Case Description: At the initial evaluation the patient reported 2-3 year history of headaches. She was experiencing headaches 3-4 times per week and headaches lasted 3-4 hours per episode. When headaches were present she would have difficulty focusing at work, difficulty being active with fitness, and difficulty turning her head to check blind spots while driving.

Objective Measures: The patient was seen for 7 physical therapy visits over the course of 1 month.

Tests and Measures	Initial Evaluation	Day of Discharge from Physical Therapy
Pain	0-7/10	0/10. No headache in 3 weeks
Headache Disability Index	14	8
Mobility	Restricted cervical retraction (50% normal limits)	Improved cervical retraction ROM (75% normal limits)
Daily Tasks	difficulty focusing at work, difficulty with playing travel tennis, difficulty checking blind spots	Able to focus at work, able to play tennis without limitation, able to turn head to check blind spots without limitation

Findings were consistent with cervicogenic headache. Pt responded very well to directional preference exercises to the cervical spine per the McKenzie Method and to postural exercises. She was able to use exercise to restore cervical mobility, reduce muscle tension, and resolve headaches. At discharge the patient reported she hadn’t experienced headaches in over 3 weeks. She had met all therapy goals. She was independent with a home exercise program to maintain improvements.

Jeremy Decker, PT, DPT
Full Potential Physical Therapy