The study compared 53 subjects who had cervicogenic headaches in accordance with the standards of the International Headache Society (see Table 1).
While both groups improved with care, the improvement of the soft tissue group was only statistically significant for the number of headache hours per day. The manipulation group's improvements were statistically significant for all three measurement criteria:
Average Number of Analgesics per Day
| Group | Before Care | After Care |
| Soft Tissue | 1.0 | 0.7 |
| Manipulation | 1.5 | 0.8 |
Average Headache Hours per Day
| Group | Before Care | After Care |
| Soft Tissue | 4.0 | 2.4 |
| Manipulation | 5.2 | 2.0 |
Average Headache Intensity per Episode
| Group | Before Care | After Care |
| Soft Tissue | 41 | 37 |
| Manipulation | 44 | 28 |
Equally compelling was the change in the use of analgesics that each group experienced:
Use of Analgesics
| Group | Decrease | Unchanged | Increase |
| Soft Tissue Group | 12 | 5 | 8 |
| Manipulation | 20 | 6 | 2 |
Those receiving manipulation for their cervicogenic headache:
- Decreased their analgesic use by 36%,
- Decreased their headache hours by 69%
- Decreased their headache intensity by 36%
While the results of this study may not be good news to the makers of over-the-counter pain medication, it should be encouraging to chiropractors to now have a randomized, blinded study to confirm a significant part of their clinical experience.
Table I. The 1990 criteria of the International Headache Society for the diagnosis of cervicogenic headache.2
Diagnostic Criteria for Cervicogenic Headache
- Pain localized to neck and occipital region. May project to forehead, orbital region, temples, vertex or ears.
- Pain is precipitated or aggravated by special neck movements or sustained neck posture.
- At least one of the following:
- Resistance to or limitation of passive neck movements.
- Changes in neck muscle contour, texture, tone or response to active and passive stretching and contraction.
- Abnormal tenderness of neck muscles.
- Radiological examination reveals at least one of the following:
- Movement abnormalities in flexion/extension.
- Abnormal posture.
- Fractures, congenital abnormalities, bone tumors, rheumatoid arthritis or other distinct pathology (not spondylosis or osteochondrosis).
Comment: Cervical headaches are associated with movement abnormalities in cervical intervertebral segments. The disorder may be located in the joints or ligaments. The abnormal movement may occur in any component of intervertebral movement, and is manifest during either active or passive examination of the movement.
Editor's note: If you would like a copy of this important paper, please contact:
Dana Lawrence,DCReference
Editor
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Fax (630) 889-6482
- Nilsson N, Christensen HW, Hartvigsen J. The effect of spinal manipulation in the treatment of cervicogenic headache. J Manipulative Physiol Ther 1997;20:326-30
- Olesen J. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facila pain. Copenhagen: International Headache Society, 1990.
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