Mobilization Versus Manipulation for the Treatment of Cervicogenic Headaches
Cervicogenic Headache
About this trial
This is an interventional treatment trial for Cervicogenic Headache
Eligibility Criteria
Inclusion Criteria:
- Patient must be English-speaking and have appropriate medical literacy to participate in the study
- The physical examination must yield a reproducible familiar/concordant neck, head, jaw symptom or dysfunction
- Pain reports of at least 2/10 for a headache or neck pain intensity
- Neck Disability reports of at least a 20% or greater impact
- Patients that report having at least two headaches within one month
Exclusion Criteria:
- The presence of any know red flags (i.e., tumor, metabolic diseases, RA, osteoporosis, prolonged history of steroid use, etc.)
- Patients who exhibit any red flag symptoms: positive upper or lower motor neuron testing. Signs or symptoms consistent cervical myelopathy or radiculopathy with nerve root compression (muscle weakness involving a major muscle group of the upper extremity, diminished upper extremity muscle stretch reflex, or diminished or absent sensation to pinprick in any upper extremity dermatome
- Patients who exhibit any red flag symptoms of cervical instability tests, or have a positive VBI or CAD testing, showing signs of the 5 D's (dizziness, drop attacks, dysarthria, dysphagia, diplopia) or patient who have signs of 3 N's (Nystagmus, nausea, other neurological symptoms).
- Prior surgery to the cervical spine or head (including cerebral shunts)
- Women who are pregnant in their third trimester
Sites / Locations
- Pain Relief and Physical Therapy
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Cervical Thrust Mobilizations
Cervical Non-Thrust Mobilizations
Once therapist has assessed subject and has found the patients most comparable sign they will be performing a high velocity thrust at the end of the patients available range, as described by Maitland's Approach. The thrust will be performed only once. The therapist will perform either a localized cervical rotation thrust which primary movement is rotation or a longitudinal cephalad C1 and C2 thrust, both targeting the upper cervical spine.
Therapists will perform unilateral posterior to anterior mobilization (UPA) or central posterior to anterior (CPA) mobilizations grades I-IV as described above by Maitland concepts at levels C0-C3 which reproduce the patient's most comparable sign. Therapists will be instructed to perform 3x 30 second bouts of mobilizations at that level.