this study will be conducted to investigate the impact of adding Instrument assisted soft tissue mobilization technique to mulligan therapy in patients with cervicogenic headache
Age group above 18 years' old
History of chronic CGH (>3 months)
CGH owing to cervical spine (neck) dysfunction
Reduced cervical motion
Participants with other types of headache (migraine headache)
Headache owing to other causes (sinus, tumor, neural, and tempero-mandibular joint issues)
Any contraindications to manual and manipulative therapy (fracture, instability, osteoporosis and neural symptoms)
Taking analgesics or corticosteroids and migraine-specific medications, such as triptans
Parallel
instrumeted assissted soft tissue mobilization and mulligan therapy
Other interventionthe patients will receive IASTM tools over the length of targeted muscles (descending fiber of trapezius, suboccipitalis muscles ) for 5 minutes. also, SNAG technique; Each patient will be asked to sit comfortably, and the treating therapist will stand beside the patient. The patient's head will be free and cradled between the therapist's right forearm and body, and the therapist stand at the patient's right side. The therapist then will place his right index, middle, and ring fingers at the base of the occiput and kept his right little finger over the spinous process of C2. Next, with the lateral border of his left thenar eminence, gentle pressure will be applied in a ventral and upward direction(45 degrees) over the right little finger. finally postural correction execises
mulligan therapy
Other interventionSNAG technique; Each patient will be asked to sit comfortably, and the treating therapist will stand beside the patient. The patient's head will be free and cradled between the therapist's right forearm and body, and the therapist stand at the patient's right side. The therapist then will place his right index, middle, and ring fingers at the base of the occiput and kept his right little finger over the spinous process of C2. Next, with the lateral border of his left thenar eminence, gentle pressure will be applied in a ventral and upward direction(45 degrees) over the right little finger. Finally, postural correction exercises will be addedd
postural correction exercises
Other interventionthe exercises will incluse, Stretching exercises for the sternocleidomastoids,the Scalenes,upper fibers of trapezius and strengthening exercises for cervical muscles
neck disability
Assessment of neck function was performed by Arabic neck disability index. It is a valid and reliable tool in the assessment of neck function. It contains ten category/classes. Each category contains six choices (zero-five).Score from zero to four no disability, from five to 15 this is mild, From 15 to 24 this is moderate, from 25 to 34 this is severe, more than 34 this is a complete disability
pain intensity
The scale will be used is the VAS, which consists of a line, usually 10 cm long, ranging from no pain or discomfort (zero) , to the worst pain that could possibly feel (10)
cervical range of motion
The CROM device will be used to assess cervical range of motion. it is headmounted equipment consists of a plastic frame placed on the head over the nose and the ears, secured by a Velcro strap. Two independent inclinometers, 1 in the sagittal plane and 1 in the frontal plane, are attached to the frame and indicate the position of the head with respect to the line of gravity. A third inclinometer is positioned in the horizontal plane and indicates the position of the head in rotation, with respect to a reference position
muscle stiffness
The MyotonPRO (Myoton AS, Tallinn, Estonia) is a recently introduced device that can objectively measure the mechanical properties of muscles including analyzing muccsle stiffness (N/m). The measurement procedure involved pressing the device against the skin, with a force of 0.18 N and instantly applying an impulse of 0.4 N for duration of 15 ms. The skin surface oscillation induced by the\\ MyotonPRO was measured
headache frequency
the number of days the subjects experienced headaches (frequency)
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