Mulligan Technique Versus Proprioceptive Training in Cervicogenic Headache

Condition(s) studied

Investigational drug(s) / intervention(s)

Mulligan Technique: 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: 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.

Conventional physical therapy program: 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.

Study summary

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.

Eligibility

Primary outcome measure(s)

• Pain Intensity — 4 weeks
  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.
• Headache Impact — 4 weeks
  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.
• Right Cervical Flexion-Rotation Range of Motion — 4 weeks
  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.
• Left Cervical Flexion-Rotation Range of Motion — 4 weeks
  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.
• Pressure Pain Threshold — 4 weeks
  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.

Trial sites (1)

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