quinta-feira, 7 de maio de 2015


Conservative physical therapy management for the treatment of  cervicogenic  headache: a systematic review                                  


Stephanie Racicki, Sarah Gerwin, Stacy DiClaudio, Samuel Reinmann, and Megan Donaldson

Introduction

Headaches are a common condition affecting 47% of the global population,, with cervicogenic headaches (CGHs) accounting for 15–20% of all chronic and recurrent headaches.– CGHs affect 22–25% of the adult population,– and appear to affect women four times more than men. CGH, also referred to as occipital headaches, are the most common persistent symptom following cervical neck/spine trauma such as a whiplash injury.–
The International Headache Society (IHS) has identified that there are 14 different types and subcategories of headache classifications. These headaches have been classified as either primary, resulting from vascular or muscular origin, or secondary, which result from another source such as inflammation or head and neck injuries. The IHS has classified a CGH as a secondary headache with ‘pain referred from a source in the neck and perceived in one or more regions of the head and/or face’. This classification has also described the pain as being unilateral or bilateral,– affecting the head or face but has most commonly affected the occipital region,, frontal region,, or retro-orbital region. CGH is commonly associated with suboccipital neck pain but can also be associated with ipsilateral arm discomfort. Other symptoms associated with CGH include dizziness,,– nausea,,, lightheadedness, inability to concentrate, retro-ocular pain, and visual disturbances.,,
CGHs are thought to arise from musculoskeletal impairment(s) in the neck. These dysfunctions have been described as arising from the joints, muscles, ligaments, and other soft tissues in the neck., Although controversy exists, several authors have agreed on the etiology of CGHs as those arising from cervical levels C3 and above,,,,– with literature supporting the primary cause as a dysfunction at the C2-3 zygapophysial joints. Additional literature supports that CGH can arise from dysfunction of the C2-3 and C3-4 discs or facet joints,– as well as dysfunction of the atlantoaxial (C1-2) and atlanto-occipital (C0-1) joints. These dysfunctions are associated with trauma, as well as prolonged neck flexion or poor static postures.,, Upper cervical joint restrictions and tenderness are often present with a CGH and can be detected by a manual therapy examination.,,,
Because of the various area and severity of dysfunction, there are a variety of treatment techniques that healthcare practitioners can use in the treatment of CGH. Treatments include invasive and/or non-invasive techniques. The invasive treatment techniques consist of injections, dry needling, and surgery. The non-invasive treatment techniques consist of transcutaneous electrical nerve stimulation (TENS), massage,exercise,, manipulation,,,, or mobilization.,,, Of the non-invasive approaches, the most commonly cited in the literature are manipulation and mobilization.,,,,, Although many treatment techniques have been presented, the most effective form of non-invasive CGH treatment has yet to be established. Therefore, the purpose of this systematic review was to assess the effectiveness of various conservative physical therapy interventions in the management of CGH.

Methods

In order to provide a thorough descriptive systematic review, the PRISMA Explanation and Elaboration documentation and guidelines were used.

Search strategy

The computerized searches were performed by two reviewers (SG and SR) through databases of CINAHL, ProQuest, PubMed, MEDLINE, and SportDiscus. The search strategies are outlined in Table 1. Once articles were obtained, reference lists were manually searched by two reviewers (SG and SR) to identify potentially eligible publications that were not identified during the database searches. Articles reviewed were limited to the English language.
Table 1
Results of computerized search strategies

Inclusion and exclusion criteria

Studies included in this review were required to fulfill the following criteria: a randomized controlled trial (RCT), a population with diagnosed CGH using the IHS classification, at least one validated outcome measure assessed function, disability, or pain, a baseline measurement, and a conservative intervention consisting of manual therapy or exercise. Studies were excluded on the following criteria: primary focus on neck pain, a diagnosis of a migraine headache and/or tension-type headache, primary treatment of pharmacological intervention, or if the study failed to meet the minimum quality assessment score on the physiotherapy evidence-based database (PEDro) scale.

