Cervicogenic Headache

The goal of this observational study is to compare physical findings across three adult groups. Cervicogenic headache (CGH) is a headache linked to a problem in the neck. Neck pain may affect posture, muscle function, grip strength, and sensitivity to pressure. Researchers do not know whether CGH has a distinct pattern of these findings. The main questions are: * Do posture, grip strength, muscle stiffness, elasticity, and pressure sensitivity differ among the groups? * Are any differences more closely associated with CGH than with neck pain? Researchers will compare adults ages 25 through 60. One group will include people with CGH lasting at least three months. Another group will include people with neck pain lasting at least six months. People in the neck pain group will have no headaches. Healthy participants will have no neck pain or headaches. Researchers will not provide treatment or change participants' usual care. Each participant will complete one study visit lasting about 15 minutes. Participants will: * Answer short questions about their health and pain * Stand while researchers measure their head and neck posture * Squeeze a device that measures grip strength * Complete brief tests of neck muscle stiffness and elasticity * Tell researchers when applied pressure first becomes painful Researchers will compare results across the three groups. The findings may guide future CGH assessment and treatment research.

The purpose of this study is to compare the effects of manual therapy and a multicomponent exercise program on suboccipital muscle thickness, joint position sense, pain, central sensitization, balance, and kinesiophobia in patients diagnosed with cervicogenic headache. Cervicogenic headache is a common secondary headache originating from dysfunction in the upper cervical spine. Dysfunction in the deep neck muscles, impaired neck joint awareness, and heightened pain sensitivity (central sensitization) are frequently observed in these patients. While both manual therapy and targeted exercise are used in physiotherapy practice, evidence regarding their direct comparative effects on suboccipital muscle morphology and somatosensory parameters remains limited. Participants will be randomly assigned to one of two treatment groups for a duration of 4 weeks (12 sessions total): 1. Manual Therapy Group: Receives joint mobilization, myofascial release, trigger point release, and suboccipital distraction targeting the cervical region. 2. Multicomponent Exercise Group: Receives deep cervical flexor strengthening, cervical proprioception training, head-eye coordination training, and progressive balance exercises. The main questions the study aims to answer are: * Do manual therapy and multicomponent exercise improve suboccipital muscle thickness and cervical joint position sense in patients with cervicogenic headache? * Is there a significant difference between manual therapy and multicomponent exercise in reducing pain intensity, central sensitization, disability, and fear of movement (kinesiophobia)? It is hypothesized that both intervention protocols will yield significant clinical improvements, with specific synergistic adaptations in muscle structure, somatosensory system processing, and pain-related fear.

Forward Head Posture (FHP) is a common postural deviation characterized by anterior translation of the head relative to the trunk, which increases load on cervical muscles and joints. This postural change is associated with muscle fatigue, joint compression, and tension in cervical soft tissues, contributing to cervicogenic headache (Al-Mutairi et al., 20242; Koseoglu et al., 2023). The deep cervical flexor (DCF) muscles, especially the longus colli and longus capitis, are key stabilizers of the cervical spine, and weakness or fatigue of these muscles leads to overuse of superficial muscles such as the sternocleidomastoid and anterior scalene, creating an imbalance between deep and superficial systems. Diminished endurance of deep cervical flexors has been linked to forward head posture, impaired motor control, and persistent neck pain (Ismail et al., 2023). Cervical proprioception is crucial for accurate head position sense. Impaired cervical proprioception results in distorted information about head orientation, causing dizziness, incoordinated movement, and neck discomfort, and has been frequently observed in juniors with cervicogenic headache, increasing muscular strain and headache intensity. In the present study, therefore, we aim to investigate the correlation between FHP, cervical endurance, and proprioceptive function in junior students with cervicogenic headache

Cervicogenic Headache (CGH) is a painful condition that has pronounced impacts on quality and activity of daily lives. It is often associated with decreased mobility, muscular tightness, and postural deviations. When neck muscles become tight, weak, or irritated, they change the way the neck moves and put pressure on nearby joints and nerves. This pressure delivers pain signals to the head, causing a Cervicogenic headache.

