Technique Update: Spinal Manipulation for Chronic Cervicogenic Headache


by Dr. David Graber, ANJC Council on Technique & Clinical Excellence Chair


Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial

A common question about spinal manipulative therapy (SMT) often centers around the optimal amount of sessions needed to resolve a condition. A study published in the latest issue of the Spine Journal, a randomized control trial examined the dose-response relationship between the number of visits of SMT and relief of chronic cervicogenic headache (CGH). Four groups were studied and they received either 0, 6, 12, or 18 sessions of SMT over a six-week period. The group receiving 18 visits of SMT had the best outcomes at 6, 12, 24, 39, and 52 weeks. The number of days with CGH were reduced by half in this group.


Physical examination tests for screening and diagnosis of cervicogenic headache: A systematic review.

One of the most reliable tests for diagnosing cervicogenic headache is the cervical flexion-rotation test (CFRT). The test is done with the patient supine and the doctor lifting the neck into full passive flexion. This isolates the rotation to the upper cervical spine. The head is then rotated to each side. Normally, there is between 39-45 degrees of rotation. Patients with cervicogenic headache average 20-28 degrees on the side of involvement. Migraine patients average 39 degrees.

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