Chiropractic Treatment of Cervicogenic Headaches

Dec 8

In the ever-evolving field of chiropractic care, staying abreast of the latest research and treatment modalities is crucial for practitioners to provide the best care for their patients. Recent studies have highlighted the importance of assessing and treating suboccipital muscles in patients suffering from headaches. This blog aims to guide chiropractors through the significance of suboccipital muscles in headache treatment and outlines four essential treatments for addressing these issues.

Understanding the Significance of Suboccipital Muscles

A recent Delphi study highlighted that cervicogenic headaches (CGH) respond positively to upper cervical spine mobilization, emphasizing the importance of addressing specific anatomical regions. (1) Tavakkoli et al. (2023) further underscored this point by revealing that suboccipital muscles are stiffer, and the range of motion in cervical rotation and extension is smaller in CGH patients than in healthy controls. This finding establishes a strong connection between suboccipital muscle dysfunction and cervicogenic headaches, paving the way for effective treatment strategies. (2)

Treatment Approach 1: SNAGs for Cervicogenic Headaches and Vertigo

One effective treatment strategy for cervicogenic headaches are Sustained Natural Apophyseal Glides (SNAGs). These maneuvers decrease symptoms, including headaches and vertigo. The application of SNAGs aligns with the findings of the Delphi study, emphasizing the importance of upper cervical spine mobilization in treating CGH.

Treatment Approach 2: Spinal Manipulation for Cervicogenic Headaches

A survey of 381 chiropractors revealed that over 80% of plans for recent-onset headaches required fewer than ten visits, scheduled at 1-2 visits per week for less than eight total weeks. Additionally, a randomized controlled trial demonstrated that 6-8 sessions of spinal manipulative therapy (SMT) produced favorable outcomes for CGH. The Spine Journal reported that spinal manipulation cuts the number of CGH symptomatic days in half, with a clear linear dose response to improvement. Incorporating spinal manipulation into treatment plans is vital for achieving positive results. (3-5)

Treatment Approach 3: Therapeutic Exercises for Cervicogenic Headache Management

Research by Becher et al. (2023) suggests that therapeutic exercises play a crucial role in achieving clinically relevant reductions in headache intensity and frequency and disability for cervicogenic headache patients. Motor control exercises, such as deep neck flexion strengthening, are highlighted as beneficial. Chiropractors can integrate these exercises into their treatment plans to enhance patient outcomes. (6)

Treatment Approach 4: Manual Therapies and Nerve Mobilization

Current evidence supports manual therapies for treating different headache types, including myofascial trigger point injections, myofascial release, massage, strain counter strain technique, ischemic compression, and spinal manipulative therapies for cervicogenic headaches. (7) Additionally, nerve mobilization techniques can contribute to the overall effectiveness of headache treatment.

Comprehensive Care: Beyond Muscular Treatment

To provide holistic care, chiropractors should also consider factors beyond muscular issues. Stress is a significant trigger for headaches, and a study published in the Journal of the Association of Physicians of India highlighted emotional stress as the most common trigger factor. Addressing stress through counseling and stress-reduction techniques can be integral to headache management. (8)

ChiroUp subscribers can download the following patient infographic in the Forms Library by searching “Stress”.

Moreover, dietary factors play a role in headache severity. The inflammatory potential of the diet is associated with severe headaches or migraines in US adults. Chiropractors can guide patients toward an anti-inflammatory diet, potentially alleviating headache symptoms.

ChiroUp subscribers can download the following patient infographic in the Forms Library by searching “Diet”.

Conclusion

An evidence-based chiropractic practice for headache management requires a multifaceted approach. Assessing and treating suboccipital muscles is crucial, given their connection to cervicogenic headaches. Chiropractors can provide comprehensive care by incorporating SNAGs, spinal manipulation, therapeutic exercises, and various manual therapies. Additionally, addressing stress triggers and promoting an anti-inflammatory diet contribute to a holistic treatment approach, ensuring better outcomes for patients suffering from headaches. Stay informed, adapt your practice, and empower your patients on their journey to headache relief.

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1. De Pauw R, Dewitte V, de Hertogh W, Cnockaert E, Chys M, Cagnie B. Consensus among musculoskeletal experts for the management of patients with headache by physiotherapists? A delphi study. Musculoskelet Sci Pract. 2021 Jan 26;52:102325.
2. Tavakkoli M, Bahrpeyma F. Elastic Modulus of Suboccipital Muscles, Cervical Range of Motion, and Forward Head Posture in Cervicogenic Headache. Journal of Biomedical Physics & Engineering. 2023 Oct;13(5):463.
3. Moore C, Leaver A, Sibbritt D, Adams J. Chiropractors' management of common recurrent headaches: a descriptive analysis of a nationally representative survey. BMC Neurol. 2018;18(1):171. Published 2018 Oct 17.
4. Dunning JR, et al. Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC Musculoskelet Disord. 2016 Feb 6;17(1):64
5. Haas M. et al. Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial. Spine J. 2018 Feb 23.
6. Becher B, Lozano-López C, de Castro-Carletti EM, Hoffmann M, Becher C, Mesa-Jimenez J, Fernandez-de-Las-Peñas C, Armijo-Olivo S. Effectiveness of therapeutic exercise for the management of cervicogenic headache: A systematic review. Musculoskeletal Science and Practice. 2023 Jul 16:102822.
7. Pillai S, Zhang N. The Role of Manual Therapies in the Treatment of Headache Disorders. Current Neurology and Neuroscience Reports. 2023 Jun 24:1-7.
8. Jain D, Pandey G. A Study on Prevalence of Trigger Factors and Associated Disorders in Tension-type Headache. The Journal of the Association of Physicians of India. 2022 Nov 1;70(11):11-2.
9. Liu H, Wang D, Wu F, Dong Z, Yu S. Association between inflammatory potential of diet and self-reported severe headache or migraine: A cross-sectional study of the National Health and Nutrition Examination Survey. Nutrition. 2023 Sep 1;113:112098.

Brandon Steele

Dr. Steele is currently in private practice at Premier Rehab in the greater St. Louis area. He began his career with a post-graduate residency at The Central Institute for Human Performance. During this unique opportunity, he was able to create and implement rehabilitation programs for members of the St. Louis Cardinals, Rams, and Blues. Dr. Steele currently lectures extensively on evidence-based treatment of musculoskeletal disorders for the University of Bridgeport’s diplomate in orthopedics program. He serves on the executive board of the Illinois Chiropractic Society. He is also a Diplomate and Fellow of the Academy of Chiropractic Orthopedists (FACO).