Effects of Manual Therapy on the Upper Cervical Spine Combined With Exercise vs Isolated Exercise in Patients With Cervicogenic Headache.

Short- and Mid-Term Effects of Manual Therapy on the Upper Cervical Spine Combined With Exercise vs Isolated Exercise in Patients With Cervicogenic Headache. A Randomized Controlled Trial.

Cervicogenic headache is defined as unilateral headache associated with neck pain. Effect of manual translatoric therapy of the upper cervical spine associated with cervical exercises in these patients is currently unknown. Our aim was to determine if adding manual therapy to an exercise and home-exercise program improved effects on symptoms and function in short- and mid-term in patients with cervicogenic headache.

A randomized controlled study will be conducted with 40 subjects with cervicogenic headache. Each group will receive four 20-minute sessions weekly and a home-exercise program. Upper cervical flexion, flexion-rotation test, Impact Headache Test-6 (HIT-6), headache intensity, craniocervical flexion test, pain pressure thresholds and Global Rating of Change (GROC)-Scale will be assessed at end of the intervention, at 3- and at 6-month follow-ups.

Inclusion Criteria:

• Diagnosis of cervicogenic headache according to Sjaastad et al. Subjects will have to fulfill both parts I and III of the major criteria for diagnosis (pain aggravated by neck movement, sustained position or external pressure, restricted cervical range of motion, and unilateral pain starting in the neck and radiating to the frontotemporal region)
• Hypomobility in one or more segments of C0-1, C1-2, C2-3 through manual evaluation.
• A positive result in the flexion-rotation test.
• A failure to pass stage 2 (24 mmHg) of the craniocervical flexion test.
• Be at least 18 years old.
• Have signed the informed consent.

Exclusion Criteria:

• Contraindications for manual therapy or exercise.
• Participation in exercise or manual therapy programs in the last three months.
• Inability to maintain supine position.
• The use of pacemakers (the magnets in the CROM device could alter their signal).
• Inability to perform the flexion-rotation test.
• Language difficulties.
• Pending litigation or lawsuits.