BACKGROUND AND PURPOSE: Cervicogenic headache (CGH) is a secondary headache characterized by unilateral headache and symptoms and signs of neck involvement. It is often worsened by neck movement, sustained awkward head position or external pressure over the upper cervical or occipital region on the symptomatic side (Chaibi, 2012). The reported prevalence of CGH varies from 13.8% to 17.8% of the headache population in different epidemiological studies (Vavrek, 2010). CGH is difficult to treat because the etiology and pathophysiology are not well understood. Current physical therapy practice relies on a variety of modalities to treat patients with CGH, including spinal manipulative therapy (SMT). The current body of evidence has been aimed at determining the effectiveness of SMT for the management of CGH. The following case study seeks to answer the following PICO question: In adult patients with cervicogenic headache, how effective is cervical manipulation compared to other conservative treatment in controlling incidence, intensity, and duration of cervicogenic headache? CASE DESCRIPTION: This case study looked at a 34-year-old man diagnosed with head injuries and cervicalgia in 2013 with suspected onset 6 months prior from military active duty. Over the past 6 months, the patient had been experiencing sharp, unilateral headaches lasting from hours to days at a time. The patient was referred to physical therapy by his primary care physician for treatment of head injuries 4 (854.00) and cervicalgia (723.1). After physical examination, the physical therapist identified signs and symptoms consistent with cervicogenic headache. The following goals were set for the patient after his initial evaluation: 1. Patient will be independent with cervical exercises and postural correction. 2. Patient will increase pain free cervical AROM to WNLs 3. Patient will increase Patient Specific Functional Scale by 3-point average for sitting, standing, and exercise. Initial score: 3.0 4. Patient will report decreased frequency of headache from 4-5x/week to >1x/week. OUTCOME: The patient was able to meet all the goals except for goal 3, which was 90% met. The patient had good outcomes for decreasing frequency of headache and increasing AROM and functional rating. DISCUSSION: As a whole, the evidence for this PICO question was insufficient to offer evidence-based support for the application of SMT for CGH. Current research lacks methodological quality and fails to sufficiently report adverse events associated with SMT of the cervical spine. This case study was relevant because it showed the significance and importance of using evidence-based practice to guide clinical assessment of CGH and treatment.


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Document Type



headache, cervicogenic headache, spinal manipulative therapy, cervical manipulation, SMT, physical therapy

Available for download on Monday, March 14, 2118