Quality assessment

The quality of the articles included in this review was assessed using the PEDro scale. The PEDro scale has been validated to measure only one construct which is the methodological quality of clinical trials. The PEDro scale has been shown to have a reliability coefficient of 068, which is considered to be fair to good reliability. The authors of this systematic review utilized the quality cutoff score of fair (5/10) on the PEDro scale.

Data collection and analysis

This systematic review includes a qualitative analysis of the studies included in this manuscript. Two authors (SG and SR) independently reviewed titles, abstracts, and keywords of retrieved publications to assess eligibility. Inclusion criteria were established prior to initiating the search. Two authors (SAR and SD) independently reviewed each study in full text to determine inclusion. The same two reviewers independently assessed the methodological quality of all the included studies and recorded the findings. Agreement was calculated using kappa statistics.
Effect sizes were calculated by one author (SAR) and reviewed by a second author (SD). This was performed by utilizing the means and standard deviations, which were acquired through independent contact of authors or extracted from within the article. Effect sizes were used to show the magnitude of the difference or relationship between interventions within a study or across multiple studies.,

Results

Study description and methodological quality

After a computerized search, 105 abstracts were pulled based on title (5 from SportDiscus, 13 from MEDLINE, 30 from PubMed, 7 from ProQuest, 24 from CINAHL, and 26 from hand searches). After abstract review, authors SG and SR deemed 81 of these abstracts inappropriate, leaving 24 full text articles to retrieve, review, and affirm for study inclusion. Of the 24 full text articles pulled, 18 were eliminated for reasons outlined in Table 2.,,– Kappa scores for agreement regarding both original and hand search title screening and abstract review resulted in a score of 100, which is considered perfect agreement. Full text review for both original and hand search results resulted in a kappa score of 057, which is considered moderate agreement. As outlined in the PRISMA flow chart (Fig. 1), six of the studies met the inclusion criteria.
Figure 1
PRISMA flowchart of inclusion.
Table 2
Rationale for excluded full text articles
The six RCTs included a total of 457 participants from ages of 7–15 and 18–60 years old. Of these, 328% were males and 672% were female, and all had confirmed CGH using the IHS criteria. Table 3 summarizes the quality scores of the included studies.,– Methodological weaknesses were found in all studies. Specifically, two of the studies received a PEDro score of 6/10,, two received a score of 7/10,, and two received a score of 8/10., All studies were qualified as ‘good’ regarding the level of internal validity based on the PEDro score grading according to Maher et al. The most common methodological weakness in all six studies was failure to blind therapists administering the therapy; however, due to the type of intervention being delivered manually from the practitioner, this was not feasible considering five of the RCTs performed manipulation as a treatment and one focused on self-sustained natural apophyseal glides (SNAGs). Three RCTs,, failed to blind the subjects and three,, failed to provide point measures as well as measures of variability for one key outcome. Three,, failed to analyze key outcomes by ‘intention to treat’ when subjects allocated to a treatment did not receive the treatment. All RCTs reported the use of cervical manipulation or mobilization. The characteristics of the included studies are outlined in Table 4.
Table 3
Quality scores of included studies utilizing the PEDro scale
Table 4
Characteristics of randomized controlled trials

Outcome assessments

Outcome measures, assessed in the articles, varied depending on the domains of pain, function, and/or disability that the authors of the studies sought to report.
The outcome measures used in the studies included:
  1. Headache frequency defined as the number of headache days per week, the mean number of headache hours per day,, and percent of days with headache.
  2. Headache intensity which was measured using the visual analog scale.,,,
  3. Headache duration measured in total hours and average number of hours headaches lasted in the past week.
  4. Headache and neck pain intensity measured by using the modified Von Korff pain scale. (The modified Von Korff pain scale for CGHs is the average of three 11-point numerical rating scales: CGH pain today, worst CGH pain in the last 4 weeks, and average cervicogenic pain in the last 4 weeks.)
  5. Disability which was measured by the modified Von Korff disability scale.
  6. Flexion rotation test (FRT) measured using a modified cervical range of motion device.
  7. Headache severity measured by a headache questionnaire which was a composite score of headache intensity, frequency, and duration.
  8. Neck pain and disability which were assessed using the Northwick Park Neck Pain Questionnaire.
  9. Analgesic use, which was measured by the mean number of pain killers per day, and percent of days needing analgesic medication.
  10. General health status using the physical and mental component summary scales of the SF-12.
  11. Missing school lessons secondary to headache when applicable to the population.

