Treatment for cervicogenic headache (CGH) can be challenging and is not always effective. Many patients turn to manipulative therapies, but what is the evidence this form of treatment works? Posadzki and Ernst performed a systematic review of trials of spinal manipulation for the treatment of CGH, which is published in this issue of Headache. The studies they located did not use clear or standard definitions for CGH or the manipulative interventions. The authors conclude that the evidence for spinal manipulative therapies for CGH is weak and more research is needed. This is particularly important because of rare but serious risks associated with this treatment option.