this study will be conducted to investigate the impact of adding integrated neuromuscular inhibition technique to postural correction exercises in patients with cervicogenic headache
20 to 60 years old patient with unilaterally of the head pain
pain triggered by external pressure over the upper cervical joints (c1-c3)
pain elicited by the neck movements, and/or sustained awkward positions with reduced neck ROM
headache intensity pain score of at least 20mm on the Visual analogue scale (VAS)
Migraine, tension- type headache, tumor, osteoporosis, fracture, rheumatoid arthritis and metabolic diseases.
Prolonged history of steroid use.
Resting blood pressure greater than 140/90 mmhg.
cervical spinal stenosis, diminished sensation and central nervous system involvement,
Parallel
Integrated Neuromuscular Inhibition Technique
Other interventionPatients will receive integrated neuromuscular inhibition technique in the form of intermittent ischemic compression, strain counterstrain, and muscle energy technique plus postural correction exercises
Postural Correction Exercise
Other interventionThe exercise program will be in the form of stretching exercises for the sternocleidomastoids (SCM), the scalenes, and upper fibers of trapezius; strengthening isometric exercises for the neck flexors, extensors, lateral flexors, and neck rotators; and postural correction exercises.
pain intensity
visual analogue scale will be used to asses pain intensity which patient will be instructed to put point on line from no pain to tolerable pain. The scale consists of a line, usually 100 mm long, ranging from no pain or discomfort (zero) , to the worst pain that could possibly feel .
headache disability
The Headache spesific Disability Questionnaire was used to assess headcahe disability. it is a self-administered scale with 9 items that assesses pain intensity, work or school disruptions, and the effect on recreational activities in individuals with headache complaints. Higher scores reflect greater impairment.
pressure pain threshold
pressure pain threshold pressure pain threshold will be assessed by commander algometer
cervical range of motion
range of motion will be measured by inclinometer CROM. The CROM (deluxe version - Performance Attainment Associates, Roseville, MN, USA) measures the cervical range of motion5- for fexion, extension, lateral fexion, and rotation using separate inclinometers. These inclinometers are attached to a frame similar to that for eyeglasses one in the sagittal plane for fexion - extension, second in the frontal plane for lateral fexion and a third in the horizontal plane for rotation.
headache frequency
the number of days the subjects feel headache (headache frequency).
medication intake
from the patients' diary in the last week , medications intake will be recorded as follow: 1) not at all; 2) once a week; 3) once every couple of days; 4) once or twice a day; or 5) three or more times a day
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