Cervicogenic headache (CGH) is a secondary headache that originates from dysfunction in the upper cervical spine, particularly the atlanto-occipital and C1-C3 segments, and is perceived in one or more regions of the head and/or face. The underlying mechanism involves convergence of cervical and trigeminal afferents in the trigeminocervical nucleus. Structures innervated by the C1, C2, and C3 spinal nerves are capable of producing referred pain to the head. CGH is relatively common, accounting for approximately 15-20% of all chronic headaches. It typically worsens with neck movement and is often associated with limited cervical range of motion. One of the key impairments in individuals with CGH is disrupted cervical sensorimotor control, particularly affecting proprioception and deep cervical muscle coordination. Physical therapy is widely recognized as the first-line treatment for CGH, with emerging evidence supporting interventions aimed at improving cervical proprioception and neuromuscular control. This study aims to compare the effectiveness of two sensorimotor-based physical therapy approaches-eye-cervical re-education and pressure biofeedback training of deep cervical flexors (DCF)-in patients with CGH. The primary outcomes include pain intensity, functional disability, cervical range of motion (ROM), and cervical joint position sense (proprioception). Participants will be recruited using purposive sampling from Fauji Foundation Hospital and Foundation University College of Physical Therapy (FUCP), Islamabad. After providing written informed consent, eligible participants will be randomized into two groups. Group 1 will receive conventional physical therapy along with eye-cervical re-education exercises, while Group 2 will receive conventional therapy combined with pressure biofeedback DCF training. Data will be collected at baseline and after the 10th treatment session to assess within- and between-group changes in the outcome measures. This study aims to inform evidence-based physical therapy practice in the management of cervicogenic headache.

This study aims to compare the effects of osteopathic manipulative treatment and standard physiotherapy in patients with cervicocranial dysfunction. The study will evaluate outcomes including dizziness, headache impact, neck disability, and psychological stress. Participants will be randomly assigned to one of two groups: osteopathic treatment or standard physiotherapy. The interventions will be applied over a defined treatment period, and outcomes will be measured before and after the intervention. The purpose of this study is to determine which approach is more effective in improving symptoms and functional outcomes in patients with cervicocranial dysfunction.

Cervicogenic headache (CBH) is defined as a headache caused by a disorder in the cervical spine, bones, discs, or soft tissue elements, which is also accompanied by neck pain. Unilateral, non-reversible oculo, fronto, temporal pain, pain that increases with poor neck positioning and incorrect neck movements, and may be seen with restricted movement in the upper cervical and occiput regions. The aim of this thesis is to compare the effectiveness of Mulligan mobilization technique and myofascial release methods used in the treatment of cervicogenic headache through a prospective clinical study.

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

Upper cervical spine mobility plays a crucial role in temporomandibular joint (TMJ) function. This observational study investigates the relationship between upper cervical spine mobility and TMJ range of motion in patients diagnosed with temporomandibular disorders (TMD). Cervical hypomobility may restrict mandibular movement and contribute to TMJ dysfunction through shared biomechanical and neuromuscular mechanisms.

Cervicogenic headache is a secondary headache disorder originating from cervical spine structures and is frequently associated with chronic pain, functional limitation, and impaired quality of life. The third occipital nerve, which innervates the C2-3 zygapophyseal joint, plays an important role in the pathophysiology of cervicogenic headache. Pulsed radiofrequency is a minimally invasive interventional pain management technique that modulates nociceptive transmission without causing permanent neural damage. Although third occipital nerve pulsed radiofrequency is increasingly used in clinical practice, prospective data evaluating its clinical effectiveness and safety remain limited. The aim of this prospective, single-center study is to evaluate the effectiveness and safety of ultrasound-guided third occipital nerve pulsed radiofrequency treatment in patients diagnosed with cervicogenic headache. Pain intensity, headache characteristics, analgesic consumption, and patient-reported outcomes will be assessed before treatment and during follow-up. The results of this study are expected to contribute to clinical evidence supporting interventional treatment strategies for cervicogenic headache.

Chronic cervicogenic headache is a common disease in China, with a high incidence among the elderly, and has a significant impact on patients' quality of life. Currently, both domestic and international studies have confirmed that glucocorticoid injection at myofascial trigger points(MTrPs) can alleviate patients' pain symptoms. MTrPs injection is safe and easy to operate, and can improve the clinical management efficiency of patients with chronic cervicogenic headache. Therefore, we designed a prospective, randomized controlled, blinded outcome, non-inferiority study to compare the long-term clinical efficacy of glucocorticoid injection at myofascial trigger points and greater occipital nerve block injection in treating chronic cervicogenic headache. Patients will be randomly divided into two groups and receive either glucocorticoid injection at MTrPs or dorsal rami blocks of C2 spinal nerves. After treatment, patients will be followed up for 2 years. Their NRS scores, attack frequency, attack duration, HIT-6 scores, Patient Global Impression of Change(PGIC) scale, and adverse reactions will be recorded at 2 weeks, 4 weeks, 8 weeks, 12 weeks, and 24 weeks. If the results indicate that the clinical efficacy of myofascial trigger point injection for chronic cervicogenic headache is not inferior to that of injection at intra-articular injection, it will provide a safe and simple treatment option that is easy to promote for patients who do not respond to conservative treatment.

