Headache

Is There a Difference in Head Posture and Cervical Spine Movement in Children With and Without Pediatric Headache?

By Frank M. Painter|August 27, 2016|Headache, Pediatrics|

Is There a Difference in Head Posture and Cervical Spine Movement in Children With and Without Pediatric Headache?

SOURCE: Eur J Pediatr. 2013 (Oct); 172 (10): 1349–1356

Kim Budelmann, Harry von Piekartz, Toby Hall

University of Applied Science,
Osnabrück, Germany

Pediatric headache is an increasingly reported phenomenon. Cervicogenic headache (CGH) is a subgroup of headache, but there is limited information about cervical spine physical examination signs in children with CGH. Therefore, a cross-sectional study was designed to investigate cervical spine physical examination signs including active range of motion (ROM), posture determined by the craniovertebral angle (CVA), and upper cervical ROM determined by the flexion-rotation test (FRT) in children aged between 6 and 12 years. An additional purpose was to determine the degree of pain provoked by the FRT.

Thirty children (mean age 120.70 months [SD 15.14]) with features of CGH and 34 (mean age 125.38 months [13.14]) age-matched asymptomatic controls participated in the study. When compared to asymptomatic controls, symptomatic children had a significantly smaller CVA (p < 0.001), significantly less active ROM in all cardinal planes (p < 0.001), and significantly less ROM during the FRT (p < 0.001), especially towards the dominant headache side (p < 0.001).

In addition, symptomatic subjects reported more pain during the FRT (p < 0.001) and there was a significant negative correlation (r = -0.758, p < 0.001) between the range recorded during the FRT towards the dominant headache side and FRT pain intensity score. This study found evidence of impaired function of the upper cervical spine in children with CGH and provides evidence of the clinical utility of the FRT when examining children with CGH.

From the FULL TEXT Article:

Introduction

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Diagnostic Testing Considerations in Pediatric Cervicogenic Headache

By Frank M. Painter|August 20, 2016|Cervicogenic, Headache|

Diagnostic Testing Considerations in Pediatric Cervicogenic Headache

The Chiro.Org Blog

SOURCE: ACA News ~ May 23, 2016

Robert Vining, DC and Janice Kane, DC

The Neurological Institute,
Taipei Veterans General Hospital,
Taipei, Taiwan.

We are all aware that children commonly complain of headaches, but determining a specific diagnosis can be challenging. That’s partly because pediatric patients may not describe their symptoms as well as adults. Therefore, we asked this question: “Is there a diagnostic test that helps classify headache in pediatric patients in the range of 6-12 years?” If an evidence-based diagnostic test is available, it may help providers diagnose and develop management strategies.

Cervicogenic headache is common in pediatric patients and is defined by the International Headache Society as a condition caused by cervical spine dysfunction that is usually accompanied by neck pain. We chose this type of headache because it is commonly seen in chiropractic offices. With these thoughts in mind, we performed a search for office-based tests to help substantiate a diagnosis of cervicogenic headache diagnosis in a pediatric patient.

An evidence-based consideration

A PubMed search using the terms pediatric AND headache AND posture produced only a few articles. Included in this list is an article authored by Budelmann et al. describing a cross-sectional study entitled:

Is there a difference in head posture and cervical spine movement in children with and without pediatric headache?
Eur J Pediatr. 2013 (Oct); 172 (10): 1349-56

What happened in this study?

Investigators recruited 34 asymptomatic children from a high school and handball club in Germany and 30 symptomatic patients from physiotherapy departments in the Netherlands. Both groups had a mean age of 10 years (range of 6-12 years).

Criteria utilized for probable cervicogenic headaches were patient reports of:

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Variations in Patterns of Utilization and Charges for the Care of Headache in North Carolina, 2000-2009: A Statewide Claims’ Data Analysis

By Frank M. Painter|May 22, 2016|Headache|

Variations in Patterns of Utilization and Charges for the Care of Headache in North Carolina, 2000-2009: A Statewide Claims’ Data Analysis

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SOURCE: J Manip Physiol Ther. 2016 (May); 39 (4): 229–239

Eric L. Hurwitz, DC, PhD, Maria Vassilaki, MD, MPH, PhD,
Dongmei Li, PhD, Michael J. Schneider, DC, PhD,
Joel M. Stevans, DC, Reed B. Phillips, DC, PhD,
Shawn P. Phelan, DC, Eugene A. Lewis, DC, MPH,
Richard C. Armstrong, MS, DC

Office of Public Health Studies,
University of Hawai`i at M?noa,
Honolulu, HI.

OBJECTIVES: The purpose of the study was to compare patterns of utilization and charges generated by medical doctors (MDs), doctors of chiropractic (DCs), and physical therapists (PTs) for the treatment of headache in North Carolina.

METHODS: Retrospective analysis of claims data from the North Carolina State Health Plan for Teachers and State Employees from 2000 to 2009. Data were extracted from Blue Cross Blue Shield of North Carolina for the North Carolina State Health Plan using International Classification of Diseases, Ninth Revision, diagnostic codes for headache. The claims were separated by individual provider type, combination of provider types, and referral patterns.

RESULTS: The majority of patients and claims were in the MD-only or MD plus referral patterns. Chiropractic patterns represented less than 10% of patients. Care patterns with single-provider types and no referrals incurred the least charges on average for headache. When care did not include referral providers or services, MD with DC care was generally less expensive than MD care with PT. However, when combined with referral care, MD care with PT was generally less expensive. Compared with MD-only care, risk-adjusted charges (available 2006-2009) for patients in the middle risk quintile were significantly less for DC-only care.

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Mobilization and Manipulation of the Cervical Spine in Patients with Cervicogenic Headache: Any Scientific Evidence?

