PMID- 37261421 OWN - NLM STAT- MEDLINE DCOM- 20231120 LR - 20240109 IS - 2042-6186 (Electronic) IS - 1066-9817 (Print) IS - 1066-9817 (Linking) VI - 31 IP - 6 DP - 2023 Dec TI - Utilizing directional preference in the management of cervicogenic headache: a case series. PG - 466-473 LID - 10.1080/10669817.2023.2217592 [doi] AB - BACKGROUND/PURPOSE: Headaches are among the most common complaints requiring medical care, and annual expenditures for this condition are estimated to be 14 billion US dollars. The International Headache Society (IHS) describes cervicogenic headache (CGH) as a secondary type of headache emanating from the cervical spine which may be referred to one or more regions of the head and/or face. Mechanical Diagnosis and Therapy (MDT) is an approach shown to be effective in the management of spinal musculoskeletal disorders; however, there is limited evidence as to its efficacy in the management of CGH. The purpose of this case series was to examine the MDT approach in the assessment, classification, and management of a sample of patients experiencing cervicogenic headache. CASE DESCRIPTION: This study was a prospective case series. Following IRB approval, 15 patients meeting the study inclusion criteria were recruited from a hospital-based outpatient physical therapy clinic. All subjects received a physical therapy examination by a Diploma trained MDT clinician which included but was not limited to patient self-report forms and the testing of repeated end range movements. The Numerical Pain Rating Scale (NPRS), Neck Disability Index (NDI), Headache Disability Index (HDI), Yellow Flag Risk Form (YFRF), Cervical Flexion Rotation Test (CFRT), and the Craniocervical Flexion Test (CCFT) were administered at the initial visit, 5th visit, and 10th visit or discharge, whichever occurred first. The NPRS, NDI, and HDI were re-administered at a 3 month follow up. Following the initial examination, patients were classified into the MDT categories of derangement, dysfunction, postural, or 'other' and then received intervention based on directional preference. OUTCOMES: Fifteen subjects (mean age, 45.9 years; F = 11, M = 4; symptom duration, 44.3 months; average visits, 8.8) received an examination and intervention and completed follow-up outcome measures. Based on MDT classification criteria, all 15 subjects in this case series were classified as derangements. A non-parametric Friedman test of Powered by Editorial Manager(R) and ProduXion Manager(R) from Aries Systems Corporation differences among repeated measures was conducted on all outcome measures revealing statistically significant improvements in NPRS (p < .01), NDI(p < .01), and HDI (p < .01) scores at visit 10 and 3 month follow up. The mean change scores exceeded the minimal clinical important difference (MCID) for NPRS (4.2), NDI (7.6), and HDI (28.5). CCFT scores improved significantly from the initial examination to visit 5 (p < .01) and YFRF scores improved significantly between visits 5 and 10 (p < .01). DISCUSSION/CONCLUSION: The diagnosis of CGH is difficult to determine based on pathoanatomical assessment. This case series suggests that the patient's response to repeated end range movements may indicate a directional preference for manual procedures and exercises which may be used in management of musculoskeletal conditions such as CGH. FAU - Pu, Lan Lin AU - Pu LL AD - Faith Regional Health Services, Department of Physical Therapy, Norfolk, NE, USA. FAU - Miller, Eric AU - Miller E AD - Program in Physical Therapy, D'Youville University, Buffalo, NY, USA. FAU - Schenk, Ronald AU - Schenk R AD - Department of Physical Therapy, Tufts University School of Medicine, Boston, MA, USA. LA - eng PT - Case Reports PT - Journal Article DEP - 20230601 PL - England TA - J Man Manip Ther JT - The Journal of manual & manipulative therapy JID - 9433812 SB - IM MH - Humans MH - Middle Aged MH - Cervical Vertebrae MH - Headache/therapy MH - *Musculoskeletal Diseases MH - Physical Examination MH - *Post-Traumatic Headache/therapy MH - Risk Factors MH - *Spinal Diseases MH - Male MH - Female PMC - PMC10642309 OTO - NOTNLM OT - Directional preference OT - Headache OT - Psychosocial risk COIS- No potential conflict of interest was reported by the author(s). EDAT- 2023/06/01 13:10 MHDA- 2023/11/13 06:42 PMCR- 2024/06/01 CRDT- 2023/06/01 10:53 PHST- 2024/06/01 00:00 [pmc-release] PHST- 2023/11/13 06:42 [medline] PHST- 2023/06/01 13:10 [pubmed] PHST- 2023/06/01 10:53 [entrez] AID - 2217592 [pii] AID - 10.1080/10669817.2023.2217592 [doi] PST - ppublish SO - J Man Manip Ther. 2023 Dec;31(6):466-473. doi: 10.1080/10669817.2023.2217592. Epub 2023 Jun 1.