Trigger Point Therapy in Cervicogenic Headache

Study Overview
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Brief Summary
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It is a pilot randomized controlled trial comparing real and simulated manual treatment of trigger points (TrPs) in patients with cervicogenic headache (CeH). The purpose of the current randomized clinical pilot trial was to determine the preliminary effects of TrP manual therapy in individuals with CeH with sternocleidomastoid muscle active TrPs as compared to manual contact over the muscle tissues.

Detailed Description
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CeH pain has been mostly related to joint, disk and ligament pain from the upper cervical spine; however, clinicians should consider that the upper cervical spine also receives afferent inputs from muscles. In fact, the role of referred pain to the head elicited by muscle TrPs has received particular interest in recent years. No study has investigated the effectiveness of TrP manual therapy in patients with CeH exhibiting active TrPs. Investigators hypothesized that patients receiving a real TrP treatment will exhibit a greater reduction in pain, sensitivity, cervical range of motion and neck endurance than those receiving a manual control non-therapeutic intervention.

Official Title
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MANUAL TREATMENT OF ACTIVE TRIGGER POINTS IN THE STERNOCLEIDOMASTOID MUSCLE IN PATIENTS WITH CERVICOGENIC HEADACHE: A PILOT RANDOMIZED CLINICAL TRIAL

Conditions
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Cervicogenic Headache

Intervention / Treatment
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* Other: TrP therapy
* Other: TrP manual control therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: unilateral pain starting in the neck and radiating to the frontal-temporal region pain aggravated by neck movement restricted cervical range of motion joint tenderness in at least one of the joints of the upper cervical spine (C1-C3) headache frequency of at least one per week over a period greater than 3 months active TrPs in the sternocleidomastoid muscle Exclusion Criteria: other primary headaches (i.e., migraine, tension type-headache) bilateral headaches had received treatment for neck or head pain in the previous year presented any contraindications to manual therapy had pending legal action regarding their neck and head pain.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 55 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: TrP therapy<br>TrP manual therapy comprises different manual approaches, e.g., compression, stretching, or transverse friction massage applied over active TrPs in the sternocleidomastoid muscle | Other: TrP therapy<br>* TrP manual therapy comprises different manual approaches, e.g., compression, stretching, or transverse friction massage applied over active TrPs in the sternocleidomastoid muscle<br>|
| Placebo Comparator: TrP manual control therapy<br>The treatment consisted of a simulation of the same TrP therapy treatment applied to the experimental group without the application of any therapeutic pressure. | Other: TrP manual control therapy<br>* The treatment consisted of a simulation of the same TrP therapy treatment applied to the experimental group without the application of any therapeutic pressure.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in headache intensity from baseline to one week after treatment | The intensity of head and neck pain was separately assessed with an 11-point numerical pain rate scale (NPRS, 0: no current pain, 10: maximum pain). It was recorded as a mean based on headaches experienced in the preceding week. | Baseline and one week after the intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in cervical range of motion from baseline to one week after treatment | Cervical range of motion was measured using a cervical range of motion (CROM) device. Subjects were asked to move their head as far as they could without pain in a stan¬dardized sequence: flexion, extension, affected/non-affected lateral flexion, and affected/non-affected rotation. | Baseline and one week after the intervention | 
| Change in pressure pain sensitivity from baseline to one week after treatment | Pressure pain thresholds (PPT), i.e., the amount of pressure where a sensation of pressure first changes to pain was assessed with an analogical algometer over C0-C1, C1-C2 and C2-C3 zygapophyseal joints on the symptomatic side. | Baseline and one week after the intervention | 
| Change in deep cervical flexors motor performance from baseline to one week after treatment | The motor performance of the deep cervical flexor muscles was tested in all patients by using the cervical flexor test (CCFT). | Baseline and one week after the intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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cervicogenic headache, trigger point, sternocleidomastoid, manual therapy