this study will be conducted to investigate impact of adding jones technique to mulligan therapy 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
jones and mulligan therapy
Other interventionfor jones technique in upper trapezius and suboccipital muscles, the participants supine , the therapist used manual palpation to locate the tender area in the UT and sub-ossipital muscles. Once detected, pressure to the tender area was progressively increased . The participant was then repositioned passively to decrease the stress under palpation, resulting in a 70% subjective decrement in pain. That position was maintained for 90 s. eventually, the participant returned to the neutral position slowly and passively. for mulligan SNAGS,The therapist held the patient with his trunk, and wrapped the patient's head lightly with his arm on the patient's side, and placed the ring finger on the trouble spot right above the small vertebral joint. The therapist placed the thenar eminence of his opposite hand on the ring finger, which was touching the lesion site. On the site, the therapist performed gliding in the upward direction of the front pupil (45 degrees) exercises
mulligan therapy
Other interventionmulligan SNAGS,The therapist held the patient with his trunk, and wrapped the patient's head lightly with his arm on the patient's side, and placed the ring finger on the trouble spot right above the small vertebral joint. The therapist placed the thenar eminence of his opposite hand on the ring finger, which was touching the lesion site. On the site, the therapist performed gliding in the upward direction of the front pupil (45 degrees). The hand, which was touching the spinous process, should be relaxed in order not to squeeze too hard. The source of the power of gliding on the joint surface must come from the opposite hand of the patient-contacting hand. Gliding was applied rhythmically (three times per second) and the width of gliding starts from the middle to the end+ exercises
exercises program
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 intesnity
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.
neck disability
will be measured by Arabic neck disability index. 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
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).
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