The purpose of this research is to compare two different approaches for treating patients
with cervicogenic headaches: non-thrust mobilization and exercise versus thrust manipulation
and dry needling. Physical therapists commonly use all of these techniques to treat
cervicogenic headaches. This study is attempting to find out if one treatment strategy is
more effective than the other.
Patients with cervicogenic headaches will be randomized to receive 1-2 treatment sessions
per week for 4 weeks (up to 8 sessions total) of either: (1) Dry Needling and HVLA thrust
manipulation group, or the (2) Exercise and non-thrust mobilization group
1. Diagnosis of cervicogenic headache as defined by Cervicogenic Headache International
Study Group criteria
2. Headache frequency of at least one per week for a minimum of 3 months
3. Minimum pain score (NPRS) of 2/10 and minimum disability score (NDI) of 10/50
1. Presence of any of the following atherosclerotic risk factors: hypertension,
diabetes, heart disease, stroke, transient ischemic attack, peripheral vascular
disease, smoking, hypercholesterolemia or hyperlipidemia
2. Red flags noted in the patient's Neck Medical Screening Questionnaire (i.e. tumors,
fracture, metabolic diseases, RA, osteoporosis, history of prolonged steroid use,
3. History of whiplash injury within the last 6 weeks
4. Diagnosis of cervical stenosis
5. Bilateral upper extremity symptoms
6. Evidence of CNS involvement, to include hyperreflexia, sensory disturbances in the
hand, intrinsic muscle wasting of the hands, unsteadiness during walking, nystagmus,
loss of visual acuity, impaired sensation of the face, altered taste, presence of
pathological reflexes (i.e. positive Hoffman's and/or Babinski reflexes).
7. Two or more positive neurologic signs consistent with nerve root compression,
including any 2 of the following:
1. Muscle weakness involving a major muscle group of the upper extremity.
2. Diminished UE deep tendon reflex of the biceps, brachioradialis, triceps or
3. Diminished or absent sensation to pinprick in any UE dermatome.
8. Prior surgery to neck of thoracic spine
9. Involvement in litigation or worker's compensation regarding their neck pain and/or
10. PT or chiropractic care treatment for neck pain or headaches in the 3 months prior to
11. Any condition that might contraindicate spinal manipulative therapy.