Clinical Effects of Upper Cervical Translatoric Mobilization in Patients With Headache

Study Overview
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Brief Summary
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Frequently, headache is associated with disorders of the cervical spine, specially on the upper cervical spine. Therefore, restoration of the upper cervical mobility is considered fundamental for the treatment of headache. Manual therapy interventions seek to restore upper cervical mobility through a wide range of therapeutic procedures, including mobilization or manipulation techniques. Previous systematic reviews reported preliminary evidence for the application of upper cervical manual therapy techniques for the management of headache. The objective of this study is to study the effects of upper cervical translatoric spinal mobilization (UC-TSM) on headache intensity, cervical mobility and pressure pain threshold in subjects with headache. For this purpose, the investigators will conduct a randomized controlled trial. Volunteers with headache will participate in the study and will be randomly divided into control or treatment group. Treatment group will receive UC-TSM and the control group will receive no treatment. Headache intensity, cervical mobility, temporomandibular mobility and pressure pain thresholds (PPT) will be measured before and immediately after each treatment session (3 treatment sessions in one week period) and after one month follow-up. At this moment, global perceived effect will be assessed.

Conditions
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Headache

Intervention / Treatment
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* Other: UC-TSM


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Present a history of headache. Exclusion Criteria: Receive cervical treatment in the previous month. Present red flags for headache. Present any contraindications to manual therapy. Current involvement in compensations.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: UC-TSM<br>Upper cervical translatoric spinal mobilization (UC-TSM). UC-TSM is a physical therapy technique used to improve range of movement, consisting on a manual stretching of the cervical spine of the patient during 30 minutes. | Other: UC-TSM<br>* Upper cervical translatoric spinal mobilization: a 30 minutes treatment consisting of 30 series of translatoric mobilizations of the upper cervical spine with 10 rest between sets. For that purpose, the patient is positioned in supine, with the cervical spine in neutral position. The therapist place a hand dorsally at the level of the vertebral arch of C1 with the metacarpophalangeal and radial border of the index finger. The other hand is placed posteriorly under the occiput, with the shoulder positioned anteriorly on the patient's forehead. The mobilization force is directed dorsally from the shoulder until the therapist feel a marked resistance and then apply slightly more pressure in order to perform a stretching mobilization.<br>|
| No Intervention: Control<br>The control group receive no treatment intervention during 30 minutes (a similar time as the UC-TSM group). | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Headache intensity as measured by Visual Analog Scale |  | From Baseline to one month follow-up | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cervical mobility as measured by cervical range of motion device (CROM) |  | 1 minute Pre-Intervention, 1 minute Post-Intervention, One month follow-up | 
| Pressure pain threshold as measured by digital algometer (Somedic Farsta) |  | 1 minute Pre-Intervention, 1 minute Post-Intervention, One month follow-up | 
| Temporomandibular joint mobility as measured by digital calipher (mouth opening) |  | 1 minute Pre-Intervention, 1 minute Post-Intervention, One month follow-up | 
| Global Perceived Effect as measured by Global Perceived Effect Scale (-5 to +5 Likert Scale) |  | One month follow-up | 
| Immediate headache intensity changes as measured by Visual Analog Scale |  | 1 minute Pre-Intervention, 1 minute Post-Intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Physiotherapy, Manual Therapy