By some estimates, up to 20% of headaches are caused by a disorder of the cervical spine and its components (bone, disk, and soft tissue) usually accompanied by neck pain. It’s very common for patients with a cervicogenic headache to seek and receive manual therapies—like spinal manipulation and mobilization—from chiropractic care. Spinal manipulation is characterized by a high-velocity, low amplitude (HVLA) thrust accompanied by joint cavitation (release of gas causing a cracking sound) and spinal mobilization consists of slow, rhythmic, oscillating movements. Which approach is the most effective for this cervicogenic headaches?

In a 2016 randomized controlled study, researchers compared the effect of upper cervical and upper thoracic manipulation against mobilization plus exercises in a group of 110 patients with cervicogenic headache. Participants received six to eight treatments spread over four weeks, and researchers assessed headache intensity (0-100 scale), headache duration, disability, medication intake, and overall improvement at baseline, after one week of treatment, after four weeks of treatment, and after two months following the conclusion of care.

The data show that patients in the manipulation group experienced less frequent headaches and shorter headache duration at all follow-up points, greater overall improvement at the one-week and four-week time points, and greater reductions in headache intensity and disability at the final follow-up.  Patients in each group reported improvements compared with their baseline readings, which suggests that both manual therapies can benefit the cervicogenic headache patient. It’s very common for chiropractors to incorporate both approaches into a treatment plan, depending on the patient’s unique case, as well as their own training and clinical preferences. This multimodal approach may also include other manual therapies, traction, physical therapy modalities, nutrition recommendations, and specific exercises targeting the neck and upper back.

It’s also important to note that while this study focused on cervicogenic headache patients, dysfunction in the cervical spine and associated tissues may also play some role in other forms of headache, such as migraines. In fact, studies have demonstrated that migraineurs often have an increased number of trigger points in their cervical muscles and that treatment aimed at reducing these trigger points is associated with reduced headache frequency and intensity.

For patients suffering from headaches of any type, it may be prudent to consult with a doctor of chiropractic to assess the cervical spine for any issues that may contribute to their headaches.

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