Due to cervical spine dysfunction, the diagnosis of CGH was given. Nevertheless, the history and characteristics of her headache suggested it was at least partly a migraine headache.
Treatment consisted of six physiotherapy visits over six weeks, including manual therapy, general exercises and education regarding her posture. Manual therapy included a Mulligan Sustained Natural Apophyseal Glide (SNAG) maneuver to C3 and C7. This was given as a home exercise as well, in addition to a deep neck flexor strengthening exercise. It was then progressed to further endurance training for the neck flexors, in addition to strengthening of the upper quadrant for shoulder and postural training.
In a six-month follow-up the participant’s headaches had reduced dramatically from sixteen days a month to only days a month. Her headache intensity had reduced to 23/100 on the Visual Analogue Scale and she reported improvements in activities of daily living.
This article supports a multi-modal approach in clinical management. Many symptoms of CGH cross over with migraine, and in this case study, manual therapy has evidently alleviated CGH symptoms. However, according to the authors, this particular case also supports the notion that manual therapy can potentially be used to aid in treatment of migraine headaches.