title: Chiropractic/rehabilitative management of chronic headaches: A retrospective case report.
abstract: OBJECTIVE
  To discusses management of cervicogenic headache by chiropractic manipulation and an active rehabilitation program.
  
  
  METHODS
  A 28-year-old female had headaches of approximately a 10-year duration that were located on the right occipital-cervical region with radiation into the right paraspinal musculature of the cervical spine. Prior allopathic intervention included pharmaceutical approaches without resolution of symptoms. The area involved demonstrated marked point tenderness to static/motion palpation techniques. Manual resisted muscle testing of the sub-occpitals, upper trapezious, levator scapulae and the rhomboids decreased her pain, while testing of the anterior scalenes and sternocleidomastoids muscles created an increase in her pain. Seated cervical spine range of motion was diminished in all ranges and was limited by an increase in her pain of the right sub-occipital joint. The remainder of the examination was unremarkable.
  
  
  RESULTS
  Treatment plan and intervention included patient education in posture and an in-office treatment program progressing to home therapy was reviewed with the patient. She noticed an increase in signs and symptoms after her first 3 visits followed by a decrease in her primary signs and symptoms during visits 3-5. An in-office active rehabilitation program was included with a continued positive response. She was released to home therapy and supportive chiropractic manipulation with continued positive response.
  
  
  CONCLUSIONS
  Management of cervicogenic headaches with chiropractic manipulation and rehabilitation is discussed. A literature review is included. Past trauma with altered postural biomechanics appeared to be the cause in this particular case. Management strategies including education of proper biomechanics, rehabilitation and chiropractic manipulation were effective in this case.
authors.affiliation: Private Practice of Chiropractic, Novicky Chiropractic, Inc., Youngstown, OH.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Novicky
references.citation: J Orthop Sports Phys Ther. 1994 Dec;20(6):276-86
references.pmid: 7849747
references.citation: Spine (Phila Pa 1976). 1995 Sep 15;20(18):2060-6
references.pmid: 8578385
references.citation: J Manipulative Physiol Ther. 2002 Sep;25(7):E7
references.pmid: 12214190
references.citation: JAMA. 1998 Nov 11;280(18):1576-9
references.pmid: 9820258
references.citation: Cephalalgia. 1995 Jun;15(3):205-10
references.pmid: 7553810
references.citation: Spine (Phila Pa 1976). 1990 Jun;15(6):514-21
references.pmid: 2144916
references.citation: J Manipulative Physiol Ther. 2000 Jul-Aug;23(6):404-8
references.pmid: 10951310
references.citation: Z Orthop Ihre Grenzgeb. 2000 Jan-Feb;138(1):2-7
references.pmid: 10730356
references.citation: J Manipulative Physiol Ther. 1983 Dec;6(4):181-3
references.pmid: 6668455
references.citation: Pain. 1993 Sep;54(3):353-359
references.pmid: 8233552
references.citation: J Manipulative Physiol Ther. 2002 Jun;25(5):285-92
references.pmid: 12072848
references.citation: J Manipulative Physiol Ther. 1995 Jan;18(1):21-4
references.pmid: 7706955
references.citation: J Manipulative Physiol Ther. 1994 Nov-Dec;17(9):591-5
references.pmid: 7884328
references.citation: J Manipulative Physiol Ther. 1990 Jan;13(1):17-25
references.pmid: 2182754