Abstract:
This case report discusses the treatment of 2 patients with cervicogenic headache (CHA) attending the Outpatient Clinic of the Hungarian National Institute for Rheumatology and Physiotherapy (Budapest, Hungary) and reviews the pathophysiology, therapeutic strategy, and problems associated with the treatment of CHA.

Discussion:
Patient 1 was a 27-year-old female who sustained a whiplash injury. A sharp. shooting headache developed, readily induced, and aggravated by just bending the neck backward or by turning her head. Magnetic resonance imaging revealed a disk protrusion at C4-05 pressing the anterior cerebrospinal space. Patient 2 was a 62-year-old female who sustained a whiplash injury; her cervical movements became restricted, which precipitated headaches. Magnetic resonance imaging revealed a paramedian disk hernia between the C4 and C5 vertebrae that intruded into the right ventral cerebrospinal space.

After 4 weeks of manipulative therapy for patient 1, both active and passive range of motion returned to normal, and the high tumor necrosis factor-a (TNF-cx) level (63 pg/mL) was substantially reduced (28 pg/mL). Patient 2 was started on manipulative therapy twice a week for 4 weeks; after 2 months, the patient became symptom-free. and high INF-a level (72 pg/mL) was reduced greatly (35 pg/mL).

Conclusion:
Two patients with whiplash injury and disk herniation developed CHA associated with very high INF-a levels. After manipulative therapy, these patients became symptom-free, and their INF-a levels decreased substantially.

Reference:
Ormos G, Mehrishi JN, Bakacs. Reductions in high blood tumor necrosis factor-alpha levels after manipulative therapy in 2 cerviogenic headache patients. J of Manipulative and Physiol Ther. 2009 Sep;32(7):586-91. doi: 10.1016/j.jmpt.2009.08.006 https://www.ncbi.nlm.nih.gov/pubmed/19748410

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