Abstract
M.Tech.
OBJECTIVE: An association between cervicogenic headache, cervical joint dysfunction and
the presence of myofascial trigger points in the sternocleidomastoid muscle exists. This study
is aimed at determining the most effective Chiropractic treatment protocol in the management
of cervicogenic headache by comparing the objective and subjective measurements gained in
delivering Chiropractic spinal manipulative therapy to the upper cervical spine, myofascial dry
needling therapy to myofascial trigger points in the sternocleidomastoid muscle and/or a
combination of both therapies.
DESIGN: Forty-eight participants suffering from cervicogenic headache were allocated into one
of three groups of equal male to female ratio. Each patient was examined and cleared for
participation in a clinical trial in which Diversified Chiropractic techniques and/or myofascial dry
needling therapy were delivered. Group 1 received Chiropractic spinal manipulative therapy to
the upper cervical spine. Group 2 received myofascial dry needling therapy to myofascial
trigger points in the sternocleidomastoid muscle. Group 3 received a combination of the
mentioned therapies.
DURATION AND MEASUREMENTS: Participants were consulted seven times in a four week
period. They were treated twice per week for three weeks and a final, follow-up assessment
was performed at the start of the fourth week. Subjective and objective measurements were
taken and recorded on the first, fourth and seventh consultations. Subjective measurements
were taken via the Vernon-Mior Neck Pain and Disability Questionnaire, Triple Visual Analogue
Scale and the Headache Disability Index. Objective measurements included cervical spine
ranges of motion which were measured using the Cervical Range of Motion Instrument
(CROM). The data was statistically analysed using the Shapiro-Wilk, Kruskal-Wallis,
Mann-Whitney, Friedman and Wilcoxon Signed Ranks tests.
RESULTS: Clinically and statistically significant improvements in all three groups were noted
over the course of the study, with regards to perception of pain, disability and cervical spine
range of motion. Statistically significant changes in ranges of motion were demonstrated in
Group 1 for flexion, extension, lateral flexion (right and left) and right rotation; in Group 2 for
right lateral flexion and left rotation and in Group 3 for all cervical ranges of motion. The
comparison between the groups (intergroup analysis) showed no statistically significant
changes except for right lateral flexion at the first consultation (pre-treatment).
CONCLUSION: The results show that Chiropractic spinal manipulative therapy and dry
needling are both effective treatment protocols in decreasing pain and dysfunction and
increasing cervical range of motion in patients suffering from cervicogenic headache. This was
demonstrated clinically, and to a lesser degree, statistically. The results carry a possible
suggestion that although the different treatment options are effective individually, no treatment
option proves to be statistically superior.