Effects of interventions

Manipulative/mobilization therapy; thrust and non-thrust

All of the studies included in this review, Borusiak et al., Hass et al., Hall et al., Jull et al., Nilsson,and Nilsson et al. assessed the effect of manipulation or mobilization interventions on patients diagnosed with CGHs. Hass et al. and Nilsson et al. scored a 7/10, and Jull et al. and Nilsson scored a 6/10 on the PEDro scale (Table 3). There was conflicting evidence regarding the effects of manipulative therapy on CGHs amongst these six studies. Haas et al., Hall et al., Nilsson et al., and Jull et al. concluded that manipulative therapy was significantly effective. However; the studies by Borusiak et al., and Nilssonindicated no clinically or statistically significant differences.
Boursiak et al. scored an 8/10 on the PEDro scale, and was the only study to research the efficacy of thrust cervical manipulative therapy (CMT) in children and adolescents with recurring CGH, aged 7–15 years. Outcomes measures utilized were: percentage of days with headache, duration of headache, percentage of missed school days due to headache, percentage of days where medication was needed, and intensity of headache. The authors found no statistically significant differences between the CMT group and the sham CMT group. Additionally, the calculated effect sizes for these outcome measures were as follows: percentage of days with headache (−002), duration of headache (010), percentage of missed school days due to headache (015), percentage of days where medication was needed (001), and headache intensity (−027). These values suggest that the conservative intervention had a small effect on the outcomes measured (Table 5).
Table 5
Calculated effect size interpretation of conservative treatment groups compared to placebo/control groups on unique outcome measures
Haas et al. scored a 7/10 on the PEDro scale, and investigated the effects of two doses (eight and 16 treatment sessions) of cervical and upper thoracic manipulation in those with chronic CGH compared to a placebo group. Outcome measures were: CGH pain intensity, neck pain, neck disability, CGH disability, CGH frequency measured in a 4-week period, and over the counter analgesic use measured in a 4-week period. The manipulation had statistically significant decreases in neck disability, CGH frequency, and analgesic use with effect sizes of −034, −025, and −025, respectively. There were no statistically significant decreases between the manipulation and placebo groups in regards to CGH pain intensity, neck pain, and CGH disability. The corresponding effects sizes were −039, −037, and −039, respectively.
Hall et al. scored a 7/10 on the PEDro scale. Their study explored the efficacy of a C1–C2 self-SNAG in relation to two CGH outcomes; CGH intensity and FRT in subjects with CGH. When compared to a placebo SNAG group, the true SNAG group displayed a statistically significant decrease in CGH intensity and an increase in FRT range of motion. The manipulation group displayed effect sizes of −063 at 4 weeks and −067 at 12 months in regards to CGH intensity and 057 in regards to FRT range of motion.
Jull et al. scored a 6/10 on the PEDro scale for their study which investigated the effects that combined cervical manipulation and mobilization would have on the four CGH outcomes: CGH frequency, CGH intensity, CGH duration, and neck pain. At 7 weeks, the manipulation group displayed statistically significant reductions in CGH frequency, intensity, and neck pain. The corresponding effect sizes were 071, 062, and 053, respectively. Reductions in these outcomes were statistically significant at 12 months as well. However, there was no statistically significant reduction in CGH duration at 7 weeks or at the 12-month follow-up with an effect size of 033 at 7 weeks. There were insufficient data available to calculate effect sizes at the 12-month follow-up.
Nilsson scored a 6/10 on the PEDro scale. This study examined patients with CGH and the effect that high-velocity, low amplitude cervical manipulation would have on: CGH hours per day, use of analgesics, or CGH intensity when compared to a placebo group. No statistically significant findings were present in the manipulation group in regards to CGH hours per day, CGH intensity, and use of analgesics. The effect sizes were unable to be calculated due to insufficient data supplied by the authors and inability to successfully contact authors for required data.
Nilsson et al. scored a 7/10 on the PEDro scale. The purpose of this study was to determine whether high-velocity, low amplitude cervical manipulation would have an effect on: CGH hours per day, use of analgesics, or CGH intensity in a population with CGH when compared to a placebo group. The manipulation group displayed statistically significant reductions in CGH hours and CGH intensity. Concurrently, there was no statistically significant reduction in analgesic use. The effect sizes were unable to be calculated due to insufficient data supplied by the authors and inability to successfully contact authors for required data.

