Cervicogenic headache: locus of control and success of treatment

Headache. 2003 Oct;43(9):956-61. doi: 10.1046/j.1526-4610.2003.03187.x.


Background: A number of extraneous factors have been implicated in the effectiveness of treatment of headache, including patient beliefs about aspects of the treatment or persons delivering the treatment.

Objective: The concept of external locus of control for headaches refers to patients with a high level of belief that headache and relief are influenced primarily by health care professionals. The aim of this study was to examine whether external locus of control is associated with a reduction in frequency of cervicogenic headaches among patients treated by a physiotherapist.

Design: A recent randomized controlled trial of the effectiveness of physiotherapy among 200 patients with headache enabled a test of this relationship. Treatment consisted of manipulative therapy, therapeutic exercise, or a combination of the 2. Analysis of relative change in headache frequency was conducted after 6 weeks of treatment and at 3- and 12-month follow-up appointments.

Results: Results of the analysis indicated that participants with relatively high external Headache-Specific Locus of Control scores were more likely to achieve a reduction in headache frequency if they received the combined manipulative therapy and exercise therapy, compared with those who received no treatment. This was not determined for the group who received manipulative therapy, which is a treatment received passively by the patient.

Conclusions: The interpretation of these findings is considered in the context of nongeneralization to the other physiotherapy treatment groups and sustained reduction in headache frequency following withdrawal of treatment. The pattern of findings suggests that characteristics of the therapy were more pertinent than characteristics of the therapist.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Analgesics / therapeutic use
  • Female
  • Headache Disorders / psychology*
  • Headache Disorders / therapy*
  • Humans
  • Internal-External Control*
  • Male
  • Middle Aged
  • Musculoskeletal Manipulations
  • Physical Therapy Modalities*
  • Prospective Studies
  • Treatment Outcome


  • Analgesics