Cervicogenic headache (headache resulting from problems in the neck) is recognized by the International Headache Society as a distinct headache diagnosis. Cervicogenic headache is described as pain originating in the structures of the cervical spine and characterized as a deep, non-throbbing, recurring headache. Its prevalence has been estimated to be as high as 16% of the population.
Several treatments for cervicogenic headache have been studied, but most have unimpressive results. The exception is cervical manipulation. As two researchers, Haldeman and Dagenais, state in their critical review, “the only treatment approach supported by a reasonable body of controlled trials is cervical manipulation“. Other treatments, such as rehabilitative exercises, may increase the practitioner’s results and should also be considered.
There is a growing body of medical evidence supporting cervical manipulation as an effective intervention in the treatment of cervicogenic headache. A recent review of spinal manipulation in the treatment of chronic headache located 2 randomized controlled trials of cervicogenic headache which found cervical manipulation superior to controls. A second review, specifically addressing cervicogenic headache, found 11 studies, ranging from RCTs to case reports. All reported positive benefits.
In 1995, the first major trial investigating the effectiveness of spinal manipulation compared chiropractic cervical manipulation to low-level laser treatments and deep friction massage in 53 patients. Significant improvement was found for spinal manipulation with a 36% reduction of pain medications use, 69% decrease in headache hours, and 36% decrease in headache intensity among the study population.
The benefit of the frequency of chiropractic manipulation for cervicogenic headache has also been studied. A study of 24 patients found 4 visits per week provided greater relief at 4 weeks than 1 or 3 visits per week.
Some researchers have investigated exercise as a treatment for cervicogenic headache. One study combined exercise with chiropractic spinal manipulation and found the worse the patient’s headache, the more likely they were to improve with a combination of exercise and spinal manipulation. A second study of 200 patients found specific exercise and spinal manipulation were equally effective, but an additional 10% of patients gained relief when the two treatments were combined.
- Rasmussen BK, Jensen R, Schroll M, Olesen J. Epidemiology of headache in a general population–a prevalence study. J Clin Epidemiol 1991; 44(11):1147-1157
- Haldeman S, Dagenais S. Cervicogenic headaches: a critical review. Spine J 2001; 1(1):31-46.
- Haas M, Groupp E, Aickin M, Fairweather A, Ganger B, Attwood M et al. Dose response for chiropractic care of chronic cervicogenic headache and associated neck pain: a randomized pilot study. J Manipulative Physiol Ther 2004; 27(9):547-553.
- Stanton WR, Jull GA. Cervicogenic headache: locus of control and success of treatment. Headache 2003; 43(9):956-961.
- Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine 2002; 27(17):1835-1843.