Therapeutic strategy with indirect spinal manipulations in C2-C3 segments for long-term treatment of cervicogenic headache.

Cervicogenic Headache (CGH) is a secondary type headache, associated with dysfunction in upper cervical segments (C1-C2-C3) and manifested by specific clinical features. It is unilateral, starting from one side of the posterior head and neck, migrating to the front, sometimes associated with ipsilateral arm discomfort and, in addition, neuralgia with ipsilateral conjunctival inection. Our research is based on 29 patients (with average age of 49.78 years ± 10.41 (34-73)) with headache: 19 females and 10 males. We examined the active range of motion (AROM). We used palpatory maneuvers, finding local symptoms (facet joints' tenderness) and symptoms in the segmental territory - cellulalgia in the supraorbital and submandibular region (found by the pinch-roll test - PR-SO and PR-SM). The clinical examination before and immediately after the indirect high velocity low amplitude (HVLA) manipulations, as well as at the end of treatment, showed a significant reduction in the Visual Analogue Scale (VAS) score, in local symptoms and especially in measurable indicators - skin fold (PR-SO and PR-SM) in mm. (p<0.01 and p<0.001). Our study shows that indirect HVLA-spine manipulations have an invariable place in the treatment of cervicogenic headache.