Therapeutic exercise

Jull et al. was the only RCT which investigated the effects of only exercise in the treatment of CGH. The exercise-only group displayed statistically significant improvements (P<0001) at 7 weeks when compared to the control group for headache frequency, headache intensity, and neck pain, but not headache duration. Improvements in neck pain, headache frequency, and intensity were still statically significant compared to the control group at month 12. At 7 weeks, effect sizes for the exercise group were 087 for frequency of headache, 072 for intensity of headache, 000 for headache duration, and 056 for neck pain (Table 5). There were insufficient data available to calculate effect sizes at the 12-month period.

Combination treatment of thrust and non-thrust mobilization/manipulation and exercise therapy

Jull et al. was the only RCT that studied the effects of exercise as well as thrust and non-thrust manipulation. During the seventh week of the study, the cervico-scapular exercise and manipulation group displayed statistically significant improvements in all outcome measures when compared to the control group. Additionally, statistically significant improvements persisted at the 12-month follow-up period. Effect sizes at 7 weeks were: 068 for frequency of headache, 076 for intensity of headache, 053 for duration of headache, and 064 for neck pain (Table 5). There were insufficient data available to calculate effect sizes at the 12-month period.

Discussion

The purpose of this systematic review was to assess the effectiveness of various conservative physical therapy interventions in the management of CGH. Interventions assessed included: cervical and/or upper thoracic manipulation in isolation, cervical SNAG mobilization, cervical manipulation and mobilization, and cervical manipulation and mobilization with exercise. Based on effect sizes, the results indicate that both cervical manipulation and mobilization, along with exercise, were the most effective conservative interventions for decreasing CGH intensity, frequency, and neck pain, which is consistent with the literature.,
One interesting finding is the lack of variety in conservative physical therapy treatment techniques. Though many other conservative treatment options are available, such as modalities, traction, and deep tissue massage, no RCTs reported the use of these conservative interventions. Of the six RCTs included in this body of literature, two had the same lead author with very similar methodologies. Five of the six included studies that utilized manipulation or mobilization as the primary conservative intervention. Additionally, only one study compared exercise only to a combination of exercise with mobilization and manipulation. No other RCT studies were found to use a combination method of active strengthening with manual therapy.
Another finding of interest was that significant differences were found between the self-SNAG group and the placebo group in terms of FRT range and headache intensity. However, what is known about mobilization in general is that it produces a hypoalgesic effect thereby increasing pressure pain thresholds and reducing visual analog pain scale scores. This may explain why the self-SNAG decreased headache index scores. However, it does not explain the increase in FRT ranges. Additionally, a study by Hall and Robinsonidentified no clinical significance in cervical ROM in patients with CGH who received repeated trials of the FRT as an intervention.
The clinical importance of this systematic review is that it has provided a comprehensive review of the conservative physical therapy treatment approaches for patients diagnosed with CGH. Based on the literature, a variety of manual procedures, whether patient-driven or therapist-driven, with the combination of therapeutic exercise may improve patients’ pain outcomes. The current review indicates that cervical spinal manipulation is effective in the management of CGH, which is consistent with a recent literature review.However, no studies have evaluated the difference between manipulation and mobilization for CGH. Some patient populations are not appropriate for manipulation of the cervical spine due to patient values, patient history, and/or other examination findings. Therefore, future studies should be designed prospectively to identify which approach provides better patient outcomes or recovery.
Some studies included in this review indicated statistically significant reductions in headache intensity and frequency and neck pain, with complementary effect sizes ranging from minimal to moderate;– whereas one failed to reach statistical significance with less than minimal effect sizes (Table 5). Some RCTs that met the inclusion criteria for this study indicated statistically significant reductions in CGH intensity and analgesic use, but did not provide enough statistical reporting information for calculation of effect sizes.,
Not surprisingly, a very recent systematic review also reviewed five of the manipulation studies that met the inclusion criteria for this systematic review. There are several differences, however, in the findings from the current review to those of Chaibi and Russell. The latter study did not capture the article by Hall et al., which scored well on the PEDro scale and provided useful information for CGH management utilizing a C1–C2 self-SNAG.
Due to the variety of physical therapy approaches that conservatively treat CGH, it is critical to evaluate all conservative physical therapy management techniques and review the effectiveness on patient outcomes. Table 5 summarizes the effectiveness of each intervention by reporting effect sizes, which sets this review apart from previous ones. In addition, Table 5 summarizes the variety of outcome measures used in the eligible studies.

