Manual Treatment For Cervicogenic Headache And Active Trigger Point In The Sternocleidomastoid Muscle

Cervicogenic headache (CeH) is a secondary headache, which means “head pain with a cervical source.”  It is characterized by unilateral headache with symptoms and signs of neck involvement, for example, pain by movement, by external pressure over the upper cervical, and/or sustained awkward head positions. Physical therapy is commonly used for the management of individuals with CeH. A survey study conducted in Australia revealed that upper cervical spine mobilization or manipulation was the most used intervention by physical therapists.

The author wanted to determine feasibility of a clinical trial to measure the effects of manual therapy on sternocleidomastoid active trigger points (TrPs) in patients with cervicogenic headache (CeH). They included twenty patients with a clinical diagnosis of CeH and active TrPs in the sternocleidomastoid muscle which were randomly divided into 2 groups. One group received TrP therapy and the other group received simulated TrP. The primary outcome was headache intensity (numeric pain scale) and secondary outcomes included neck pain intensity, cervical range of motion (CROM), pressure pain thresholds (PPT) over the upper cervical spine joints and deep cervical flexors motor performance. Outcomes were captured at baseline and 1 week after the treatment.

The results showed that patients receiving TrP therapy showed greater reduction in headache and neck pain intensity than those receiving the simulation. Patients receiving the TrP therapy experienced greater improvements in motor performance of the deep cervical flexors, active CROM, and PPT than those receiving the simulation.

The findings show that manual therapy targeted to active TrPs in the sternocleidomastoid muscle may be effective for reducing headache and neck pain intensity and increasing motor performance of the deep cervical flexors, PPT, and active CROM in individuals with CeH showing active TrPs in this muscle.


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Ina Diener
Ina Diener
August 28, 2013 at 4:11 am

Nice study. We always have to remember that migraine/tension-type headaches may also have SCM trigger points. Treating any nociceptive input to the Trigemino-Cervical Nucleus may reduce headache – so actually the word cervicogenic headache which is used currently, should change to musculo-skeletal headache, as that is what manual therapists are actually treating

Erik Thoomes
Erik Thoomes
August 28, 2013 at 11:02 am

An interesting study. I would be keen to know what the “clinical diagnosis” of CeH included exactly; which tests were used, were the criteria of the IHS followed etc? Also it would be of interest to know if all patients in the active intervention group actually all had Triggerpoints RELEVANT to their clinical diagnosis and if so how was this established? And last but not least: comparing an intervention to a sham is not evidence of effectiveness of the intervention…

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