J Manipulative Physiol Ther. 1994 Jul-Aug; 17(6): 369-75.

The effect of manipulation (toggle recoil technique) for headaches with upper cervical joint dysfunction: a pilot study.

Whittingham W, Ellis WB, Molyneux TP.

Faculty of Biomedical and Health Sciences, School of Chiropractic and Osteopathy, R.M.I.T., Melbourne, Australia.

OBJECTIVE: The objective of this pilot study was to investigate the effect of spinal manipulation for the relief of chronic headache of cervical origin, utilizing a specific technique, toggle recoil, to treat the two upper cervical vertebrae. This study will help delineate the design for a future, larger study. DESIGN: Twenty-six patients were accepted for a continuous time series analysis (6 wk) design. SETTING: Chiropractic outpatient research clinic. PATIENTS: The patients--16 females (average age 42.1 yr, SD 11.03) and 10 males (average age 52.1 yr, SD 10.69) all had chronic headaches (> 3 mo) with upper cervical joint dysfunction. INTERVENTION: All the patients received four upper cervical toggle recoil adjustments over a 2-wk period. MAIN OUTCOME MEASURES: Standardized headache history, daily questionnaires for the duration of the trial, measuring; frequency; and severity of the headache, plain film with dynamic spinal radiographs and motion palpation. RESULTS: The results indicate statistically significant outcomes (p < .001) that indicate changes in headache frequency, duration and severity in all but two of the patients. The overall duration of headaches decreased from 110 hr pretreatment to 25 hr posttreatment, a decrease of 77%. The overall score for severity dropped from 55 to 22--a 60% improvement in perceived pain. The frequency of headaches over a 2-wk period dropped from 18 to 7, an improvement of 62%. CONCLUSIONS: Since the results of this pilot study were not adequately controlled they cannot be seen as proof supporting the clinical efficacy of manipulation for chronic headaches. However, as a group for duration, severity and frequency all measures were significant. These findings would suggest that further study of upper cervical manipulation for the treatment of chronic headaches with upper cervical joint dysfunction in a randomized, controlled clinical trial is needed.