Limitations

There are a number of limitations to this study. One limitation is that articles included in this review were limited to those published in English. Additionally, while extensive literature searches were performed, there is the possibility that not all literature was captured and that biases may have existed within the search strategy utilized. This study’s external validity must be considered with caution due to variability in manual therapy technique, background/experience of clinicians, and methods of patient instruction. Additionally, many of the included articles had potential biases that may limit their external validity including a lack of strict inclusion criteria, various clinicians from different backgrounds/experience/training and observational bias. Lastly, two of the studies, did not report specific data required to calculate effect sizes. On the other hand, the study by Jull et al. utilized pre-calculated effect sizes that employed a more conservative approach to calculate effect size compared to the calculations used in this systematic review.

Conclusion

The results of this systematic review indicate that conservative physical therapy treatment techniques are effective interventions for decreasing CGH intensity and frequency, as well as neck pain, based on the calculated effect sizes. Additionally, a combination of thrust and non-thrust manipulation does not appear to provide significant symptom reduction compared to exercise alone. Therefore, utilizing a combination of mobilization, manipulation, and cervico-scapular strengthening exercises to treat a patient with CGH may be the most effective intervention based on the results of this systematic review. While this finding is an important step towards determining effective treatment for patients with CGH, it is important to keep in mind that the quality of the studies in this review was ‘good’, but not ‘excellent.’
Due to the diversity of outcome measures found in this study, the data were heterogeneous, and therefore a meta-analysis of this topic was not possible. The summative report of outcome measures presented in Table 5is novel and should be used to guide future studies of this topic.

