Orthopaedic Manual Physical Therapy Including Thrust Manipulation and Exercise in the Management of a Patient with Cervicogenic Headache: A Case Report

Abstract

It has been reported that in Western society as many as 16% of individuals experience cervicogenic headache, which can lead to signifi cant amounts of pain and perceived disability. Cervicogenic headache is characterized by unilateral occipital-temporal pain that is increased by neck movement; it is accompanied by cervical hypomobility, postural changes, and/or increased cervical muscle tone. This case report describes the physical therapy differential diagnosis, management, and outcomes of a patient with cervicogenic headache. The patient was a 40-year-old woman referred by her physiatrist with complaints of cervical pain and ipsilateral temporal headache. The patient presented with increased muscle tone, multiple-level joint hypomobility in the cervical and thoracic spine, muscle weakness, and postural changes. Self-report outcome measures included the Visual Analog Scale for headache pain intensity and the Neck Disability Index. Management consisted of various thrust and non-thrust manipulations, soft tissue mobilizations, postural re-education, and exercise to address postural defi cits and cervical and thoracic hypomobility and diminished strength. At discharge, the patient demonstrated clinically meaningful improvements with regard to pain, disability, and headache. This case report indicates that a multimodal physical therapy treatment program may be effective in the management of a patient diagnosed with cervicogenic headache.Key Words: Cervicogenic Headache, Manipulation, Thrust, Exercise, Physical Therapy Orthopaedic Manual Physical Therapy Including Thrust Manipulation and Exercise in the Management of a Patient withCervicogenic Headache: A Case Report C ervicogenic headaches are commonly encountered in physical therapy (PT) practice. Cervicogenic headache is a headache type validated recently by the International Headache Society (IHS) that is hypothesized to originate due to nociception in the cervical area. In a Scandinavian population study, its prevalence was established at approximately 16%1 . Table 1 outlines the diagnostic criteria for cervical headaches as described by the IHS 2 . Horn and Smith 3 reviewed the literature on approaches to management of cervicogenic headache using orthopedic manual physical therapy (OMPT) principles. They recommended careful examination to identify all impairments, to provide a differential diagnosis, and to plan appropriate intervention. Recommended interventions included joint mobilization, soft tissue mobilization, retraining of specifi c postural muscle groups, and patient education. The authors recommended that emphasis should be placed on home and self-management skills and on increasing patient understanding of the predisposing factors with regard to cervicogenic headache. Jull 4 also described the importance of an accurate differential diagnosis ascertaining the cervical musculoskeletal origin of the headache to assure success with management of a cervical headache patient. She described the history and symptomatic features of cervical headach...

Clinical reasoning for manual therapy management of tension type and cervicogenic headache

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The effect of thoracic manipulation on shoulder pain: a regional interdependence model

“…It is a consistent theme throughout research that manual therapy techniques when combined with therapeutic exercises have a better outcome than when manual therapy is utilized in isolation. [110][111][112][113][114][115][116][117][118][119] Therefore, therapeutic exercises focused upon the thoracic spine should be an integral part of any shoulder rehabilitation program.…”

Development of the Headache Activities of Daily Living Index: Initial Validity Study

“…The NDI was used as a template for the new instrument on account of the strong psychometric record of this instrument. 24,25 Furthermore, it has been used as an outcome measure in several headache studies, [26][27][28][29][30][31][32][33][34][35][36][37] although we would argue that this, in itself, is not appropriate. Therefore, the first set of possible items for inclusion in a new instrument was from the NDI items, which were deemed applicable to headaches.…”