Headache symptom modification: the relevance of appropriate manual therapy assessment and management of a patient with features of migraine and cervicogenic headache – a case report

ABSTRACT

Objectives

People who suffer from headache frequently present with multiple headache forms and the precise diagnosis of the dominant headache form can be challenging. This case report describes a headache symptom modification approach in the diagnosis and management of a patient presenting with combined features of chronic migraine and cervicogenic headache (CGH).

Methods

A 28-year-old female presented with combined features of chronic migraine and CGH diagnosed according to guidelines published by the International Headache Society. Her main complaints were frequent and severe headache along with frequent neck pain and disability. Symptom modification based on the Mulligan Concept was utilized for assessment of musculoskeletal dysfunction associated with headache which identified upper cervical articular impairment. Impairments were also identified in craniocervical muscle control and endurance. Interventions comprised six sessions of Mulligan manual therapy to address cervical spine impairments, exercise for craniocervical control and endurance, as well as patient education.

Results

Headache frequency at 6 months follow up was reduced from 16 to 3 days per month and intensity from 72 to 23 on Visual Analogue Scale. Clinically relevant improvements were also found in headache duration, pressure pain thresholds, medication intake and Headache Activities of Daily Living Index post-treatment and continued up to 6 months follow-up without adverse events.

Discussion

This case report illustrates the use of a manual therapy symptom modification approach in the management of headache. Improvement in headache symptoms and disability suggests that the musculoskeletal impairments and headache symptoms were more a feature of CGH rather than migraine. The mechanisms underlying these changes in symptoms and impairments are discussed.

KEYWORDS:

• Headache
• migraine
• cervicogenic headache
• manual therapy
• upper cervical spine
• FRT
• C0-C2 axial rotation test
• musculoskeletal

Disclosure statement

Kiran Satpute and Toby Hall are Accredited Mulligan Concept teachers and gain a teaching fees when running these courses.

Additional information

Notes on contributors

Kiran Satpute

Kiran Satpute [M.P.Th. Musculoskeletal, C.O.M.T.] is a Associate Professor and Head of Musculoskeletal Department at Smt. Kashibai Navale College of Physiotherapy, India. He is a PhD Scholor at Sancheti College of Physiotherapy.

Nilima Bedekar

Dr. Nilima Bedekar [Msc PT (UK) PhD PT, MCSP] is a Phd Guide, Professor and Head of Musculoskeletal Department at Sancheti College of Physiotherpy, India.

Toby Hall

Dr. Toby Hall [PhD, FACP] is a Specialist Musculoskeletal Physiotherapist and Adjunct Associate Professor at Curtin University Australia.