Cervicogenic headache is defined as a headache caused by a cervical spine disorder. This type of headache is estimated to account for up to 20% of headache cases. The primary features of cervicogenic headache usually include unilateral head pain (one side only), limited neck range of motion, and are triggered by various awkward or sustained neck movements. Cervicogenic headaches often respond well to chiropractic care, but which therapies in the chiropractor’s toolkit provide the most benefit to the patient?
One of the primary forms of treatments used by doctors of chiropractic is spinal manipulative therapy. This treatment is characterized by a quick, high-velocity low-amplitude thrust, which usually results in the crack or pop noise that is often associated with chiropractic care. Another common treatment is mobilization therapy, which consists of slow, rhythmic, oscillating techniques. Research supports both methods for managing cervicogenic headaches with the decision to use one over the other based on patient and provider preference.
Doctors of chiropractic may also utilize acupuncture and dry needling in the management of cervicogenic headaches. A 2022 systematic review and several Cochrane reviews reported that acupuncture provides meaningful reductions in the frequency of migraine and tension-type headache as well as neck pain and osteoarthritis pain. Dry needling is similar to acupuncture in that the same kind of needles are used, but they are applied directly to tight muscles rather than to specific acupuncture points.
A 2021 study compared four weeks of dry needling (plus electric stim) and spinal manipulation with four weeks of mobilization and exercise in patients with cervicogenic headache. A review of assessments conducted at the start of care, at the conclusion of care, and three months following the final treatment showed patients in the first group (which included spinal manipulation) experienced greater improvements in headache intensity, frequency, duration, and disability. The patients in this group were also five times more likely to still be satisfied three months post-treatment (77% vs 15%) and three times more likely to stop taking medication for their pain (66% vs 21%). A prior randomized controlled trial found that six to eight sessions of upper cervical and upper thoracic manipulation to be superior to mobilization and exercise in patients with cervicogenic headaches.
While we often discuss musculoskeletal conditions in general terms, each patient is unique, and there is no one approach that will work for everyone. Following a thorough examination and review of the patient’s history, a doctor of chiropractic will decide on an initial treatment approach and evaluate the patient’s progress after several treatments and make adjustments as needed.
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