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CompletedNCT04954716Updated Aug 24, 2021

Manual Techniques in Cervicogenic Headache

An interventional study of Deep Neck Flexor Massage and Post-Isometric Relaxation Technique in Cervicogenic Headache, sponsored by Riphah International University. Completed at 1 site in Pakistan. Open to participants aged 18 Years to 60 Years. Per ClinicalTrials.gov, last updated 2021-08-24.

Sponsored by Riphah International University · Not applicable, Interventional, and Treatment

From the registry’s dates

  • Registered 5 months after the study started (first participant enrolled Jan 2021, registered Jul 2021).
Phase
Not applicable
Study type
Interventional
Enrollment
20
Allocation
Randomized
Ages
18 Years to 60 Years
Sex
All
01

Study 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.

Read the 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.

02

Conditions studied

  • Cervicogenic Headache

Keywords

  • Cervicogenic headache (CH, CGH)
  • Muscle Energy Technique (MET)
  • ,Post-isometric relaxation(PIR)
03

In context

Post-Traumatic Headache

188 studies on the registry are indexed under Post-Traumatic Headache; 50 are open to participants now.

This study's enrollment of 20 is below the median of 44 across 166 interventional studies indexed under Post-Traumatic Headache.

Browse Post-Traumatic Headache studies →

Lead sponsor

Riphah International University is the lead sponsor of 2,133 studies on the registry; 633 are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years to 60 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

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

Exclusion criteria

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
05

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Double (Participant, Investigator)
Enrollment
20 participants (actual)

Study arms

  • Experimental
    Deep Neck Flexor Massage

    INTERVENTIONAL GROUP(DEEP Neck FLEXOR MASSAGE)

    Other: Deep Neck Flexor Massage

  • Active comparator
    Post-Isometric Relaxation Technique

    CONTROL GROUP (POST-ISOMETRIC RELAXATION TECHNIQUE)

    Other: Post-Isometric Relaxation Technique

Interventions

  • OtherDeep Neck Flexor Massage

    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.

  • OtherPost-Isometric Relaxation Technique

    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.

06

What researchers measure

Primary outcomes

  1. Headache disability index

    This scale is used to identify difficulties that you may be experiencing because of your headache. Please check off "YES", "SOMETIMES", or "NO" to each item. Proforma consist of 25 question Scoring The following responses are given the following values: Response Points Yes 4 Sometimes 2 No 0 Interpretation A 29 point change (95% confidence interval) or greater in the total score from test to retest must occur before the change can be attributed to treatment effects.

    Time frame: 3 week

Secondary outcomes

  1. Upper cervical spine(ROM)

    standard technique for measuring cervical spine motions in different rotations, including sagittal, frontal, transversal, and rotational

    Time frame: 3 weeks

07

Study locations

1 site
  • Central hospital Gujranwala
    Gujrānwāla, Punjab 54560, Pakistan
08

References and documents

Publications

  • Martelletti P, van Suijlekom H. Cervicogenic headache: practical approaches to therapy. CNS Drugs. 2004;18(12):793-805. doi: 10.2165/00023210-200418120-00004. PubMed 15377169 ↗
  • 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. PubMed 17381554 ↗
  • 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. PubMed 26934859 ↗
  • 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. PubMed 16178960 ↗
  • 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. PubMed 27047446 ↗
  • 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. PubMed 11403743 ↗
  • 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. PubMed 32841969 ↗
  • 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. PubMed 18810110 ↗
  • 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. PubMed 22457537 ↗
  • 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. PubMed 23411644 ↗
  • 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. PubMed 22460941 ↗

Individual participant data

Plan to share: No

09

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Aug 24, 2021, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT04954716
Lead sponsor
Riphah International University
Responsible party
Sponsor
First posted
Jul 8, 2021
Start date
Jan 10, 2021
Primary completion
Aug 10, 2021
Completion
Aug 10, 2021
Last update
Aug 24, 2021

Study contacts

Muhammad Sana ullah, MS
principal investigator · Riphah International University

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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This study is completed, as verified in Aug 2021. You cannot join it, but the record below documents what was studied.

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