Manual Techniques in Cervicogenic Headache
Condition: Cervicogenic Headache
MeSH terms: Post-Traumatic Headache; Headache
Study type: Interventional

Summary: 
      This project will explore the effect of deep friction massage and post isometric relaxation
      techniques in Cervicogenic headache. The population sample will be 20 divided randomly into
      two groups by Lottery method. Then i will collect data from central hospital, Gujranwala. One
      group will be treated with a deep friction massage technique thrice a week for 3 weeks.
      Another group will be treated with a post isometric relaxation technique thrice a week for 3
      weeks. Both groups will receive a heating pad and neck isometric as baseline treatment.
      Baseline measurements are taken by an inclinometer. After a treatment plan, the group will be
      assessed again and post-treatment measured values will be compared with the pretest values.
      Subjects will be asked to come for follow-up after 4 weeks. The follow-up will show which
      technique is more effective in subjects having Cervicogenic headaches. Both the techniques
      used are non-invasive and having minimum side effects. This project will help Physical
      Therapy Practitioner to explore which technique is more useful to treat Cervicogenic
      headaches.
    

Detailed description: 
      Cervicogenic headache is a relatively common and still controversial form of headache arising
      from structures in the neck. In patients with this disorder, attacks or chronic fluctuating
      periods of neck/head pain may be provoked by the sustained neck. The International Headache
      Society (IHS), 2013 defined Cervicogenic Headache (CGH) as a secondary headache, which
      implies that headache is caused by a disorder of the cervical spine and its components bony,
      disc, and soft tissue elements. CGH can be a perplexing pain disorder that is refractory to
      treatment if it is perceived. Patients with CGH exhibited decreases in the quality of life
      comparable to migraine patients and patients with tension-type headaches, with even lower
      scores for physical functioning.

      .Headache is a common disorder affecting up to 66% of the general population. headache
      negatively influences both quality of life and labor productivity.Cervicogenic headache is
      one of the common types of headache accounting for 0.4-15% of the headache population.

      we distinguished it from other types of headaches, such as a migraine, that may present with
      some common symptoms. The International Headache Society (IHS) classified CGH as a secondary
      headache arising from musculoskeletal disorders in the cervical spine. The complicated
      convergence of cervical afferents with trigeminal afferents in the trigemino-cervical complex
      is intended as the physiologic basis of a headache arising from cervical structures.

      The aim of friction massage is to take care of the quality at intervals the soft tissue
      structures of ligament, tendon, and muscle and stop adherent scars from forming. The massage
      is deep and should be applied transversally to the precise tissue concerned in contrast to
      the superficial massage given within the longitudinal direction parallel to the vessels which
      boosts circulation and come of fluid. Profound cervical flexor (DCF) has a noteworthy
      postural capacity in supporting and rectifying the cervical lordosis. It has been discovered
      that specific muscles in the cervical spine have a tendency to debilitate , the most widely
      recognized of these being the DCF.

      MET is a treatment technique that includes a willful constriction of a subject's muscle in a
      correctly controlled bearing, against a counterforce that is given by the specialist. MET is
      utilized to diminish the pain, extend the tight muscles and belts, decrease muscle tone,
      enhances nearby flow, strengthen the feeble musculature, and mobilizes the joint
      restrictions. MET increases the extensibility of muscles and spinal range of motion, treating
      patients with reduced mobility. Extending includes the use of manual or mechanical power to
      prolong/protract the structures that are adaptively been abbreviated and are hypomobile.

      Post-isometric relaxation (PIR) may be a technique typically employed by manual therapists
      for treating muscle tension and joint pathology in myofascial pain syndromes There is a lack
      of evidence demonstrating the efficacy of deep friction massage therapy in the management of
      cervicogenic headache, particularly targeting cervical muscle tightness related to
      Cervicogenic headache. The purpose of this study is to compare the effect of soft tissue
      massage with MET to access which technique has a greater clinical impact than others in
      improving cervicogenic headache.
    

Intervention name(s): Deep Neck Flexor Massage; Post-Isometric Relaxation Technique
Intervention type(s): Other; Other
Intervention description(s): Deep friction massage is a specific connective tissue massage that was given across the affected fibers.The therapist's fingers and patient's skin must move as one, otherwise moving subcutaneous fascia against muscle or ligament could lead to blister formation or subcutaneous bruising.The friction massage must have sufficient sweep and be deep enough.; The PIR technique is performed as follows.The hypertonic muscle is taken to a length just short of pain, or to the point where resistance to movement is first noted.A submaximal (10-20%) contraction of the hypertonic muscle is performed away from the barrier for between 5 and 10 seconds and the therapist applies resistance in the opposite direction . The patient should inhale during this effort.After the isometric contraction the patient is asked to relax and exhale while doing so.Following this a gentle stretch is applied to take up the slack till the new barrier.Starting from this new barrier, the procedure is repeated two or three times.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: Cervicogenic headache (CH, CGH); Muscle Energy Technique (MET); ,Post-isometric relaxation(PIR)