Head Pain Reproduction and Resolution Behavior in Response to Sustained Mobilization of the Upper Cervical Spine: A Case Series.

Background: Reproduction and resolution of head pain with sustained upper cervical mobilization has been proposed as a diagnostic indicator of Cervicogenic Headache (CGH). However, there has been little focus on describing head pain response during the application of these maneuvers. The purpose of this study was to describe the head pain response during the performance of sustained upper cervical spine mobilization in people with probable CGH. Methods: In this case series of 20 individuals with probable CGH as defined under the International Headache Society criteria, were assessed by one experienced physiotherapist who administered five sustained upper cervical spine mobilization techniques to each participant. Reproduction of head pain during mobilization was noted. At the start, during, and end of each mobilization technique, change in head pain intensity and time taken to achieve head pain resolution was recorded. Results: Sixteen of the 20 participants experienced reproduction and resolution of head pain within 90 seconds of sustained upper cervical mobilization. This phenomenon occurred no more frequently with the mobilization of C2 than with C1. Eight patients reported this on the dominant head pain side only, 6 patients experienced this bilaterally. Neck pain was present in 13 of the 20 participants. Conclusion: From this case series, it seems that neither the duration (measured in seconds) nor the magnitude of reduction in head pain intensity was markedly different across dominant compared to non-dominant head pain sides or across cervical levels, indicating reproduction and resolution behavior is irregular. The presence of CGH without neck pain is possible.