Traditional Chinese Cervical Manipulation for Cervicogenic Headache

Inclusion Criteria: 1. The diagnostic criteria of cervical spondylosis according to "The expert consensus on the classification, diagnosis, and non-surgical treatment of cervical spondylosis (2018)" are as follows: 1. Patients must have a chief complaint of abnormal sensations such as pain in the occipital, neck, or shoulder area, and can be accompanied by related localized pain and tenderness 2. X-ray imaging shows degenerative changes in the cervical spine 3. Other conditions that could cause symptoms of the neck are excluded 2. The diagnostic criteria of CGH as listed by ICHD-3: a. Any headache fulfilling criterion C b. Clinical and/or imaging evidence of a disorder or lesion within the cervical spine or soft tissues of the neck, known to be able to cause headache c. Evidence of causation demonstrated by at least two of the following: i. headache has developed in temporal relation to the onset of the cervical disorder or appearance of the lesion ii. headache has significantly improved or resolved in parallel with improvement in or resolution of the cervical disorder or lesion iii. cervical range of motion is reduced and headache is made significantly worse by provocative manoeuvre iv. headache is abolished following diagnostic blockade of a cervical structure or its nerve supply v. Not better accounted for by another ICHD-3 diagnosis 3. Of age between 18 to 65 years old 4. Headache recurs for at least three months 5. The frequency of headaches in the past three months is at least once a week 6. The frequency, dosage, and type of painkillers have remained stable over the past 6 weeks 7. Score at least 10 points on the Neck Disability Index - Exclusion Criteria: 1. Presented with red flag presentations of headache listed in the SNNOOP10 list (systemic symptoms/signs and disease, neurologic symptoms or signs, onset sudden or onset after the age of 40 years, and change of headache pattern), including fever, vascular and non-vascular intracranial diseases, history of brain tumor, brain neurological dysfunction or disorder, etc. 2. With suspected cervical spinal stenosis, cervical spinal cord lesions, cervical vascular disease, cervical nerve root disease, cervical instability, or cervical fracture 3. Has suffered from a whiplash injury within the past 6 weeks 4. Had surgery on the neck or head 5. Currently pregnant or breastfeeding