Physical Examination and Self-Reported Pain Outcomes From a Randomized Trial on Chronic Cervicogenic Headache

Journal of Manipulative and Physiologic Therapeutics

Volume 33, Issue 5, Pages 338-348 (June 2010)
Darcy Vavrek, ND, MSa, Mitchell Haas, DC, MAb, Dave Peterson, DCc
Received 23 July 2009; received in revised form 17 November 2009; accepted 29 November 2009.



Abstract

Objective

Objective clinical measures for use as surrogate markers of cervicogenic headache (CGH) pain have not been established. In this analysis, we investigate relationships between objective physical examination (PE) measures with self-reported CGH outcomes.



Methods

This is an exploratory analysis of data generated by attention control PE from an open-label randomized clinical trial. Of 80 subjects, 40 were randomized to 8 treatments (spinal manipulative therapy or light massage control) and 8 PE over 8 weeks. The remaining subjects received no PE. Physical examination included motion palpation of the cervical and upper thoracic regions, active cervical range of motion (ROM) and associated pain, and algometric pain threshold evaluated over articular pillars. Self-reported outcomes included CGH and neck pain and disability, number of CGH headaches, and related disability days. Associations between PE and self-reported outcomes were evaluated using generalized linear models, adjusting for sociodemographic differences and study group.



Results

At baseline, number of CGH and disability days were strongly associated with cervical active ROM (P < .001 to .037). Neck pain and disability were strongly associated with ROM-elicited pain (P < .001 to .035) but not later in the study. After the final treatment, pain thresholds were strongly associated with week 12 neck pain and disability and CGH disability and disability days (P ≤ .001 to .048).



Conclusions

Cervical ROM was most associated with the baseline headache experience. However, 4 weeks after treatment, algometric pain thresholds were most associated. No one PE measure remained associated with the self-reported headache outcomes over time.

a Assistant Professor of Research, Center for Outcomes Studies, Western States Chiropractic College, Portland, Ore
b Dean of Research, Center for Outcomes Studies, Western States Chiropractic College, Portland, Ore
c Professor of Chiropractic Sciences, Western States Chiropractic College, Portland, Ore

Submitted requests for reprints to: Darcy Vavrek, ND, MS, Center for Outcomes Studies, Western States Chiropractic College, 2900 132nd Avenue, Portland, OR 97230-3009