Reduction in High Blood Tumor Necrosis Factor-α Levels After Manipulative Therapy in 2 Cervicogenic Headache Patients

Abstract 

Objective

This case report discusses the treatment of 2 patients with cervicogenic headache (CHA) attending the Outpatient Clinic of the Hungarian National Institute for Rheumatology and Physiotherapy (Budapest, Hungary) and reviews the pathophysiology, therapeutic strategy, and problems associated with the treatment of CHA.

Clinical Features

Patient 1 was a 27-year-old female who sustained a whiplash injury. A sharp, shooting headache developed, readily induced, and aggravated by just bending the neck backward or by turning her head. Magnetic resonance imaging revealed a disk protrusion at C4-C5 pressing the anterior cerebrospinal space.

Patient 2 was a 62-year-old female who sustained a whiplash injury; her cervical movements became restricted, which precipitated headaches. Magnetic resonance imaging revealed a paramedian disk hernia between the C4 and C5 vertebrae that intruded into the right ventral cerebrospinal space.

Intervention and Outcome

After 4 weeks of manipulative therapy for patient 1, both active and passive range of motion returned to normal, and the high tumor necrosis factor-α (TNF-α) level (63 pg/mL) was substantially reduced (28 pg/mL).

Patient 2 was started on manipulative therapy twice a week for 4 weeks; after 2 months, the patient became symptom-free, and high TNF-α level (72 pg/mL) was reduced greatly (35 pg/mL).

Conclusion

Two patients with whiplash injury and disk herniation developed CHA associated with very high TNF-α levels. After manipulative therapy, these patients became symptom-free, and their TNF-α levels decreased substantially.

Key Indexing Terms: Cervicogenic Headache, Tumor Necrosis Factor-α, Musculoskeletal Manipulations, Whiplash Injuries