Cervical Spine Manipulation for Treatment of Headaches

This week from Dr. Cerami and Utah Sports and Wellness

From: Frontiers in Neurology, March 2016

Quick Summary:

The purpose of this article, was to investigate the effects of cervical mobilization and manipulation on pain intensity and headache frequency, compared to traditional physical therapy in patients diagnosed with cervicogenic headache. Officially, cervicogenic headache is a “secondary headache arising from musculoskeletal disorders in the cervical spine and is frequently accompanied by neck pain.” Around 4.1% of the total population have cervicogenic headache, with its accounting for nearly 15% of the headache population. The symptoms of CH may arise from any of the components of the cervical spine, including vertebrae, disks or soft tissue. However, CH pain “most commonly arises from the second and third cervical spine (C2/3) facet joints, followed by C5/6 facet joints.” Cervical mobilization and manipulation are frequently used to treat patients diagnosed with CH, and many studies on the effectiveness of such treatment have found it to be beneficial in reducing headache pain or disability, intensity, frequency and duration. The benefits of manual therapy for CH have also shown to be maintained at long-term follow up assessments.

Abstract:

Cervical mobilization and manipulation are frequently used to treat patients diagnosed with cervicogenic headache (CEH); however, there is conflicting evidence on the efficacy of these manual therapy techniques. The purpose of this review is to investigate the effects of cervical mobilization and manipulation on pain intensity and headache frequency, compared to traditional physical therapy interventions in patients diagnosed with CEH. A total of 66 relevant studies were originally identified through a review of the literature, and the 25 most suitable articles were fully evaluated via a careful review of the text. Ultimately, 10 studies met the inclusion criteria: (1) randomized controlled trial (RCT) or open RCT; the study contained at least two separate groups of subjects that were randomly assigned either to a cervical spine mobilization or manipulation or a group that served as a comparison; (2) subjects must have had a diagnosis of CEH; (3) the treatment group received either spinal mobilization or spinal manipulation, while the control group received another physical therapy intervention or placebo control; and (4) the study included headache pain and frequency as outcome measurements. Seven of the 10 studies had statistically significant findings that subjects who received mobilization or manipulation interventions experienced improved outcomes or reported fewer symptoms than control subjects. These results suggest that mobilization or manipulation of the cervical spine may be beneficial for individuals who suffer from CEH, although heterogeneity of the studies makes it difficult to generalize the findings.

These authors also note:

• Women may be affected with cervicogenic headache four times more frequently than men.
• Patients who have sustained concussion or whiplash injuries with neck pain and limitation of movement often develop cervicogenic headache.
• “The symptoms of cervicogenic headache may arise from any of the components of the cervical spine, including vertebrae, disks, or soft tissue.”
• However, cervicogenic headache pain “most commonly arises from the second and third cervical spine (C2/3) facet joints, followed by C5/6 facet joints.”
• “The afferent fibers of the trigeminal nerve and the upper three cervical nerves converge on second-order sensory neurons at the dorsal horn of the upper cervical spinal cord. This convergence is the anatomical basis for the clinical observation that patients with cervicogenic headache often present with headache at both cervical and trigeminal dermatomes.”
• “Upper cervical spine mobility restriction (hypomobility), cervical pain, and muscle tightness are clinical findings associated with cervicogenic headache during physical examination.”
• The neurophysiological benefit for cervicogenic headache may be that the “afferent input induced by manual therapy may stimulate neural inhibitory pathways in the spinal cord and can also activate descending inhibitory pathways in the lateral periaqueductal gray area of the midbrain.”
• “Cervical mobilization and manipulation are frequently used to treat patients diagnosed with cervicogenic headache.”
• “Many studies on the short-term effectiveness of manual therapy to the cervical spine (mobilization and manipulative therapy) have found it beneficial in reducing headache pain or disability, intensity, frequency, and duration.”
• The benefits of manual therapy for cervicogenic headache have been shown to be maintained at long-term follow-up assessments.
• There is evidence that the lasting benefits of manipulation for cervicogenic headache is enhanced by combining therapeutic exercise.