title: A specific exercise program and modification of postural alignment for treatment of cervicogenic headache: a case report.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  To describe an intervention approach consisting of a specific active-exercise program and modification of postural alignment for an individual with cervicogenic headache.
  
  
  BACKGROUND
  The patient was a 46-year-old male with a 7-year history of cervicogenic headache. He reported constant symptoms with an average intensity of 5/10 on a visual analogue scale where 0 indicated no pain and 10 the worst pain imaginable. Average pain intensity in the week prior to the initial evaluation was 3/10 secondary to trigger point injections. The patient's headache symptoms worsened with activities that involved use of his arms and prolonged sitting.
  
  
  METHODS
  The patient was treated 7 times over a 3-month period. Impairments of alignment, muscle function, and movement of the cervical, scapulothoracic, and lumbar regions were identified. Outcome measurements included headache frequency, intensity, and the Neck Disability Index (NDI) questionnaire. Intervention included modification of alignment and movement during active cervical and upper extremity movements. The patient also received functional instructions focused on diminishing the effect of the weight of the upper extremities on the cervical spine.
  
  
  RESULTS
  The patient reported a decrease in headache frequency and intensity (1 headache in 3 weeks, intensity 1/10) and a decrease in his NDI score from 31 (severe disability) to 11 (mild disability). The patient also demonstrated improvement in upper cervical joint mobility, cervical range of motion, scapular alignment, and scapulothoracic muscle strength.
  
  
  CONCLUSIONS
  Interventions that included modification of alignment in the cervical, scapulothoracic, and lumbar region, along with instruction in a specific active-exercise program to address movement impairments in these 3 regions, appeared to have been successful in relieving headaches and improving function in this patient.
authors.affiliation: Washington University School of Medicine, St Louis, MO 63110, USA. mcdonnellm@wustl.edu
authors.forename: Mary Kate
authors.initials: MK
authors.lastname: McDonnell
authors.forename: Shirley A
authors.initials: SA
authors.lastname: Sahrmann
authors.forename: Linda
authors.initials: L
authors.lastname: Van Dillen
mesh_terms: D000009:Abdominal Muscles / Q000503:physiopathology; D001696:Biomechanical Phenomena; D002574:Cervical Vertebrae / Q000503:physiopathology*; D005081:Exercise Therapy; D020773:Headache Disorders / Q000503:physiopathology* / Q000534:rehabilitation*; D006801:Humans; D006811:Humerus / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011187:Posture / Q000502:physiology; D016059:Range of Motion, Articular; D012540:Scapula / Q000503:physiopathology