manual examination , pressure pain thresholds , muscle length , performance in the cranio-cervical flexion test and cervical kinaesthetic sense .  The results indicated that when compared to the migraine with aura and control groups who scored similarly in the tests , the cervicogenic headache group had less range of cervical flexion/extension ( P=0.048 ) and significantly higher incidences of painful upper cervical joint dysfunction assessed by manual examination ( all P<0.05 ) and muscle tightness ( P<0.05 ) . Sternocleidomastoid normalized EMG values were higher in the latter three stages of the cranio-cervical flexion test although they failed to reach significance . There were no between group differences for other measures . A discriminant analysis revealed that manual examination could discriminate the cervicogenic headache group from the other subjects ( migraine with aura and control subjects combined ) with an 80 % sensitivity Abstract The present study was comprised of 43 patients ( 16 men ) with cervicogenic headaches for over three months , diagnosed according to the International Classification of Diagnostic Criteria of Headaches ( ICDH-ll ) . The patients were r and omly assigned to receive either manual therapy for the cervical region ( usual care group ) or additional manual therapy techniques to the temporom and ibular region to additionally influence temporom and ibular disorders ( TMD ) . All patients were assessed prior to treatment , after six sessions of treatment , and at a six-month follow-up . The outcome criteria were : intensity of headaches measured on a colored analog scale , the Neck Disability Index ( Dutch version ) , the Conti Anamnestic Question naire , noise registration at the m and ibular joint using a stethoscope , the Grade d Chronic Pain Status ( Dutch version ) , m and ibular deviation , range of mouth opening , and pressure/pain threshold of the masticatory muscles . The results indicate in the studied sample of cervicogenic headache patients , 44.1 % had TMD . The group that received additional temporom and ibular manual therapy techniques showed significantly decreased headache intensities and increased neck function after the treatment period . These improvements persisted during the treatment-free period ( follow-up ) and were not observed in the usual care group . This trend was also reflected on the question naires and the clinical temporom and ibular signs . Based on these observations , we strongly believe that treatment of the temporom and ibular region has beneficial effects for patients with cervicogenic headaches  , even in the long-term
Conclusions : Despite low levels of evidence , manual examination of the cervical spine appears to aid the diagnostic process related to CGH and can be implemented by both experienced and inexperienced examiners
Objective : To evaluate the diagnostic validity of manual examination techniques used to diagnose  cervicogenic headache ( CGH ) .
Background : Cervicogenic headache is a specific type of headache that originates from the cervical spine and is typically chronic in nature .
Diagnostic criteria for CGH have been established by the International Headache Society ( IHS ) and are cited extensively in the literature .
Diagnosis of CGH through manual examination is a more recent practice .
To our knowledge , no systematic review of manual diagnosis of CGH has been performed .