• Journal of International Academy of Physical Therapy Research
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• v.9 no.3
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• pp.1564-1570
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• 2018

The International Headache Society (IHS) has validated cervicogenic headache (CGH) as a secondary headache type that is hypothesized to originate due to nociception in the cervical area. CGH is a common form of headache and accounts for 15% to 20% of all chronic and recurrent headaches. CGH is commonly treated with manual and exercise therapy. To date, no studies have isolated only one manual intervention in an attempt to determine its effectiveness. In this case study we present a 28-year-old patient with right upper cervical (UC) and occipital pain who responded well to a single manual intervention technique. This technique was applied in isolation for the first three visits and two therapeutic exercises prescribed on the fourth and fifth visit. In total, manual and exercise intervention occurred over 8 visits at which point in time the patient was discharged with no UC motion impairments, an NPRS rating of 0, a NDI and HDI demonstrating a 100% improvement and a 37% improvement in FOTO score. The traction based manual intervention and two therapeutic exercises prescribed for this patient were successful in relieving UC pain and CGH. At six months follow up, the patient was still symptom free.

• Journal of Acupuncture Research
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• v.34 no.3
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• pp.131-138
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• 2017

Objectives : This study examined the effects of miniscalpel acupuncture (MA) in three patients with cervicogenic headache. Methods : Patients were treated with MA, which was performed once per week for three weeks. A headache score, visual analogue scale (VAS), and neck disability index (NDI) were used for the evaluation of treatment effects. Results : In cases 1, 2, and 3, the headache score decreased from 4 to 1, 3 to 0, and 3 to 1, respectively. The VAS score decreased from 8.5 to 1.9, 5 to 0.4, and 5.3 to 2 in cases 1, 2, and 3, respectively. The NDI score decreased from 28 to 4, 50 to 4, and 38 to 16 in cases 1, 2, and 3, respectively. Conclusion : MA appears to be effective for the treatment of cervicogenic headache. Further data should be collected and a comparative study using other treatment methods should be performed.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.12 no.1
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• pp.1-12
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• 2017

Objective : The purpose of this study is to review the randomized clinical trials of Chuna manual therapy for cervicogenic headache and provide a evidence for the efficacy of Chuna manual therapy. Methods : We searched randomized clinical trials that performed Chuna manual therapy for cervical headache up to Feb. 2017 in 6 databases. Randomized clinical trials were selected according to the inclusion criteria and the data were extracted and analyzed. The risk of bias was assessed using the Cochrane Risk of Bias Criteria. Results : 16 RCTs met the inclusion criteria. The meta-analysis of 13 RCTs showed favorable results for the use of chuna manual therapy compared to drug, physical treatment. Conclusions : In 16 RCTs, we found that Chuna manual therapy was effective in cervicogenic headache. However, all RCTs are exposed to a number of bias risks. Therefore, well designed clinical trial would be needed to raise the evidence level of Chuna manual therapy.

• Journal of Oriental Neuropsychiatry
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• v.30 no.2
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• pp.89-105
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• 2019

Objectives: We conducted this study to evaluate the efficacy of Chuna Manual Therapy (CMT) for treatment of cervicogenic headache (CeH) through systematic review and Meta-analysis of randomized controlled trials (RCTs) as a preceding research to further research the effective of Chuna Manual Therapy for patients who suffered from CeH. Methods: We conducted a systematic review and meta-analysis by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched the studies from MEDLINE, Elsevier-EMBASE, The Cochrane Library, CAJD, KISS, KMBase, Korean Traditional Knowledge Portal, NDSL, and OASIS. The studies selected only in randomized controlled trials. We selected the chosen studies by the selection and the exclusion criteria, and evaluated the quality of the selected studies using the Jadad score and the Cochran ROB tool. We used the Visual Analogue Scale score (VAS) and Clinical total Effective Rate (CER) for the results and analyzed the results of the included studies using RevMan 5.3 software provided by the Cochran library. Results: We included 20 RCTs, including 1,673 subjects, in the systematic review and meta-analysis. After the intervention, the CMT group showed better results than the pharmacotherapy group, the physiotherapy group, and the combined treatment group. The CMT group showed a good effect on the CER and the VAS but showed a significant heterogeneity compared to the pharmacotherapy group. Conclusions: The CMT as monotherapy might have benefits on Cervicogenic Headache patient. Further well-designed studies need to be conducted.