References

1. Stovner LJ, Hagen K, Jensen R, Katsarava Z, Lipton R, Scher A, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia. 2007;27:193–210 [PubMed]
2. Jensen R, Stovner LJ. Epidemiology and comorbidity of headache. Lancet Neurol. 2008;7:354–61[PubMed]
3. Pfaffenrath V, Kaube H. Diagnostics of cervical headache. Funct Neurol. 1990;5:157–64
4. Nilsson N. A randomized controlled trial of the effect of spinal manipulation in the treatment of cervicogenic headache. J Manipulative Physiol Ther. 1995;18:435–40 [PubMed]
5. Haldeman S, Dagenais S. Cervicogenic headaches: a critical review. Spine J. 2001;1:31–46 [PubMed]
6. Maciel JA., Jr. Cervicogenic headache. A study of 203 cases. Proceedings of the 1st Pan American Headache Congress, 1997. Book of Abstracts. In: Hall T, Robinson K. The flexion-rotation test and active cervical mobility- a comparative measurement study in cervicogenic headache. Manual Therapy. 2004;9:197–202. [PubMed]
7. Sjaastad O, Fredriksen TA, Pfaffenrath V. Cervicogenia headache: diagnostic criteria. Headache.1990;30:725–6 [PubMed]
8. Sjaastad O, Fredriksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. The cervicogenic headache international study group. Headache. 1998;38:442–5 [PubMed]
9. Antonaci F, Sjaastad O. Cervicogenic headache: a real headache. Curr Neurol Neurosci Rep.2011;11:149–55 [PubMed]
10. Hagen K, Einarsen C, Zwart JA, Svebak S, Bovim G. The co-occurrence of headache and musculoskeletal symptoms amongst 51050 adults in Norway. Eur J Neurol. 2002;9:527–33 [PubMed]
11. Balla J, Iansek R. Headaches arising from disorders of the cervical spine. In: Hopkins A, editor. Problems in diagnosis and management London: Saunders; 1988. p. 241–67
12. Schoensee SK, Jenson G, Nicholson G, Gossman M, Katholi C. The effect of mobilization on cervical headaches. JOSPT. 1995;21:184–96 [PubMed]
13. Fredricksen TA, Hovdal H, Sjaastad O. ‘Cervicogenic headache’: clinical manifestation. Cephalalgia.1987;7:147–60 [PubMed]
14. Knight G. Post-traumatic occipital headache. Lancet. 1963;2:6–8 [PubMed]
15. Pffaffenrath V, Dandakar R, Pollmann W. Cervicogenic headache — the clinical picture, radiological findings and hypothesis on its pathology. Headache. 1987;27:495–9 [PubMed]
16. Sjaastad O, Saunte C, Hovdahl H, Breivik H, Gronbaek E. ‘Cervicogenic’ headache: a hypothesis.Cephalalgia. 1983;3:249–56 [PubMed]
17. Trevor-Jones R. Osteo-arthritis of the paravertebral joints of the second and third cervical vertebrae as a cause of occipital headaches. S Afr Med J. 1964;38:392–4 [PubMed]
18. International Headache Society The international classification of headache disorders: 2nd edition.Cephalalgia. 2004;24:1–160 [PubMed]
19. Bogduk N, Corrigan B, Kelly P, Schneider G, Farr R. Cervical headache. Med J Aus. 1985;3:206–7[PubMed]
20. Jirout J. comments regarding the diagnosis and treatment of dysfunction in the C2-C3 segment. Man Med. 1985;2:16–7
21. Sjaastad O, Wang H, Bakketeig LS. Neck pain and associated head pain: persistent neck complaint with subsequent, transient, posterior headache. Acta Neurol Scand. 2006;114:392–9 [PubMed]
22. Edmeads J. The cervical spine and headache. Neurology. 1988;38:1874–8 [PubMed]
23. Jull G. Headaches associated with the cervical spine — a clinical review. In: Grieve GP, editor. Modern manual therapy of the vertebral column New York: Churchill Livingstone Inc.; 1986. p. 322–9
24. Bogduk N. Cervical cause of headache and dizziness. In: Grieve GP, editor. Modern manual therapy of the vertebral column New York: Churchill Livingston Inc.; 1986. p. 289–302
25. Edeling J. The abandoned headache syndrome. In: Grieve GP, editor. Modern manual therapy of the vertebral column New York: Churchill Livingston Inc.; 1986. p. 330–5
