An interventional study of Mulligan Technique and Proprioceptive Training in Cervicogenic Headache, sponsored by Cairo University. Not yet recruiting at 1 site in Egypt. Open to participants aged 18 Years to 45 Years. Per ClinicalTrials.gov, last updated 2026-09-22.
Sponsored by Cairo University · Not applicable, Interventional, and Treatment
This study will be conducted to compare the effectiveness of mulligan versus proprioceptive training on pain severity, headache disability, flexion rotation test, pain threshold, cervical joint position error in patients with cervicogenic headache.
Cervicogenic headache (CGH) is a type of headache, and it occurs commonly due to neck dysfunctions. Many studies found positive association between the neck dysfunction and CGH. The prevalence of this problem is more common in women than men. Headache disorders are classified as primary, such as migraine or tension-type headache, or secondary, such as CGH. The one-year prevalence of CGH in the adult population varies between 0.2 and 2.2%.
It is severely impacts the general public, burdening public health and putting pressure on the local economy and community.
The International Classification of Headache Disorders (ICHD BETA 3) defined cervicogenic headache as "Headache caused by a disorder of the cervical spine and its component bony, disc and/or soft tissue elements, usually but not always accompanied by neck pain.
No drugs are effective for cervicogenic headache. Studies showed that treatment with manual therapy, specific exercises, or manual therapy plus exercises was significantly more effective at reducing headache frequency and intensity than was no treatment. Manual therapy alone, however, was not more effective than exercises alone, and combining the two interventions did not achieve better outcomes than either intervention alone. About 76% of patients achieved a more than 50% decrease in headache frequency and 35% achieved complete relief at the 7-week follow-up. At 12 months, 72% had a more than 50% decrease in headache frequency, but the proportion that had complete relief was not reported.
A recent systematic review concluded that manual therapy may be effective in the short term and neck exercise in the long term in treating adults with cervicogenic headache.
A popular method for mobilizing joints is the Mulligan Mobilization Technique (MMT), in which the patient moves actively as the therapist slides the affected joint. Efficacy of MMT has been proven in patients experiencing acute to subacute CGH for both short and long-term periods.
There is a link between proprioceptive afferent information and the ability to maintain body posture and good balance. Patients with neck pain have reduced proprioceptive abilities and balance training can improve deficits in proprioception and balance.
A correlation was seen between CGH and a rise in cervical reposition error as well as restricted range of motion as compared to healthy individuals. Patients with CGH should have their rehabilitation programs take these effects into account.
A case report shows that we can effectively enhance overall balance control when we combine balance training with conventional manual therapy methods for the treatment of cervicogenic headache.
Despite studies demonstrating the effectiveness of balance training regimens for cervicogenic dizziness, there is no studies done on patient with CGH except one case report and it seems to be effective. there is no current literature addressing the addition of a proprioceptive training added to mulligan mobilization for patients with cervicogenic headache. Therefore, the aim of this case study was to identify if proprioceptive training exercise in addition to mulligan mobilization had an impact on the headache frequency, pain, disability and overall quality of life in a patient with CGH.
192 studies on the registry are indexed under Post-Traumatic Headache; 54 are open to participants now.
This study's planned enrollment of 48 is close to the median of 44 across 169 interventional studies indexed under Post-Traumatic Headache.
Browse Post-Traumatic Headache studies →Cairo University is the lead sponsor of 4,941 studies on the registry; 1,458 are open to participants now.
Of its 37 completed or terminated interventional studies of FDA-regulated products, 5 (14%) have results posted.
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Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.
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Participants in this arm will receive Mulligan Mobilization Technique in addition to the conventional physical therapy program. Mulligan techniques will include Headache SNAG, Reverse Headache SNAG, and C1-C2 SNAG rotation. Treatment will be administered for 12 sessions, 3 sessions per week for 4 weeks.
Other: Mulligan Technique · Other: Conventional physical therapy program
Participants in this arm will receive proprioceptive training in addition to the conventional physical therapy program. Proprioceptive training will include head relocation practice, cervical joint position retraining using a head-mounted laser pointer, and oculomotor exercises including gaze stability, eye-follow, saccades, and eye-head coordination exercises. Treatment will be administered for 12 sessions, 3 sessions per week for 4 weeks.
Other: Proprioceptive Training · Other: Conventional physical therapy program
Mulligan Mobilization Technique will include Headache SNAG, Reverse Headache SNAG, and C1-C2 SNAG rotation. All techniques will be performed with the participant sitting in an erect posture. Headache SNAG and Reverse Headache SNAG will be applied at C2 for 10-30 seconds, with a maximum of 10 repetitions. C1-C2 SNAG rotation will be performed toward the restricted side for 10 repetitions with end-range overpressure and 30 seconds of rest between repetitions. The intervention will be administered in addition to the conventional physical therapy program for 12 sessions, 3 sessions per week for 4 weeks.
Proprioceptive training will include head relocation practice, cervical joint position retraining, and oculomotor exercises. Joint position sense will be trained using a head-mounted laser pointer with head movements and relocation to the neutral position, progressing from eyes open to eyes closed. Cervical joint position retraining will include tracing patterns with the laser. Oculomotor training will include eye-follow, saccades, gaze stability, and eye-head coordination exercises, with progression by increasing movement speed and range and modifying visual targets. The intervention will be administered in addition to the conventional physical therapy program for 12 sessions, 3 sessions per week for 4 weeks.
The conventional physical therapy program will include hot pack application for 10 minutes, therapeutic ultrasound for 5 minutes on each side at an intensity of 1-1.5 W/cm² over the trapezius, upper cervical, and occipitovertebral regions, and low-load endurance exercises for the craniocervical and cervicoscapular muscles. The exercise program will include craniocervical flexion training using pressure biofeedback and scapular muscle endurance exercises. The conventional program will be administered to participants in both study arms.
Pain Intensity
Pain intensity will be assessed using the Visual Analogue Scale (VAS). Participants will rate their pain intensity on a 10-cm scale, where 0 indicates no pain and 10 indicates maximum intolerable pain.
Time frame: 4 weeks
Headache Impact
Headache impact will be assessed using the Arabic version of the Headache Impact Test-6 (HIT-6). The total score ranges from 36 to 78, with higher scores indicating a greater impact of headache on daily functioning.
Time frame: 4 weeks
Right Cervical Flexion-Rotation Range of Motion
Right cervical flexion-rotation range of motion will be assessed using the Cervical Range of Motion (CROM) instrument during the Flexion-Rotation Test (FRT). Rotation will be measured in degrees for the right side.
Time frame: 4 weeks
Left Cervical Flexion-Rotation Range of Motion
Left cervical flexion-rotation range of motion will be assessed using the Cervical Range of Motion (CROM) instrument during the Flexion-Rotation Test (FRT). Rotation will be measured in degrees for the left side.
Time frame: 4 weeks
Pressure Pain Threshold
Pressure pain threshold (PPT) will be assessed using a digital algometer. Measurements will be obtained over the upper trapezius muscle, C2-C3 zygapophyseal joint, suboccipital muscles bilaterally, and tibialis anterior muscle area. The mean of three trials at each measurement site will be used for analysis.
Time frame: 4 weeks
Cervical Joint Position Error
Cervical proprioception will be assessed using the Cervical Joint Position Error Test (CJPET) with a head-mounted laser pointer. Participants will attempt to relocate the head to the neutral starting position without visual cues. Joint position error will be measured and converted to degrees using the formula: angle = tan-¹ \[error distance/90 cm\].
Time frame: 4 weeks
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