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Migraines and cervicogenic headaches

...an example of how manual therapy can be used to assess and treat cervicogenic and migraine headache

Migraine headaches arise without an identifiable cause, while cervicogenic headaches (CGH) are attributed to causes from the cervical spine. However, migraines and CGH can co-exist in the same patient so they can be difficult to distinguish.

A diagnostic and treatment strategy is provided: applying a sustained pressure to the upper cervical spine can be used to both provoke as well as reduce a headache. In the cervical spine review of the subject of this particular case study, protraction of the upper cervical spine provoked, and retraction reduced the headache.

A positive outcome was achieved with a combination of hands on therapy and a home exercise programme for self-mobilisation, deep neck flexor strengthening, and shoulder strengthening.

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.

> From: Satpute et al., J Man Manip Ther (2019) (Epub ahead of print). All rights reserved to Informa UK Ltd. Click here for the online summary.

Expert opinion

This case study highlights the cross-over of symptoms that can be present with CGH and migraine headaches. It is important to recognise that – while manual therapy is used as a main component of the assessment and treatment – the authors also emphasised on posture, education and exercise therapy in order to achieve this positive outcome. 

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