By Frank M. Painter|April 13, 2016|Headache|

Mobilization and Manipulation of the Cervical Spine in Patients with Cervicogenic Headache: Any Scientific Evidence?

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SOURCE: Front Neurol. 2016 (Mar 21); 7: 40 ~ FULL TEXT

Jodan D. Garcia, Stephen Arnold, Kylie Tetley,
Kiel Voight, and Rachael Anne Frank

Department of Physical Therapy,
Georgia State University ,
Atlanta, GA , USA.

Cervical mobilization and manipulation are frequently used to treat patients diagnosed with cervicogenic headache (CEH); however, there is conflicting evidence on the efficacy of these manual therapy techniques. The purpose of this review is to investigate the effects of cervical mobilization and manipulation on pain intensity and headache frequency, compared to traditional physical therapy interventions in patients diagnosed with CEH. A total of 66 relevant studies were originally identified through a review of the literature, and the 25 most suitable articles were fully evaluated via a careful review of the text.

Ultimately, 10 studies met the inclusion criteria:

(1) randomized controlled trial (RCT) or open RCT; the study contained at least two separate groups of subjects that were randomly assigned either to a cervical spine mobilization or manipulation or a group that served as a comparison

(2) subjects must have had a diagnosis of CEH

(3) the treatment group received either spinal mobilization or spinal manipulation, while the control group received another physical therapy intervention or placebo control, and

(4) the study included headache pain and frequency as outcome measurements.

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Do Manual Therapy Techniques Have a Positive Effect on Quality of Life in People With Tension-type Headache?

By Frank M. Painter|March 2, 2016|Headache|

Do Manual Therapy Techniques Have a Positive Effect on Quality of Life in People With Tension-type Headache? A Randomized Controlled Trial

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SOURCE: Eur J Phys Rehabil Med. 2016 (Feb 29) [Epub]

Gemma V. Espí-López , Cleofas Rodríguez-Blanco, Angel Oliva-Pascual-Vaca, Francisco J. Molina-Martínez, Deborah Falla

Department of Physiotherapy,
University of Valencia,
Valencia, Spain

BACKGROUND: Controversy exists regarding the effectiveness of manual therapy for the relief of tension-type headache (TTH). However most studies have addressed the impact of therapy on the frequency and intensity of pain. No studies have evaluated the potentially significant effect on the patient’s quality of life.

AIM: To assess the quality of life of patients suffering from TTH treated for 4 weeks with different manual therapy techniques.

DESIGN: Factorial, randomized, single-blinded, controlled clinical trial.

SETTING: Specialized center for the treatment of headache.

POPULATION: Seventy-six (62 women) patients aged between 18 and 65 years (age: 39.9 ± 10.9) with either episodic or chronic TTH.

METHODS: Patients were divided into four groups: suboccipital inhibitory pressure; suboccipital spinal manipulation; a combination of the two treatments; control. Quality of life was assessed using the SF-12 questionnaire (considering both the overall score and the different dimensions) at the beginning and end of treatment, and after a one month follow-up.

RESULTS: Compared to baseline, the suboccipital inhibition treatment group showed a significant improvement in their overall quality of life at the one month follow-up and also showed specific improvement in the dimensions related to moderate physical activities, and in their emotional role. All the treatment groups, but not the control group, showed improvements in their physical role, bodily pain, and social functioning at the one month follow-up. Post treatment and at the one month follow-up, the combined treatment group (suboccipital inhibitory pressure and suboccipital spinal manipulation) showed improved vitality and the two treatment groups that involved manipulation showed improved mental health.

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Upper Cervical and Upper Thoracic Manipulation Versus Mobilization and Exercise in Patients with Cervicogenic Headache

By Frank M. Painter|February 10, 2016|Headache|

Upper Cervical and Upper Thoracic Manipulation Versus Mobilization and Exercise in Patients with Cervicogenic Headache: A Multi-center Randomized Clinical Trial

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SOURCE: BMC Musculoskel Disord. 2016 (Feb 6); 17 (1): 64

James R. Dunning, Raymond Butts, Firas Mourad,
Ian Young, Cesar Fernandez-de-las Peñas st. al.

Alabama Physical Therapy & Acupuncture,
Montgomery, AL, USA

BACKGROUND: Although commonly utilized interventions, no studies have directly compared the effectiveness of cervical and thoracic manipulation to mobilization and exercise in individuals with cervicogenic headache (CH). The purpose of this study was to compare the effects of manipulation to mobilization and exercise in individuals with CH.

METHODS: One hundred and ten participants (n = 110) with CH were randomized to receive both cervical and thoracic manipulation (n = 58) or mobilization and exercise (n = 52). The primary outcome was headache intensity as measured by the Numeric Pain Rating Scale (NPRS). Secondary outcomes included headache frequency, headache duration, disability as measured by the Neck Disability Index (NDI), medication intake, and the Global Rating of Change (GRC). The treatment period was 4 weeks with follow-up assessment at 1 week, 4 weeks, and 3 months after initial treatment session. The primary aim was examined with a 2-way mixed-model analysis of variance (ANOVA), with treatment group (manipulation versus mobilization and exercise) as the between subjects variable and time (baseline, 1 week, 4 weeks and 3 months) as the within subjects variable.

RESULTS: The 2X4 ANOVA demonstrated that individuals with cervicogenic headache (CH) who received both cervical and thoracic manipulation experienced significantly greater reductions in headache intensity (p < 0.001) and disability (p < 0.001) than those who received mobilization and exercise at a 3-month follow-up. Individuals in the upper cervical and upper thoracic manipulation group also experienced less frequent headaches and shorter duration of headaches at each follow-up period (p < 0.001 for all). Additionally, patient perceived improvement was significantly greater at 1 and 4-week follow-up periods in favor of the manipulation group (p < 0.001).

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