Case Study: Management of Chronic Cervicogenic Headache with Associated Thoracic Dysfunction

For this month’s Clinical Insight, we’ve created something a bit different. A 69-year old female patient recently presented to our team with a chronic history of headache and cervical dysfunction.

This is an interesting example of a complex condition, that requires a bespoke approach offered by clinicians with a manual therapy background.

In collaboration with this patient, we have worked on a comprehensive summary of her case and the treatment approach that we took that includes:

– A first-hand account of her symptoms: Patient Story: View Video
– Our clinical approach to this case: Clinical Case Study: Management of Chronic Cervicogenic Headache with Associated Thoracic Dysfunction
– A collation of evidence from the literature on chronic cervicogenic headache with associated thoracic dysfunction: Evidence-Based Review: Making sense of common headache presentations in Musculoskeletal Physiotherapy: Differentiation, assessment, and treatment

Prioritising the Patient Voice

This Clinical Insight has been developed as part of our commitment to ensuring the patient voice sits centrally within our conversations as clinicians. 

We hope these resources offer you a blended, evidence-informed approach that integrates patient narrative, clinical expertise and a review of current research.  

This approach enables the application of broad evidence-based principles while maintaining a person-centred focus, ensuring that interventions are both clinically appropriate and individually relevant.  

Furthermore, it supports the integration of best available evidence across musculoskeletal practice. 

Patient Reflection

We asked Kathryn to reflect on the symptoms that she initially presented with:  

“I suffered with chronic debilitating headaches for about five years. My symptoms have been extreme. It started in my shoulder, travelled up in my head and into my eye, to the point where I’d have to go to bed three times a day. I just literally couldn’t function at times. 

“I had physio, massages, an MRI. I had so many scans, which all told me there was literally nothing wrong with me. But now I can move my head, I couldn’t move it beyond a certain point at its worst moments. 

“I got scared of actually exercising because it might do more damage. 

“You become very scared of doing something that might exacerbate it, that might make things even worse. 

“When I have a setback, and I’ve literally no idea when it will happen, why it happens or what it is that happens, that knocks my confidence a little bit.” 

Clinical Case Study

The patient described a five-year history of headache distributed in a trigeminal pattern, predominantly affecting the left side of the head and extending into the eye region. Symptoms were reported as a burning sensation, with pain intensity ranging from 4/10 to 8/10, occurring daily and persistently. For more information on this, read the clinical case study entitled Management of Chronic Cervicogenic Headache with Associated Thoracic Dysfunction.

Evidence-Based Review

For clinicians seeking a deeper understanding of the evidence underpinning this approach, a detailed review is available as a downloadable PDF here: Making sense of common headache presentations in Musculoskeletal Physiotherapy: Differentiation, assessment, and treatment. (Written by Dr Neil Langridge)  

Conclusion

This clinical case study integrates three key sources of evidence to guide support for people with neck-related headache: the patient’s story, the clinical findings, and the current research on the condition. By bringing these together, we can provide an evidence-based approach tailored to each patient’s needs. This triad of patient perspective, clinical expertise, and research evidence is widely recognised as best practice for ensuring that care is evidence-informed, person-centred, and appropriately applied.