Chronic musculoskeletal pain (CMP) is a common disease in China, with a high incidence among the elderly, and has a significant impact on patients' quality of life. Knee osteoarthritis is a common type of CMP. Currently, both domestic and international studies have confirmed that glucocorticoid injection at myofascial trigger points(MTrPs) can alleviate patients' pain symptoms. MTrPs injection is safe and easy to operate, and can improve the clinical management efficiency of patients with knee osteoarthritis. Therefore, we designed a prospective, randomized controlled, blinded outcome, non-inferiority study to compare the long-term clinical efficacy of glucocorticoid injection at myofascial trigger points and complex intra-articular injection in treating knee osteoarthritis. Patients will be randomly divided into two groups and receive either glucocorticoid injection at MTrPs or joint cavities. After treatment, patients will be followed up for 2 years. Their NRS scores, WOMAC scores, Patient Global Impression of Change(PGIC) scale, and adverse reactions will be recorded at 2 weeks, 4 weeks, 8 weeks, 12 weeks, and 24 weeks. If the results indicate that the clinical efficacy of myofascial trigger point injection for knee osteoarthritis is not inferior to that of injection at intra-articular injection, it will provide a safe and simple treatment option that is easy to promote for patients who do not respond to conservative treatment.

This study tests if low-level laser therapy (LLLT) with different light wavelengths can help people with cervicogenic headache, a type of headache caused by neck problems. Adults aged 18-65 with this headache for at least 3 months will try one of three LLLT treatments (675nm, 820nm, or a mix of wavelengths) along with regular physical therapy like stretching and exercises. The study will check pain levels, how often headaches happen, neck movement, disability, and quality of life over 6 weeks, with follow-ups at 3 and 6 months. the investigators want to find the best LLLT option to reduce headache symptoms safely.

The primary aim is to test the combined effectiveness of OMT and targeted head exercise (THE) to achieve a significant decrease in headache measures of frequency, intensity, and duration in a Treatment group when compared to a Control group whose members receive only standard medical care. A parallel, 2-arm, longitudinal, randomized controlled trial (RCT) will focus upon female patients (18 to 75 years of age) who have been diagnosed with chronic cervicogenic headache (CeH) based upon a differential diagnosis that includes classification according to the International Headache Society Classification IHSD 3rd Edition, reproduction of referred headache resulting from manual pressure over the upper cervical regions, and objective MRI findings. It is estimated that a sample size of 30 will provide sufficient statistical power (79%) to detect an intervention effect that corresponds to a clinically meaningful recovery (60%). CeH is classified as a secondary headache disorder because the headache pain is a consequence of injury to, or disease of, the bony and/or soft tissues of the upper cervical spine. It has been reported that some patients diagnosed with CeH demonstrate atrophy and/or fatty infiltration (FI) of the RCPm muscles on MRI. FI and/or a reduction in the cross-sectional area (CSA) of active muscle would not be expected to be the direct cause of chronic headache, but either or both could prevent muscles from generating normal physiologic levels of force. It has been shown that there is a functional connection between the pain sensitive dura mater and RCPm muscles and it is known that mechanical stretching of the dura mater results in referred headache. While FI and/or a reduction in the CSA of active muscle would not be expected to be the direct cause of chronic headache, it is known that muscle pathology will result in functional deficits. It is proposed that pathology in RCPm muscles will compromise the normal functional relationship between the RCPm and the dura mater and result in referred head and neck pain. It is predicted that at the end of the study, the Treatment group will show a significant decrease in headache measures that will be accompanied by a significant increase in CSA and a significant decrease in FI on MRI, and restoration of a normal head posture that will not be seen in the Control group. The proposed study is unique in that we are proposing both a mechanism and a source for some instances of CeH. By testing the effectiveness of specific interventions to address a specific pathology within a specific headache population, and by restricting the study cohort to female subjects presenting with CeH, this study will increase the ability to detect a significant change in the outcomes by increasing the power of the statistical analysis.

this study will be conducted to investigate the impact of adding integrated neuromuscular inhibition technique to postural correction exercises in patients with cervicogenic headache

Cervicogenic dizziness is defined as a sensation of rotation, resulting from an alteration of the neck proprioceptive afferents of the upper cervical spine.Sub-occipital Release, a type of Myofascial Release (MFR) is a form of manual therapy technique which can be used for the treatment of cervicogenic dizziness. Sub-occipital muscles, dura matter and C2 vertebrae are connected to each other through the fascia. Sustained natural apophyseal glides (SNAGs) are also an effective treatment for cervicogenic dizziness. This study aim to determine Comparative Effect of Sub-Occipital Myofascial release with and without Sustained Natural Apophyseal Glide among patients with Cervicogenic Dizziness.