• Journal of The Korean Society of Integrative Medicine
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• v.7 no.4
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• pp.301-309
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• 2019

Purpose : The purpose of this study was to provide an effective method of exercise therapy for patients with cervicogenic headache. Methods : The subjects were divided into the following two groups according to the intervention received: cervical stretch exercise (n=15, control group) cervix-stabilizing exercise (n=15, experimental group) tone (Hz) and stiffness (N/m) of the suboccipital and upper trapezius muscles were measured. T1 slope angle and neck tilt angle were measured. After the exercise program intervention, a greater amount of change in muscle tone and stiffness of suboccipital and upper trapezius muscles was found in the experimental group, as compared to the control group. Greater amount of change in posture was found in the experimental group, as compared to the control group (p<0.05). Results : After the exercise program intervention, a greater amount of change in muscle tone and stiffness of suboccipital and upper trapezius muscles was found in the experimental group, as compared to the control group. Greater amount of change in posture was found in the experimental group, as compared to the control group (p<0.05). Conclusion : The neck-stabilizing exercise were shown to be effective in decreasing the tone of the cervical muscles by stabilizing the cervical bone and improving muscle activity, and in improving the posture by decreasing muscle tone and stiffness.

• The Journal of Internal Korean Medicine
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• v.41 no.3
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• pp.414-423
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• 2020

Background: This study examines the clinical effect on quality of life of herbal medicine and local acupuncture point stimulation administration for a cervicogenic dizziness (CGD) patient. This case report was described in accordance with CARE guidelines. Case Report: A 25 year-old female patient suspected to be suffering from CGD was examined. The patient was treated with herbal medicine and local acupuncture point stimulation. We used the Headache Impact Test-6 (HIT-6), Dizziness Handicap Inventory (DHI), Pittsburgh Sleep Quality Index (PSQI), 36-Item Short Form Health Survey Version 2 (SF-36v2), and verbal numerical rating scale (VNRS) to assess the patient's symptoms. As new herbal medicine and local acupuncture point stimulation were applied, dizziness, headache, and neck pain symptoms improved. Quality of life affected by the symptoms significantly improved. Adverse effects were not observed. Conclusions: This study may suggest that herbal medicine and local acupuncture point stimulation may be effective therapy for the treatment of typical symptoms in patients with CGD.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.28 no.2
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• pp.25-34
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• 2022

Background: Cervical headache (CGH) is a common condition that causes serious damage. Mulligan described a sustained natural apophyseal glides (SNAGs) as a manual therapy approach to treat this dysfunction. Although there have been several case studies to evaluate the effectiveness of SNAG, the efficacy of SNAG for cervical headaches is still controversial. Therefore, this study examined the effects of Mulligan's SNAG technique on cervical headache and pain intensity to present basic clinical data. Methods: Thirty-two subjects participated in this study, 16 each in the experimental and control groups. The experimental group applied Mulligan's SNAGs technique and the control group applied the placebo SNAGs technique. Results: Significant differences (p<.05) in the changes in pain, neck disability index (NDI) and Hamilton rating scale for depression (HRSD) were observed between the two groups. Conclusion: The application of Mulligan's SNAG technique to patients with cervical headaches effectively reduced headache, depression, and neck dysfunction. Based on this study, Mulligan's SNAGs technique can be used as an objective research method for additional studies targeting cervical headache patients in the future.