26. Edeling J. Manual therapy for chronic headache. London: Butterworth-Heinemann Ltd; 1988
27. Jull G. Management of cervical headache. Man Ther. 1997;2:182–90 [PubMed]
28. Bogduk N. Cervicogenic headache: anatomic basis and pathophysiologic mechanisms. Curr Pain Headache Rep. 2001;5:382–6 [PubMed]
29. Bogduk N. On the concept of third occipital headache. J Neurol Neurosurg Psychiatry. 1986;49:775–80[PMC free article] [PubMed]
30. Jull G. Headaches of cervical origin. In: Grant R, editor, Physical therapy of the cervical and thoracic spine New York: Churchill Livingstone Inc.; 1988. p. 195–217
31. Lewit K. Pain arising in the posterior arch of the atlas. Eur Neurol. 1977;16:263–9 [PubMed]
32. Vernon HT. Chiropractic manipulative therapy in the treatment of headache: a retrospective and prospective study. J Manipulative Physiol Ther. 1982;5:109–12 [PubMed]
33. Vernon HT. Spinal manipulation and headaches of cervical origin. J Manipulative Physiol Ther.1989;12:455–68 [PubMed]
34. Schellhaus KP, Garvey TA, Johnson BA, Rothbart PJ, Pollei SR. Cervical discography: analysis of provoked responses at C2-C3, C3-C4, and C4-C5. AJNR Am J Neuroradiol. 2000;21:269–75 [PubMed]
35. Slipman CW, Plastaras C, Patel R, Isaac Z, Chow D, Garvan C, et al. Provocative cervical discographic symptom mapping. Spine J. 2005;5:381–8 [PubMed]
36. Lord S, Barnsley L, Wallis B, Bogduk N. Third occipital headache: a prevelance study. J Neurol Neurosurg Psychiatry. 1994;57:1187–90 [PMC free article] [PubMed]
37. Dreyfuss P, Michaelsen M, Fletcher D. Atlanto-occipital and lateral atlanto-axial joint pain patterns.Spine (Phila Pa 1976). 1994;19:1125–31. [PubMed]
38. Vincent MB. Cervicogenic headache: a review comparison with migraine, tension-type headache, and whiplash. Curr Pain Headache Rep. 2010;14:238–43 [PubMed]
39. Ehni G, Benner B. Occipital neuralgia and the C1-2 arthrosis syndrome. J Neurosurg. 1984;61:961–5[PubMed]
40. Turk Z, Ratkolb O. Mobilization of the cervical spine in chronic headaches. Man Med. 1987;3:15–7
41. Liberati A, Altman DG, Tetziaff J, Mulrow C, Gotzsche PC, Ioannids JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700. [PMC free article] [PubMed]
42. Morton N. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother. 2009;55:129–33 [PubMed]
43. Fleiss JL. The design and analysis of clinical experiments. New York: John Wiley & Sons Inc; 1986
44. Jett AM, Delitto A. Physical therapy treatment choices for musculoskeletal impairments. Phys Ther.1997;77:145–54 [PubMed]
45. Jette DU, Jette AM. Physical therapy and health outcomes for patients with spinal impairments. Phys Ther. 1997;76:930–45 [PubMed]
46. Akansha S, Abdul HU, Shalini G. Multimodal therapy in cervicogenic headache — a randomized controlled trial. Indian J Physiother Occup Ther. 2011;5:9–13
47. Badtke G. The role of manual therapy in treatment of headache. Z Artztl Fortbild (Jena). 1991;85:49–51[PubMed]
48. Bender SD. Cervicogenic headache. Tex Dent J. 2006;123:266–70 [PubMed]
49. Erickson D. Conservative management of cervical syndromes. Postgrad Med. 1964;36:194–200[PubMed]
50. Feng FL, Schofferman J. Chronic neck pain and cervicogenic headaches. Curr Treat Options Neurol.2003;5:493–8 [PubMed]
51. Haas M, Groupp E, Aickin M, Fairweather A, Ganger B, Attwood M, et al. Dose response for chiropractic care of chronic cervicogenic headache and associated neck pain: a randomized pilot study. J Manipulative Physiol Ther. 2004;27:547–53 [PubMed]
52. Haldeman S, Dagenais S. Choosing a treatment for cervicogenic headache: when? what? how much?Spine J. 2010;10:169–71 [PubMed]
