LA TERAPIA MANUALE MIGLIORA GLI OUTCOME DI UN PAZIENTE CON CEFALEA CERVICOGENICA CRONICA RESISTENTE A TRATTAMENTO CHIRURGICO. UN CASO CLINICO

Background: Cervicogenic headache is deined as chronic headache as the result of a dysfunction of the vertebrae, discs or soft tissue of the cervical spine commonly associated with neck pain. It is the third most common headache and is classiied as a “secondary headache” from the International Headache Society. he most Recent randomized controlled trials on the conservative treatment of this condition concluded that one of the most efective treatment option is High Velocity Low Amplitude thrust spinal manipulation. However, some carefully selected patients need surgery. his clinical case report describes the conservative management (i.e. manual therapy and musculoskeletal physiotherapy) of a patient with chronic cervicogenic headache, which still sufer of persistent symptoms, even after surgery. Case Presentation: a 36-years old male seeking treatment in a direct access setting, complaining of frequent headaches since eight years, with at least five attacks a week in the last three months. In 2006, due to the failure of the pharmacological treatment, the patient underwent to his first surgery. However, following the surgical intervention, the patient still complained of an occipital headache. After eleven months of pharmacological therapy, another surgical procedure was performed. However, after the second surgery procedure, patient still reported the same symptoms. Only later the patient was sent to a specific conservative treatment with musculoskeletal physiotherapy and manual therapy. he patient received 9 treatment sessions. hen, the patient was evaluated at both 63-days follow up and at 180-days follow up from the last visit. Conclusions: he patient of this case showed a significant symptoms improvement. A better understanding of the pathophysiology, diagnosis and classification of headaches would help in the best treatment option for this complex clinical condition. Therefore, surgery should be considered as a second option if the conservative management fail in reducing headaches parameters. Manual therapy and musculoskeletal physiotherapy could be a valid alternative in the management of patients after surgery for chronic cervicogenic headache, in the absence of clear and defined postoperative therapeutic pathways. To our knowledge, this is the first case describing a manual therapy management after the failure of surgery for a patient suffering of chronic cervicogenic headache.