Effects of Sustained Natural Appophyseal Glide Versus Rocababo 6x6 Program in Subjects With Cervicogenic Headache.
Condition: Cervicogenic Headache
MeSH terms: Post-Traumatic Headache; Headache
Study type: Interventional

Summary: 
      The purpose of this study is to investigate the effects of TMJ directed treatment approach
      using the Rocabado 6x6 program in patients with cervicogenic headache on the intensity of
      headache, function of the neck, and quality of life and compare its effectiveness with
      headache SNAGs which have been proven very effective in treatment of cervicogenic headache.
    

Detailed description: 
      The efectiveness of Sustained Natural Apophyseal Glide on Flexion Rotation Test, pain
      intensity, and functionality in subjects with Cervicogenic Headache was evaluated. The
      research was conducted on five computerized databases PubMed/Medline, Web of Science, PEDro,
      Lilacs, and Cochrane Library (CENTRAL), using the keywords combination: (sustained natural
      apophyseal glide OR SNAG OR joint mobilization OR Mulligan) AND (cervicogenic headache)
      according to PRISMA guidelines. The methodological quality of the included studies was
      analyzed using the Physiotherapy Evidence Database (PEDro) scale. Eight articles fulflled the
      eligibility criteria and were included in the review. The selected studies had a
      methodological quality of 6.6/10 on the PEDro scale and included a total of 357 participants.
      The SNAG signifcantly improved pain, Flexion Rotation Test and reduced functional symptoms.
      Conclusion: The available evidence suggests that SNAG may be a relevant intervention for CH.

      Effectiveness of different physiotherapy interventions in the management of cervicogenic
      headache was measured. Spinal mobilization, neural mobilization, and postural correction
      exercises techniques are physiotherapy interventions used for managing CGH symptoms. 80
      participants with diagnosed CGH were recruited and divided into 4 groups. The spinal
      mobilization group received posteroanterior glide at the spinous and transverse process of C2
      and C3 vertebra, lateral glide at affected side of the spinous process of C2 and C3 vertebra
      and translatoric glide at the transverse process of C1 vertebrae and SNAG. The neural
      mobilization group received neural mobilization of meninges, brachial plexus, and trigeminal
      nerve. In postural correction exercises group stretching of tight muscles (rectus capitus
      posterior, suboccipital, upper trapezeius, scalene, levator scapulae, sternocleidomastoid,
      pectoralis major/minor muscles) were given. Strengthening and endurance exercises for weak
      muscles (cervical flexors and deep cervical flexor, rhomboidus, and lower trapezeius muscles)
      were given. The control group was given normal range of motion exercises for the neck and
      shoulder region. It was concluded by results that applying any of the three modalities
      randomly in groups of patients with established CGH resulted in improvements of measured
      outcomes compared to a control group.

      Limited literature is available about TMJ treatment in patients with headaches, and few
      studies has applied direct interventions to the muscles involved in TMJ movement to relieve
      headache symptoms. Due to the methodological shortcomings, diversity of interventions and
      inconsistency of findings, there is currently low certainty that there is an effect of
      physical therapy for TMJ on concomitant headache intensity compared to control interventions.
      More studies of higher methodological quality are needed so better conclusions could be
      taken.Further, till now very few studies have done to prove the effect of Rocabado's approach
      and neither a single study conducted on its effectiveness for headache.
    

Intervention name(s): cervical spine mobilization; Rocabado 6x6
Intervention type(s): Other; Other
Intervention description(s): headache SNAGs, 10 repetitions holding for 10 seconds in each glide with a rest time of 30 seconds in between. Eight weeks of treatment session will be provided and assessment of the improvement in cervicogenic headache will done at baseline, after 04, 06 and at the end of 8 week.; The Rocabado 6x6 program includes 6 types of exercises which are- rest position of the tongue, TMJ rotation control, upper cervical distraction, axial extension of cervical spine, shoulder girdle retraction, and rhythmic stabilization technique, which are to be performed 6 times in a day with 6 repetitions of each exercise in each session,
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: cervical spine; neurological disorder; post-traumatic disorder; secondary headache