Clinical trial NCT04954716: Manual Techniques in Cervicogenic Headache
Official title: Comparison of Deep Friction Massage and Post Isometric Relaxation Technique in Cervicogenic Headache
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Cervicogenic Headache
Keywords: Cervicogenic headache (CH, CGH)
Muscle Energy Technique (MET)
,Post-isometric relaxation(PIR)
Lead sponsor: Riphah International University
Sponsor class: OTHER
First posted: 2021-07-08
Enrollment: 20
Sex: ALL
Minimum age (years): 18
Maximum age (years): 60
Standard ages: ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief 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.

Eligibility criteria: Inclusion Criteria:

* Both genders.
* Symptoms duration more than 6 months.
* Age 18 -60
* Patient has confirmed the diagnosis of cervicogenic headache

Exclusion Criteria:

* Rule out cervical malignancy
* infection (such as osteomyelitis or diskitis)
* osteoporosis, inflammatory arthritis.
* fracture, pregnancy
* cord compression, uncontrolled hypertension
* cardiovascular disease
* in the setting of carotid or vertebral artery disease.
* Trauma cases

Primary outcomes:
measure: Headache disability index
timeFrame: 3 week
Secondary outcomes:
measure: Upper cervical spine(ROM)
timeFrame: 3 weeks
Other outcomes:
Locations:
city: Gujrānwāla
country: Pakistan
facility: Central hospital Gujranwala
state: Punjab
Study officials:
affiliation: Riphah International University
name: Muhammad Sana ullah, MS
role: PRINCIPAL_INVESTIGATOR
References:
citation: Martelletti P, van Suijlekom H. Cervicogenic headache: practical approaches to therapy. CNS Drugs. 2004;18(12):793-805. doi: 10.2165/00023210-200418120-00004.
citation: Stovner Lj, Hagen K, Jensen R, Katsarava Z, Lipton R, Scher A, Steiner T, Zwart JA. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia. 2007 Mar;27(3):193-210. doi: 10.1111/j.1468-2982.2007.01288.x.
citation: Castien RF, De Hertogh W, Scholten-Peeters GG. Letter to the Editor: Physical examination tests for screening and diagnosis of cervicogenic headache: A systematic review by Rubio-Ochoa et al. (2015). Man Ther. 2016 Jun;23:e7-8. doi: 10.1016/j.math.2016.01.006. Epub 2016 Jan 29. No abstract available.
citation: Fernandez-de-Las-Penas C, Alonso-Blanco C, Cuadrado ML, Pareja JA. Spinal manipulative therapy in the management of cervicogenic headache. Headache. 2005 Oct;45(9):1260-3. doi: 10.1111/j.1526-4610.2005.00253_1.x.
citation: Garcia JD, Arnold S, Tetley K, Voight K, Frank RA. Mobilization and Manipulation of the Cervical Spine in Patients with Cervicogenic Headache: Any Scientific Evidence? Front Neurol. 2016 Mar 21;7:40. doi: 10.3389/fneur.2016.00040. eCollection 2016.
citation: Bogduk N. Cervicogenic headache: anatomic basis and pathophysiologic mechanisms. Curr Pain Headache Rep. 2001 Aug;5(4):382-6. doi: 10.1007/s11916-001-0029-7.
citation: Li L, Stoop R, Clijsen R, Hohenauer E, Fernandez-de-Las-Penas C, Huang Q, Barbero M. Criteria Used for the Diagnosis of Myofascial Trigger Points in Clinical Trials on Physical Therapy: Updated Systematic Review. Clin J Pain. 2020 Dec;36(12):955-967. doi: 10.1097/AJP.0000000000000875.
citation: Chamberlain GJ. Cyriax's Friction Massage: A Review. J Orthop Sports Phys Ther. 1982;4(1):16-22. doi: 10.2519/jospt.1982.4.1.16.
citation: Emary P. Use of post-isometric relaxation in the chiropractic management of a 55-year-old man with cervical radiculopathy. J Can Chiropr Assoc. 2012 Mar;56(1):9-17.
citation: Youssef EF, Shanb AS. Mobilization versus massage therapy in the treatment of cervicogenic headache: a clinical study. J Back Musculoskelet Rehabil. 2013;26(1):17-24. doi: 10.3233/BMR-2012-0344.
citation: Chaibi A, Russell MB. Manual therapies for cervicogenic headache: a systematic review. J Headache Pain. 2012 Jul;13(5):351-9. doi: 10.1007/s10194-012-0436-7. Epub 2012 Mar 30.