Inclusion criteria | Exclusion criteria |
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- 18 years of age and older - History of CGH ≥ 3 months at Baseline 1, ≥5 days of CGH per month - CGH intensity ≥3 (0–10 scale) - Cervical spine dysfunction (cervical joint tenderness and/or restricted segmental motion) - Clear temporal sequence linking the source of CGH to the neck: headache preceded by neck pain, stiffness, movement and/or awkward postures - English literate - Independent ambulation | - Other headaches within one year of enrollment (e.g. migraine occurring on >1 day per month in the last year, medication overuse, daily, cluster, temporomandibular joint dysfunction related headaches, sinus, posttraumatic, tumor and glaucoma related, occipital neuralgia, metabolic/toxic/substance abuse related). - Spinal manipulative therapy, massage or exercise therapy for neck pain or headaches in the previous 3 months. Any other types of care by a licensed provider in the previous month for headaches or neck pain - Contraindications to study treatments (e.g., inflammatory arthropathies, cervical instability, severe osteoporosis, vertigo, dizziness) - Daily prescription or nonprescription pain medication; corticosteroid use in previous month - Cancer in the past five years - Cardiovascular comorbidities (e.g., history of stroke, transient ischemic attacks, stage 2 hypertension, taking anticoagulant medication, syncope, myocardial infarction, hemophilia) - Neurological comorbidities (e.g., multiple sclerosis, ALS, Parkinson’s, myelopathy, seizures, cervical radiculopathy, herniated disc, thoracic outlet syndrome, brachial plexus neuropathy) - Spinal pathology (e.g., infection, tumor, fracture, diffuse idiopathic skeletal hyperostosis, degenerative joint disease, stenosis) - Involved in a research study about pain - Active or pending medical litigation, personal injury, workers compensation; disability compensation - Noncompliance with headache diary at baseline (<24/28 days completed); pre-randomization noncompliance - Pregnancy, trying to get pregnant, 3 months post-partum - Brain or cervical spine surgery in previous 5 years; trauma to head or neck requiring hospitalization in previous year - Severe, unmanaged depression |