53. Jull G. Use of high and low velocity cervical manipulative therapy procedures by Australian manipulative physiotherapists. Aust J Physiother. 2002;48:189–93 [PubMed]
54. McCrory P. Headaches and exercise. Sports Med. 2000;30:221–9 [PubMed]
55. Rosendahl B. Cervical headache and its treatment. Sven Lakartidn. 1964;61:1094–101 [PubMed]
56. Schulman EA, Silberstein SD, Kudrow L, Saper J, Rapoport A. Advances in the treatment of headache.Pa Med. 1987;90:54, 56,, 58 [PubMed]
57. Vavrek D, Haas M, Peterson D. Physical examination and self-reported pain outcomes from a randomized trial on chronic cervicogenic headache. J Manipulative Physiol Ther. 2010;33:338–48[PMC free article] [PubMed]
58. von Piekartz H, Ludtke K. Effect of treatment of temporomandibular disorders (TMD) in patients with cervicogenic headache: a single-blind, randomized controlled study. Cranio. 2011;29:43–56 [PubMed]
59. Wihlidal L. Neck pain & headaches. Fitness Informer. 1993;9:7
60. Yelland M. Manipulative therapy and a low load exercise regimen each reduced the frequency and intensity of cervicogenic headaches. Roy Soc Med Int Cong. 2003;8:109
61. Ylinen J, Nikander R, Nykanen M, Kautiainen H, Hakkinen A. Effect of neck exercises on cervicogenic headache: a randomized controlled trial. J Rehabil Med. 2010;42:344–9 [PubMed]
62. Altman DG. Practical statistics for medical research. London: Chapman and Hall; 1991
63. Borusiak P, Biedermann H, Boβerhoff S, Opp J. Lack of efficacy of manual therapy in children and adolescents with suspected cervicogenic headache: result of a prospective, randomized, placebo-controlled and blinded trail. Headache. 2010;50:224–30 [PubMed]
64. Haas M, Spegman A, Peterson D, Aickin M, Vavrek D. Dose response and efficacy of spinal manipulation for chronic cervicogenic headache: a pilot randomized controlled trial. Spine J. 2010;10:117–28[PMC free article] [PubMed]
65. Hall T, Chan HT, Christensen L, Odenthal B, Wells C, Robinson K. Efficacy of a C1-C2 self-sustained natural apophyseal glide (SNAG) in the management of cervicogenic headache. JOSPT. 2007;37:100–7[PubMed]
66. Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine (Phila Pa 1976). 2002;27:1835–43 [PubMed]
67. 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 [PubMed]
68. Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003;83:713–21 [PubMed]
69. Underwood MR, Barnett AG, Vickers MR. Evaluation of two time-specific back pain outcome measures. Spine (Phila Pa 1976). 1999;24:1104–12 [PubMed]
70. Domholdt E. Rehabilitation research: principles and applications. 3rd ed. St Louis, MO: Elsevier Saunders; 2005
71. Batavia M. Clinical research for health professionals: a user-friendly guide. Boston, MA: Houghton Mifflin; 1963
72. Fernandez-de-Las-Penas C, Alonso-Blanco C, Cuadrado ML, Pareja JA. Spinal manipulative therapy in the management of cervicogenic headache. Headache. 2005;45:1260–3 [PubMed]
73. Chaibi A, Russell MB. Manual therapies for cervicogenic headache: a systematic review. J Headache Pain. 2012;13:351–9 [PMC free article] [PubMed]
74. Sterling M, Jull G, Wright A. Cervical mobilization: concurrent effects on pain, sympathetic nervous system activity and motor activity. Man Ther. 2001;6:72–81 [PubMed]
75. Hall T, Robinson K. The flexion-rotation test and active cervical mobility — a comparative measurement study in cervicogenic headache. Man Ther. 2004:9:197–202 [PubMed]
76. Miller J, Gross A, D’Sylva J, Burnie SJ, Goldsmith CH, Graham N, et al. Manual therapy and exercise for neck pain: a systematic review. Man Ther. 2010;15:334–54 [PubMed]
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