Spinal Manipulation and Dry Needling Versus Conventional Physical Therapy in Patients With Cervicogenic Headache

Inclusion Criteria: 1. Diagnosis of cervicogenic headache as defined by Cervicogenic Headache International Study Group criteria 2. Headache frequency of at least one per week for a minimum of 3 months 3. Minimum pain score (NPRS) of 2/10 and minimum disability score (NDI) of 10/50 Exclusion Criteria: 1. Presence of any of the following atherosclerotic risk factors: hypertension, diabetes, heart disease, stroke, transient ischemic attack, peripheral vascular disease, smoking, hypercholesterolemia or hyperlipidemia 2. Red flags noted in the patient's Neck Medical Screening Questionnaire (i.e. tumors, fracture, metabolic diseases, RA, osteoporosis, history of prolonged steroid use, etc. 3. History of whiplash injury within the last 6 weeks 4. Diagnosis of cervical stenosis 5. Bilateral upper extremity symptoms 6. Evidence of CNS involvement, to include hyperreflexia, sensory disturbances in the hand, intrinsic muscle wasting of the hands, unsteadiness during walking, nystagmus, loss of visual acuity, impaired sensation of the face, altered taste, presence of pathological reflexes (i.e. positive Hoffman's and/or Babinski reflexes). 7. Two or more positive neurologic signs consistent with nerve root compression, including any 2 of the following: 1. Muscle weakness involving a major muscle group of the upper extremity. 2. Diminished UE deep tendon reflex of the biceps, brachioradialis, triceps or superficial flexors 3. Diminished or absent sensation to pinprick in any UE dermatome. 8. Prior surgery to neck of thoracic spine 9. Involvement in litigation or worker's compensation regarding their neck pain and/or headaches 10. PT or chiropractic care treatment for neck pain or headaches in the 3 months prior to baseline exam. 11. Any condition that might contraindicate spinal manipulative therapy.