Sixty-four patients with cervicogenic headache were randomized to receive spinal manipulation therapy (SMT) (n=32) or SMT combined with instrument-assisted soft tissue mobilization (SMT + ISM) (n=32) for four weeks. Both groups also received heat therapy and neck isometric exercises three times a day. The primary outcome of interest was cervicogenic headache (CGH) frequency. Secondary outcomes included CGH pain intensity, CGH disability, neck pain frequency, neck pain intensity, neck disability index, and quality of life. Outcomes were assessed at baseline, after four weeks, and at six months. Overall, the results of the study revealed that the SMT + ISM group showed significantly greater improvements in CGH frequency and secondary outcomes compared to the SMT group. No adverse effects were reported. The findings suggest that adding ISM to SMT enhances long-term clinical outcomes in patients with cervicogenic headache.