Palpation Enhances Headache Diagnosis

Palpation Enhances Headache Diagnosis


  • Chiropractic physicians have historically relied heavily on palpation skills in their examination process.
  • Medical physicians have been criticized for a reduction in use of manual examination and have begun to rely more solely on laboratory and radiographic examination.
  • This article affirms that manual examination of the spine enhances the diagnostic accuracy of cervicogenic headache.
  • Chiropractic physicians are well positioned to differentiate headache types due to their patient examination approach.



To evaluate the diagnostic validity of manual examination techniques used to diagnose cervicogenic headache (CGH).

Palpation Enhances Headache DiagnosisBACKGROUND:

Cervicogenic headache is a specific type of headache that originates from the cervical spine and is typically chronic in nature. Diagnostic criteria for CGH have been established by the International Headache Society (IHS) and are cited extensively in the literature. Diagnosis of CGH through manual examination is a more recent practice. To our knowledge, no systematic review of manual diagnosis of CGH has been performed.


Searches of electronic databases (CINAHL, Cochrane Library, Medline, PEDro, Scopus, and SPORTDiscus) were conducted for research studies from July 2003 to February 2014. The GRADE approach was used to determine the quality of each paper.


Twelve papers that fulfilled the inclusion and exclusion criteria were identified (12 observational studies). The level of evidence ranged from very low to low, and recommendations for use of specific manual techniques ranged from weak to strong.


Despite low levels of evidence, manual examination of the cervical spine appears to aid the diagnostic process related to CGH and can be implemented by both experienced and inexperienced examiners.


Howard PD, Behrns W, Martino MD, DiMambro A, McIntyre K, Shurer C. Manual examination in the diagnosis of cervicogenic headache: a systematic literature review. J Man Manip Ther. 2015 Sep;23(4):210-8. doi: 10.1179/2042618614Y.0000000097.


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