An interventional study of Dynamic Cupping and Facilitated Positional Release technique in Cervicogenic Headache, sponsored by University of Management and Technology Lahore. Not yet recruiting at 1 site in Pakistan. Open to participants aged 20 Years to 45 Years. Per ClinicalTrials.gov, last updated 2026-11-02.
Sponsored by University of Management and Technology Lahore · Not applicable, Interventional, and Treatment
Cervicogenic headache (CGH) is a secondary headache disorder originating from structural and functional impairments of the cervical spine, accounting for approximately 15-20% of all chronic headaches worldwide. It is characterized by unilateral head pain referred from the osseous, discal, or soft tissue elements of the upper cervical spine, frequently accompanied by restricted cervical range of motion, myofascial tenderness, significant neck disability, and disrupted sleep quality. Due to prolonged poor posture, repetitive neck movements, and increased sedentary lifestyles, the prevalence of cervicogenic headache has increased significantly in recent years. Although various physiotherapy interventions are available for its management, identifying the most effective conservative treatment approach remains a challenge due to the multifactorial nature and complexity of the condition, highlighting the need for further research. This study therefore aims to conduct the first randomized clinical trial directly comparing the effects of Dynamic Cupping and Facilitated Positional Release across five clinically relevant, multidimensional outcomes in patients with cervicogenic headache specifically pain intensity, headache impact, cervical range of motion, neck disability, and sleep quality.
The study design will be a randomized clinical trial. Non-probability Consecutive sampling technique will be used, and participants will be randomly allocated into two groups. Evaluation will be done using the Numeric Pain Rating Scale (NPRS), Headache Impact Test (HIT-6), Universal Goniometer (UG), Neck Disability Index (NDI), and Pittsburgh Sleep Quality Index (PSQI). Group A will receive Dynamic Cupping therapy, while Group B will receive Facilitated Positional Release technique. Both groups will receive three treatment sessions per week over four weeks, totaling 12 sessions, alongside a standardized baseline conventional therapy comprising hot pack application and cervical muscle stretches and Isometrics. Measurements of all outcome variables will be taken at baseline and after 4 weeks. The collected data will be analyzed using SPSS version 25.
197 studies on the registry are indexed under Post-Traumatic Headache; 53 are open to participants now.
This study's planned enrollment of 41 is close to the median of 44 across 173 interventional studies indexed under Post-Traumatic Headache.
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Dynamic Cupping was applied using small sized silicone cups with a gliding technique over massage oil or gel. The target areas included the suboccipital region, upper trapezius and levator scapulae with suction maintained at a mild to moderate level according to patient tolerance. Intervention was delivered 3 sessions per week over 4 weeks, totaling 12 treatment sessions.
Other: Dynamic Cupping
Facilitated Positional Release technique will be applied targeting tender points in the suboccipital region, upper trapezius and levator scapulae. The affected area will be placed in a position of ease to reduce tension, followed by the application of a facilitating force such as compression or rotation for 3-5 seconds to further reduce tissue tension, with the patient positioned supine throughout. Intervention was delivered 3 times per week for 4 weeks, comprising 12 total treatment sessions.
Other: Facilitated Positional Release technique
Dynamic Cupping was applied using small sized silicone cups with a gliding technique over massage oil or gel. The target areas included the suboccipital region, upper trapezius and levator scapulae with suction maintained at a mild to moderate level according to patient tolerance. Intervention was delivered 3 sessions per week over 4 weeks, totaling 12 treatment sessions.
Facilitated Positional Release technique will be applied targeting tender points in the suboccipital region, upper trapezius and levator scapulae. The affected area will be placed in a position of ease to reduce tension, followed by the application of a facilitating force such as compression or rotation for 3-5 seconds to further reduce tissue tension, with the patient positioned supine throughout. Intervention was delivered 3 times per week for 4 weeks, comprising 12 total treatment sessions.
Numeric Pain Rating Scale
The patient is asked to rate their pain by selecting a value on the scale. An 11-point numerical rating scale is used, where "0" indicates no pain and "10" represents the worst pain imaginable at the time of assessment. (27)
Time frame: Baseline and after 4 weeks
Headache Impact Test-6 (HIT-6)
The HIT-6 is a six-item questionnaire designed to assess the impact of headaches. Each item is rated on a five-point Likert scale, with responses scored as never (6), rarely (8), sometimes (10), very often (11), and always (13). The scale scores can range between 36 and 78. A score of ≤49 indicates no impact (Grade I), 50-55 represents moderate impact (Grade II), 56-59 indicates significant impact (Grade III), and a score of ≥60 signifies severe impact (Grade IV). The tool evaluates overall quality of life by examining two main domains: pain-related effects, including severity and functional limitation, and psychological and social consequences such as vitality, cognition, role performance, and social functioning. HIT-6 is widely recognized as a reliable and valid measure for assessing headache-related disability. (28) (29)
Time frame: Baseline and after 4 weeks
Universal Goniometer (UG)
The range of motion will be measured using a universal goniometer which is a 12-inch transparent plastic model, featuring a protractor scale, two arms, and a fulcrum that has an inter-rater reliability (ICC2, 2 = 0.79 to 0.92) for cervical region. UG requires a high level of examiner proficiency and involves the use of a measurement scale, although the final position does not need to be maintained for immediate reading, as the score can be recorded after completion. The procedure depends on accurate alignment of three anatomical landmarks: the axis, the stationary arm, and the movable arm which requires precise identification of anatomical structures. (30)
Time frame: Baseline and after 4 weeks
Neck Disability Index (NDI)
It is a self-reported questionnaire comprising 10 items used to assess the level of disability associated with neck pain. It evaluates various aspects of daily functioning, including pain intensity, personal care, lifting, reading, headaches, concentration, work, driving, sleep, and recreational activities. Each item is scored from 0 to 5, with higher scores reflecting greater disability, resulting in a total possible score of 50. Based on the total score, disability is classified as no disability (0-4), mild disability (5-14), moderate disability (15-24), severe disability (25-34), and complete disability (35 or above). The NDI is a valid and reliable instrument that can be interpreted using either continuous scores or categorical disability levels. (31)
Time frame: Baseline and after 4 weeks
Pittsburgh Sleep Quality Index (PSQI)
It is a 19-item self-report questionnaire that assesses sleep quality and sleep-related problems over the previous month. It evaluates areas such as perceived sleep quality, sleep habits, and sleep disturbances. An additional five questions completed by a bed partner may provide clinical information but are not included in scoring. PSQI scoring generates seven component scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction. Each component is scored from 0 (no difficulty) to 3 (severe difficulty), producing a global score ranging from 0 to 21. Higher scores indicate poorer sleep quality, and a total score above 5 is generally considered evidence of poor sleep quality. (32)
Time frame: Baseline and after 4 weeks
Plan to share: Yes — The results data collected , de-identified individual participant data will be shared.
Supporting information: Study protocol, Statistical analysis plan, Informed consent form
Time frame: 6 months after the publication of the manuscript.
Access criteria: The data can be requested from the corresponding author.
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University of Management and Technology Lahore