Does restoration of sagittal cervical alignment improve cervicogenic headache pain and disability: A 2-year pilot randomized controlled trial

Abstract

Background To investigate the feasibility and effect of a multimodal program for improving chronic cervicogenic headache (CGH) via the addition of sagittal cervical spine alignment correction. Design Pilot, parallel-group, randomized controlled trial. Participants 60 patients with CGH, straightening of the cervical lordosis, and forward head posture (FHP) were randomly assigned using permuted-block randomization either to a control (n = 30) or an experimental group (n = 30). Interventions Subjects in both groups received a multimodal program where the denneroll cervical spine extension traction orthotic was added to the experimental group only. Feasibility was assessed through recruitment rate, compliance rate, adherence rate, safety, and global satisfaction in addition to clinical outcome measures: FHP distance, cervical lordosis, headache frequency, headache disability inventory (HDI), headache impact test-6 (HIT-6), and daily defined dose (DDD). Evaluations were performed at: baseline, 10 weeks, 1 year follow up, and 2-year follow up. The assessor was blind to group allocation for all measured outcomes. Results The recruitment rate was 60%, 78 % out of them completed the entire study. The recruited participants complied with 98% of the required visits. No adverse events were recorded and greater overall satisfaction with the interventions was reported. Greater improvements were found for the experimental group's cervical lordosis (f = 259.9, P < < .001) and FHP (f = 142.5, P < < .001). At 10 weeks, both groups showed equal improvements in CGH outcomes: headache frequency ( P = 0.07), HDI ( P = 0.07), HIT-6 (P = .2), and DDD (P = .3). In contrast, at the 1-year and 2-year follow up, between group differences were found for all CGH outcomes, P < .00, indicating greater improvement in the experimental group. Conclusion The results indicated feasibility for recruitment rate, compliance rate, exercise session adherence, safety, and global satisfaction. At 1-year and 2-year follow-up, the addition of the denneroll orthotic device revealed positive influence on CGH management outcomes. Trial registration The trial was retrospectively registered with the Pan African Clinical Trial Registry (PACTR201605001650300).

Improving the cervical lordosis relieves neck pain and chronic headaches in a pediatric: a Chiropractic Biophysics^® (CBP^®) case report with a 17-month follow-up

“…Altered cervical lordosis, particularly kyphosis, has been found to be associated with neck pains and headaches 10,11,24,25) . As re-alignment of the cervical spine in adults has been shown to be effective at long-term headache symptom resolution 15) , it seems logical that paralleled successful outcomes would be expected in children presenting with cervical hypolordosis and chronic headaches as shown in this case.…”

“…The limitations to this case include the lack of a home traction diary to track the accuracy of the frequency and duration of traction performed that was verbally reported by the parent. Also, although cervical manipulation as well as cervical extension traction were performed, we acknowledge that although the lordosis correction is theoretically possible from either treatment, recent trials by Moustafa et al [14][15][16] demonstrate that it is the extension traction that is responsible for lordosis increase; as well, manipulation of the spine has not been shown to change spine alignment [34][35][36] . Although natural recovery is always a possibility regarding symptoms resolution, the simultaneous symptom relief with the current treatment occurred, and recent clinical trials also show this form of treatment leading to symptom resolution in those with co-existing cervical loss of lordosis and cranio-cervical symptoms [14][15][16] .…”

“…CBP technique methods is a full-spine and posture correcting program that uses the concept of mirror image ® to stress the spine and related tissues towards the unique opposite to achieve the goal of improving the spine alignment to more ideal/normal [20][21][22][23] . Regarding the cervical lordosis, a unique form of cervical traction in an extension position has proven effective for increasing the lordosis in many clinical trials [14][15][16] . Lordosis measured by the posterior tangent method from C2-C7, AHT: anterior head translation; APL: atlas plane line.…”

“…Kasai et al presented data on the pediatric cervical lordosis between the ages of 2 to 18 years 12) , adjusting for the measurement method, it is determined that a normal lordosis curve (C2-C7 posterior tangents) for a 10 year old should be about 22.7°1 3) . Although the correction of cervical lordosis in adults is becoming well supported in recent randomized trials [14][15][16] , the improvement in lordosis in children is underreported with no clinical trials, and only the odd case report 13) .…”

Smoke Screen to Distract From Flawed Science: A Response to Côté et al. Over Criticisms to Their Deficient ‘Rapid Review’ on Chiropractic X-Ray Utility

“…Some of these excluded RCTs are summarized in recent systematic reviews, 4 , 5 and three more RCTs further showing the superiority of X-ray-guided treatment over tradition treatment approaches have also been published this year. 6 - 8 These RCTs can no longer be ignored and must be considered in any future discussion of X-ray utility in chiropractic and spine rehabilitation practice.…”