The Effect of Myofascial Release in Patients With Cervicogenic Headache
Condition: Cervicogenic Headache
MeSH terms: Post-Traumatic Headache; Headache
Study type: Interventional

Summary: 
      Cervicogenic headache (CeH) is a secondary and often unilateral that is known by referring
      pain from soft or hard cervical structures to occipital, temporal, frontal and sometimes
      pre-orbital regions. There is higher prevalence of cervical muscle tightness, assessed
      clinically in CeH patients and anatomically there are some fascial connections between
      sub-occipital muscles with vertebra of C2 and Dura-mater.Therefore fascial restriction in
      this region can limit the normal movement of muscles between fascial plates in different
      directions in sub-occipital region. The purpose of current study was to compare the effect of
      MFR Technique in the upper cervical region with common (Exs) on pain intensity, frequency,
      duration and Pressure Pain Threshold (PPT) of upper cervical joints in subjects with CeH.
    

Detailed description: 
      Cervicogenic headache (CeH) is a secondary and often unilateral that is known by referring
      pain from soft or hard cervical structures to occipital, temporal, frontal and sometimes
      pre-orbital regions(Becker, 2010). Its prevalence within the general population is about
      0.4-2.5% and in women four times more than men(Racicki, Gerwin, DiClaudio, Reinmann, &
      Donaldson, 2013). It has been estimated that 15-20% of all chronic headaches include CeH
      (Racicki et al., 2013). According to reports, at a minimum about 7 million people travail
      from CeH that cause to waste many daily works and so decrease their performance
      strongly(Suijlekom, Lamé, Stomp-van den Berg, Kessels, & Weber, 2003). Based on last version
      of "Cervicogenic Headache International Study Group" a list including some clinical criteria
      as pain by cervical movement or inappropriate sustained positions, soft tissue stiffness,
      neck pain and limited cervical Range of Motion (ROM) has been mentioned for CeH. The best
      available studies has showed that the C2-3 zygapophysial joints are the most common source of
      CeH, accounting for about 70% of cases(Hall, Briffa, Hopper, & Robinson, 2010; Zito, Jull, &
      Story, 2006). One of the major problem is overlapping of CeH with other type headaches like
      migraine and tension type headache (TTH)(Yi, Cook, Hamill-Ruth, & Rowlingson, 2005) but it
      has been proven that the best clinical test with high sensitivity and specificity for
      diagnosing of CeH is upper cervical flexion-rotation test (FRT)(Amiri, Jull, &
      Bullock-Saxton, 2003; Bravo Petersen & Vardaxis, 2015). some investigations have linked CeH
      to painful dysfunction in the upper three cervical segments (C0-3)(Hall et al., 2007; Ogince,
      Hall, Robinson, & Blackmore, 2007). Jull and et al at 1999 had noted that there is higher
      prevalence of cervical muscle tightness, assessed clinically in CeH patients(G Jull, Barrett,
      Magee, & Ho, 1999; Zito et al., 2006). Nevertheless anatomically, there are some fascial
      connections between sub-occipital muscles with vertebra of C2 and Dura-mater (Robert Schleip,
      Jäger, & Klingler, 2012). It has been assumed that fascial limitations in one region of the
      body cause undue stress in another regions of the body due to fascial continuity, Therefore
      fascial restriction in this region can limit the normal movement of muscles between fascial
      plates in different directions in sub-occipital region(Ajimsha, Al-Mudahka, & Al-Madzhar,
      2015; Robert Schleip, 2003). Recent Fascia Research Congresses (FRC) explained fascia as a
      'soft tissue component of the connective tissue system that percolate the human body(Langevin
      & Huijing, 2009) and is a part of body tensional force transmission system(R Schleip,
      Findley, Chaitow, & Huijing, 2012). Myofascial Release (MFR) is a therapeutic technique that
      uses gentle pressure and stretching (in both forms of direct and indirect approaches)
      intended to restore decrease pain, optimized length, , and facilitate the release of fascial
      restrictions caused by injury, stress, repetitive use, and etc (J. F. Barnes, 1990; Robert
      Schleip, 2003). There are some studies about MFR and its effects that include: increase
      extensibilities of soft tissues, increase ROM, Improve joint biomechanics, decrease pain and
      muscles tone significantly (Ajimsha, 2011; Tozzi, Bongiorno, & Vitturini, 2011). Although; a
      lot of remedies as physiotherapy, electrotherapy, exercises therapy and spinal mobilization
      are used for cervicogenic headache (GA Jull & Stanton, 2005; Pöllmann, Keidel, & Pfaffenrath,
      1997) but it has not been studied specifically about sub-occipital MFR for CeH. Therefor the
      purpose of current study was to compare the effect of MFR Technique in the upper cervical
      region with common (Exs) on pain intensity, frequency, duration and Pressure Pain Threshold
      (PPT) of upper cervical joints in subjects with CeH.
    

Intervention name(s): Myofascial release technique; conventional exercise therapy
Intervention type(s): Other; Other
Intervention description(s): myofascial release technique take along about 3 minutes. This phase repeated 3 times in each session. At the end, for more release, sub-occipital traction will commence. The subject lies supine with head supported and therapist places the three middle fingers just caudal to the nuchal line, lifts the finger tips upward resting the hands on the treatment table, and then applies a gentle cranial pull, causing a long axis extension. The procedure is performed for 2 to 3 minutes. Subjects in each group received ten physical therapy treatment sessions. Treatment frequency was six times per week for MFR group and every day for exercise group which three times per week have been come to clinical center for checking of exercise by physiotherapist; All exercises were performed to a count of 7 seconds and subjects were instructed to perform all exercises daily, 15 repetitions each (twice a day). Treatment frequency was every day for exercise group which three times per week have been come to "clinical center" for checking of exercise by physiotherapist. They also could be taught active muscle stretching exercises to address any muscle tightness assessed to be present.
Other intervention name(s): soft tissue release
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: myofascial release; cervicogenic headache; pain intensity; exercise therapy; pressure pain threshold