Background: Headache and dizziness are common symptoms in individuals with cervical radiculopathy (CR). Despite this, knowledge about the outcomes of physiotherapy and/or surgical treatment for individuals with CR and headache or dizziness is limited.

The overall aim: To investigate and compare the outcomes of physiotherapy and/or surgical treatment in individuals with CR and headache or dizziness.

Methods: This thesis is based on three studies (A–C) and four papers (I–IV). Study A was a randomised clinical trial comparing neck-specific exercise (NSE) with prescribed physical activity (PPA) in individuals with CR. Paper I was a secondary analysis of this study including only those individuals with CR and either headache or dizziness in two separate subgroups. The effect on headache intensity was evaluated in the headache subgroup (n = 59), and self-perceived dizziness was evaluated in the dizziness subgroup (n = 73) at baseline, and at 3-, 6-, and 12‑month follow‑ups. Associations between headache intensity or dizziness and neck pain intensity, neck muscle endurance (NME), neck mobility, physical activity, and fear‑avoidance beliefs were also analysed.

Study B was a national registry‑based cohort study using prospectively collected Swespine data, on individuals with CR and neck‑related headache who underwent surgery. Paper II compared outcomes after anterior cervical decompression and fusion (ACDF; n = 2441) and posterior cervical foraminotomy (PCF; n = 448) regarding neck‑related disability, headache, and neck and arm pain. Paper III analysed explanatory factors associated with improvements in these outcomes following ACDF (n = 1866) and PCF (n = 357).

Study C was a randomised clinical trial comparing surgery followed by structured postoperative physiotherapy (SPP) or standard postoperative approach in individuals with CR. Paper IV was a secondary analysis of this study including only those individuals with neck‑related headache (n = 106). The effect on headache intensity was evaluated preoperatively to 12‑month follow‑up. Associations between changes in headache intensity and changes in NME, neck mobility, or neck pain intensity preoperatively to the 12‑month follow‑up were also analysed.

Results: In individuals with CR and headache, NSE, PPA, ACDF, and PCF reduced headache. No surgical procedures were better in reducing disability and pain, although PCF reduced headache more over time. Postoperative improvements in neck-related disability, headache, and neck and arm pain were strongly associated with baseline levels of these variables, respectively. In addition, higher education, absence of comorbidity, non-smoking status, and the number of operated levels seemed to be particularly important factors for ACDF, whereas shorter preoperative duration of neck pain, less preoperative neck-related disability and better preoperative walking ability seemed relevant for PCF. Among individuals with CR and neck-related headache who underwent surgical treatment followed by standard care, additional SPP did not demonstrate further reductions in headache intensity. Neck pain intensity was associated with headache in individuals with CR and headache. In individuals with CR and dizziness, NSE and PPA reduced dizziness in the short term but not in the long term. Neck pain intensity and dorsal NME were associated with dizziness in individuals with CR and dizziness.

Conclusions: Headache may improve in both the short- and long term with physiotherapy treatments such as NSE and PPA, and with surgical treatments such as ACDF and PCF in individuals with CR and headache. Currently, it is unclear which physiotherapy or surgical treatment provides the greatest benefit, although PCF appears to reduce headache more over time than ACDF. Postoperative improvements in neck-related disability, headache, and neck and arm pain are associated with corresponding preoperative levels of these factors, along with other explanatory factors of interest. No additional benefit of SPP is found in reducing headache. Dizziness may improve in the short term with NSE and PPA in individuals with CR and dizziness. Headache intensity is associated with neck pain intensity, and dizziness is associated with both neck pain intensity and dorsal NME. These findings highlight the importance of addressing these factors when treating individuals with CR who experience headache or dizziness.

Objective: To evaluate the effect of neck-specific exercise (NSE) compared to prescribed physical activity (PPA) on headache and dizziness in individuals with cervical radiculopathy (CR). Also, to investigate associations between headache or dizziness and pain, neck muscle endurance (NME), neck mobility, physical activity, and fear avoidance beliefs.Methods: Individuals randomized to either NSE or PPA were selected to a headache subgroup (n = 59) and/or a dizziness subgroup (n = 73). Data were evaluated, according to headache and/or dizziness outcomes at baseline and at 3, 6, and 12-month follow-ups.Results: No significant between-group differences were found between NSE and PPA in either subgroup. In the headache subgroup, significant within-group improvements were seen at all follow-ups for NSE (p < .001) and from baseline to 3 (p = .037) and 12 (p = .003) months for PPA. For dizziness, significant within-group improvements were seen from baseline to 3 months for NSE (p = .021) and from baseline to 3 (p = .001) and 6 (p = .044) months for PPA. Multiple regression models showed significant associations at baseline between headache intensity and neck pain (adjusted R-square = 0.35, p < .001), and for dizziness with neck pain and dorsal NME (adjusted R-square = 0.34, p < .001).Conclusion: NSE and PPA show similar improvements in headache intensity and dizziness in individuals with CR. Headache intensity is associated with neck pain, and dizziness with neck pain and dorsal NME, highlighting the importance of these factors when evaluating headache and dizziness.

Study Design. A prospective randomized multicenter trial. Objective. To investigate the effects of surgery with either structured postoperative physiotherapy or standard postoperative approach on neck-related headache in patients with cervical radiculopathy. Secondary, to investigate associations between change in neck-related headache and change in neck muscle endurance, neck mobility, or neck pain. Summary of Background Data. The effect of physiotherapy on individuals with neck-related headache after surgery for cervical radiculopathy due to magnetic resonance imaging-verified disc disease is unknown. Methods. One hundred six patients with neck-related headache and participating in a randomized controlled trial evaluating the additional effects of physiotherapy after surgery for cervical radiculopathy were included. Patients were randomized preoperatively to structured postoperative physiotherapy (n = 51) or the standard postoperative approach (n = 55). Outcome measures were headache intensity and neck pain intensity, neck muscle endurance, and neck mobility. Measures were obtained preoperatively and at 6 weeks, 3 months, 6 months, and 1 year postoperatively. Results. Headache intensity significantly changed from baseline to 1 year postoperatively (P < 0.001) in both groups.Post-hoctests showed a significant difference between baseline and 6 weeks (P <= 0.05). No significant differences were found between groups (P > 0.05) or between-group differences in changes over time (P > 0.05). The change in current headache intensity over time was associated with a change in current neck pain intensity over time (P = 0.003, beta = 0.40). Conclusion. There was a significant improvement in headache intensity 1 year postoperatively in patients with cervical radiculopathy and neck-related headache, but there were no differences between groups over time. Change in current headache intensity was only associated with a change in current neck pain intensity.