M.Tech. / Objective. Previous studies have provided evidence of cervical manipulation as an effective treatment in the management of cervicogenic headache reduction, however there is no record of studies ascertaining the effectiveness of biomechanical pelvic blocking in such treatment. This controlled clinical trial aimed at establishing biomechanical pelvic blocking as an alternative treatment for cervicogenic headaches yielding similar results. Methods. In this study 30 participants between the ages of 18 and 60, symptomatic of cervicogenic headaches were included in the clinical trial. These 30 participants divided in to three groups of equal size by means of random selection. Group A received cervical spine manipulation only, group B received biomechanical pelvic blocking and group C was treated by means of both cervical spine manipulation and biomechanical pelvic blocking. The design of this pilot study was such that the spinal manipulative therapy was the control between the groups, therefore allowing us to identify whether biomechanical pelvic blocking was effective in the treatment of cervicogenic headaches. The patients were treated 6 times, twice weekly over a period of three weeks. Objective data collected on the first, third and sixth visits by means of the Saunders digital inclinometer. Cervical Range of Motion digital inclinometry measurements taken were that of forward flexion, extension and both right and lateral flexion. Subjective data collected by means of The Numerical Pain Rating Scale and Mc Gill Pain Questionnaire as well as the Neck Disability Index. The Numerical Pain Rating Scale and the Mc Gill Pain Questionnaire measured the headache pain intensity and the Neck Disability Index ascertained the degree of cervical disability as well as neck pain intensity experienced by the patients. These questionnaires were completed by the patient on the first, third and sixth consultation. Results. In terms of the digital inclinometry assessment, statistically significant results existed although not consistently for the same group per ROM. Extension showed Group C demonstrating the greatest increase in terms of cervical extension range of motion. Statistically significant difference existed between the groups for extension ROM. Forward flexion calculated as the most improved for group C however, no statistically significant difference existed. Group A proved most effective in increasing both cervical left and right lateral flexion range of motion. The reliability of digital inclinometer in obtaining accurate measurements is questionable. The subjective data although overall no statistically significant difference was noted between the groups for the period of the treatments, a definite clinical significance was established, group A did show the greatest overall improvement in pain intensity. Group C followed group A, the difference between these groups indicating the small relevance of the pelvic blocking. The Neck Disability Index demonstrated the greatest improvement within group C followed by group A and then group B. This marked improvement in group C in comparison to group’s A and B is suggestive of the immediate effects of cervical manipulative therapy as well as the spinal compensation due to treatment of the pelvis by the means of blocking. As this questionnaire, serves to establish the patients’ perception in terms of cervical pain and disability it indicated the biomechanical pelvic blocking to be questionably effective in the improvement in neck disability and pain.

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Cervicogenic headache is a disorder that is gaining more recognition in the medical field annually. Although a lot of controversy surrounds cervicogenic headache due to its wide array of symptoms and overlap with pre-existing primary headaches, there are many etiologies and treatment procedures that currently exist. The aim of this study was to determine the most effective treatment protocol for cervicogenic headache by comparing three different research trials from the University of Johannesburg Chiropractic day clinic (former Technikon Witwatersrand Chiropractic day clinic) within a two-year period. The treatment protocols that were compared were cervical spinal manipulative therapy, a combination of cervical spinal manipulative therapy and cervical strengthening exercises, temporomandibular joint manipulative therapy and postural correction of the lumbar spine to decrease anterior head carriage. Seventy-eight participants from a possible 96 candidates were contacted telephonically and asked verbal consent to participate in the research trial. The participants were required to complete a telephonic questionnaire that was drawn up by the researcher involved with the aid of a statistical consultant. The questionnaire took 5 minutes to complete. The aim of the questionnaire was to assess the percentage of participants who were currently suffering from headache and the severity, duration and frequency of their headaches. Participants also needed to compare their current and previous headaches. The data was statistically analysed using cross tabulations and CHI squared tests. Statistical significance was calculated using Fischer’s exact test and Phi test for the two-by-two tables, while the Pearson test and Cramer’s V test was performed on tables larger than two-by-two. Statistical analysis revealed that the manipulation groups provided relief for up to three months, after which, symptoms recurred. The group that received the Easy Back Postural Correction Device showed the greatest improvement of symptoms in terms of headache free duration and decrease in current headache severity, duration and frequency. It can thus be concluded that postural correction of the lumbar spine, which in turn corrects anterior head translation, is the treatment of choice for cervicogenic headache. / Dr. M. Moodley Dr. R. van Zyl

M.Tech. / The primary aim of this investigation was to evaluate the possible effectiveness of a cervical support pillow in combination with cervical spine manipulation versus cervical spine manipulation alone, in the management of cervicogenic headache. The secondary aim of this study was to compare the efficacy of a cervical support pillow (Top Pillow) to the efficacy of the cervical support pillow used by Ross (2002) in the management of cervicogenic headache. During this study, thirty participants were recruited. The participants were divided into three groups of ten each. The three groups received the following treatments over a 3 week period: • Group one only received chiropractic cervical adjustments • Group two received a cervical support pillow and chiropractic cervical adjustments • Group three received only a cervical support pillow. After the treatment was concluded the recorded data was submitted to the staff at STATKON where the data was analysed using the Statistical Package for Social Sciences. The results of the clinical trial revealed that the group that received chiropractic manipulation and the cervical support pillow showed the most significant changes of all three the groups in all planes of cervical range of motion, with all the results being statistically significant. The group that only received chiropractic manipulation also exhibited a significant increase in all planes of cervical range of motion, with only extension not being statistically significant. The group that only received a cervical support pillow, revealed a statistically significant increase in almost all planes of cervical range of motion except for flexion where no increase was noted the increases were, however, still markedly less than those of the former two groups that received chiropractic adjustments to specific restricted motion segments. With regard to perceived pain measured on the Numerical Pain Rating Scale, the two groups that received chiropractic adjustments improved to a much greater degree than the group that only received a cervical support pillow. With regard to Vernon-Mior Neck Pain and Disability Index all three groups had a statistically significant decrease in the perception of disability although the adjustment groups once again showed a much greater decrease in disability than the pillow only group. The already proven benefits that patients with cervicogenic headache receive from chiropractic spinal manipulation, can be successfully supplemented by the use of a cervical support pillow and the top pillow performed better than the pillow used by Ross et al. (2002) in the treatment of cervicogenic headache.

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