The International Headache Society (IHS) has validated cervicogenic headache (CGH) as a secondary headache type that is hypothesized to originate due to nociception in the cervical area. CGH is a common form of headache and accounts for 15% to 20% of all chronic and recurrent headaches. CGH is commonly treated with manual and exercise therapy. To date, no studies have isolated only one manual intervention in an attempt to determine its effectiveness. In this case study we present a 28-year-old patient with right upper cervical (UC) and occipital pain who responded well to a single manual intervention technique. This technique was applied in isolation for the first three visits and two therapeutic exercises prescribed on the fourth and fifth visit. In total, manual and exercise intervention occurred over 8 visits at which point in time the patient was discharged with no UC motion impairments, an NPRS rating of 0, a NDI and HDI demonstrating a 100% improvement and a 37% improvement in FOTO score. The traction based manual intervention and two therapeutic exercises prescribed for this patient were successful in relieving UC pain and CGH. At six months follow up, the patient was still symptom free.

The purpose of this study was to identify the effects of manipulation on the velocity of cerebral blood flow and level of pain in cervicogeinc headache patients. The velocity of cerebral blood flow of 30 cervicogeinc headache patients(male=15, female=15, age=24.00±3.60) and 33 normal subjects(male=15, female=18, age=23.27±3.00) was compared. The 30 cervicogeinc headache patients were divided into suboccipitalis relaxation group, cervical manipulation group, and placebo group, and each were given different interventions. The velocity of cerebral blood flow and pain level was measured before intervention, and 1, 2, 3 weeks after intervention. The velocity of cerebral blood flow was measured with the Transcranial Doppler(TCD), and pain level was measured with visual analog scale(VAS). Blood flow velocity of middle cerebral artery in cervicogeinc headache patients was slower than those in healthy subjects. Physical therapy intervention did not have significant effect on velocity of cerebral blood flow, but slowly decreased at intervention for pain level increased. The suboccipitalis relaxation group and cervical manipulation group showed significant effect in decreasing pain level compared to the placebo group(p＜.05). Directly applied manipulation therapy in the neck area not only has effect on joint of cervical and soft tissue but also on blood vessels and nerves which pass the neck area, and because of those results of manual therapy seems to help recovery.