• Journal of Digital Convergence
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• v.19 no.6
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• pp.265-271
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• 2021

This study aimed to define the diagnostic criteria for cervicogenic headache and propose an efficient method of clinical evaluation and physical therapy. Fifteen patients with cervicogenic headache and 15 healthy individuals were recruited and categorized into the test group and the control group, respectively. The groups were compared in terms of muscle characteristics, muscle activity and posture, and the intervariable correlations were analyzed for the test group. A significant between-group difference was found in the stiffness of the suboccipital muscle and the tone and stiffness of the upper trapezius muscle (p<.001). In posture comparison, a significant difference was noted in neck tilt angle and the T1 slope angle (p<.05). The activity of the sternocleidomastoid muscle was also significantly different between the groups (p<.001). When the correlations among the muscle characteristics, the posture, and the activity of the sternocleidomastoid muscle were analyzed for the test group, a positive correlation was found between the tone and the stiffness of the suboccipital muscle (p<.001) and between the tone and the stiffness of the upper trapezius muscle (p<.001). The findings of this study suggest a more efficient approach for the assessment and treatment of cervicogenic headache patients. It is considered that, further studies including more subjects of various job categories and comparing the outcomes.

• Journal of Oral Medicine and Pain
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• v.45 no.4
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• pp.97-109
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• 2020

Purpose: Cervicogenic headache (CGH) is pain referred to the head/ face from the structures in vicinity of upper cervical spinal nerves via trigeminocervical pathway. Ponticulus Posticus (PP) and Elongated Styloid Process (ESP) are anatomical structures that cause compression of vasculature present around upper cervical nerve plexus. Recently, computational fluid dynamics (CFD) has shown to play an essential role in identification of these high-pressure zones in the brain. The aim of this research is to study the association of ESP and PP in patients with CGH and to develop a hypothesis by CFD to analyse vertebrobasilar insufficiency as a contributing factor in occurrence of CGH. Methods: Retrospective analysis of 4500 full skull CBCT scans was done for the presence of partial or complete PP and length of Styloid Process (SP). Research was divided into two phases; In first Preliminary Phase, 150 scans that showed the presence of PP and ESP were analysed, and only 134 patients gave consent to fill the questionnaire containing 96 question items pertaining to symptoms associated with CGH. In the second phase, simulation of Vertebral and Carotid Artery was done using Fluent 14.5 Software and by CFD, pressure distribution on arteries was obtained that helped to identify high pressure regions. Results: Both PP and ESP showed a statistically significant association with CGH (p<0.001). By CFD analysis, both steady and transient phases of simulation showed drop in pressure due to constriction of internal carotid and vertebral artery by ESP and PP respectively and were found to decrease the volume of blood reaching the brain, 0.12 /0.13 mL and 0.06 mL respectively. Conclusions: Our analysis proves ESP and PP as contributing factors towards CGH. Hence for proper diagnosis and management of headache disorders, clinicians should have adequate knowledge about these anatomical structures and their resulting clinical symptoms.

• The Korean Journal of Pain
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• v.33 no.3
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• pp.275-283
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• 2020

Background: Previous studies showed neurography and tractography of the greater occipital nerve (GON). The purpose of this study was determining diffusion tensor imaging (DTI) parameters of bilateral GONs and dorsal root ganglia (DRG) in unilateral cervicogenic headache as well as the grading value of DTI for severe headache. The correlation between DTI parameters and clinical characteristics was evaluated. Methods: The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values in bilateral GONs and cervical DRG (C2 and C3) were measured. Grading values for headache severity was calculated using a receiver operating characteristics curve. The correlation was analyzed with Pearson's coefficient. Results: The FA values of the symptomatic side of GON and cervical DRG (C2 and C3) were significantly lower than that of the asymptomatic side (all the P < 0.001), while the ADC values were significantly higher (P = 0.003, P < 0.001, and P = 0.003, respectively). The FA value of 0.205 in C2 DRG was considered the grading parameter for headache severity with sensitivity of 0.743 and specificity of 0.999 (P < 0.001). A negative correlation and a positive correlation between the FA and ADC value of the GON and headache index (HI; r = -0.420, P = 0.037 and r = 0.531, P = 0.006, respectively) was found. Conclusions: DTI parameters in the symptomatic side of the C2 and C3 DRG and GON were significantly changed. The FA value of the C2 DRG can grade headache severity. DTI parameters of the GON significantly correlated with HI.