Study Title: Evaluation of the Effectiveness of Adding Greater Occipital Nerve Block to Trigger Point Injection in Patients with Neck Pain Due to Upper Trapezius Trigger Points: A Single-Blind Randomized Controlled Trial Purpose of the Study: This study aims to evaluate whether adding a Greater Occipital Nerve (GON) block to the standard trigger point injection treatment provides better pain relief and improves daily function in patients with neck pain caused by trigger points in the upper trapezius muscle. Trigger points are small, sensitive spots in muscles that can cause significant pain and discomfort. While both trigger point injections and GON blocks are common treatments for neck and head pain, it is not yet clear if combining these two methods offers better results. Why is this study important? Neck pain related to trigger points in the upper trapezius muscle is a frequent problem, but there is limited research on the effectiveness of combining trigger point injections with GON blocks. This study will provide important information on whether the combination therapy can reduce pain more effectively and improve patients' quality of life and ability to perform daily activities. Who can participate? Adults aged 18 to 65 years old Diagnosed with myofascial pain syndrome (MAS) based on specific clinical criteria, including the presence of trigger points in the upper trapezius muscle Experiencing neck pain lasting longer than 3 months Pain intensity rated 5 or higher on a scale of 0 to 10 Who cannot participate? Pregnant or breastfeeding women, children, elderly people, unconscious or critically ill patients Patients with allergies to local anesthetics or steroids Individuals with bleeding disorders or infections near the injection site Patients with serious psychiatric or neurological diseases, or other medical conditions that may affect study results Those who have recently received similar treatments or surgery for neck or shoulder problems Study Design and Procedures: The study will include 60 patients meeting the criteria, randomly assigned to two groups using a balanced randomization method. Group A will receive only trigger point injections into the upper trapezius muscle using a mixture of lidocaine and saline solution. Group B will receive both trigger point injections and an ultrasound-guided GON block, which involves injecting a combination of local anesthetics and steroid near the greater occipital nerve to reduce pain signals. Both groups will receive the same home exercise program focusing on stretching and strengthening neck muscles to support recovery. Patients will be encouraged to perform these exercises regularly and will be followed up weekly by phone to check their progress. The doctor assessing patients' progress will not know which treatment the patient received, to ensure unbiased results. Assessments: Patients will be evaluated at three different times: before treatment, 1 week after treatment, and 4 weeks after treatment. Assessments include: Pain intensity and quality (using Visual Analog Scale and McGill Pain Questionnaire) Neck disability and ability to perform daily activities (Neck Disability Index) Quality of life (Nottingham Health Profile) Neck joint movement and position sense (using clinical tests with special equipment) Posture evaluation (measuring head position using photography) Expected Outcomes: The main goal is to determine if the combined treatment of trigger point injection plus GON block is more effective than trigger point injection alone in reducing pain, improving neck function, and enhancing quality of life. Duration and Follow-Up: The study is planned to last 12 months. Patients will be closely monitored during and after treatment to ensure safety and to collect necessary data. Potential Benefits and Risks: Participants may experience pain relief and improved function if the combined treatment is effective. Risks include mild discomfort or side effects related to injections, which will be minimized by experienced medical staff.

this study will be conducted to investigate impact of adding jones technique to mulligan therapy in patients with cervicogenic headache

This study is a randomised control trial and the purpose of this study is to compare ventro-cephalic to dorso-caudal translatoric glides in management of cervicogenic headache.

The purpose of this research is to compare two different approaches for treating patients with cervicogenic headaches associated with type II whiplash associated disorder: non-thrust mobilization and exercise versus thrust manipulation and dry needling. Physical therapists commonly use all of these techniques to treat cervicogenic headaches. This study is attempting to find out if one treatment strategy is more effective than the other.

The primary objective of the study is to determine the effects of Jones and Ischemic compression technique on pain, range of motion and disability in patients with cervicogenic headache. Cervicogenic headache is a distinctive type of secondary headache where the pain originates from structures in the neck or cervical spine and radiates to the head. Trigger point release has been associated with decrease in symptoms of patients with cervicogenic headache. This study will be a randomized clinical trial with the sample size of 32 patients. Participants will be randomly allocated into two groups: Group A and Group B. The setting of the study will be Bahawal Victoria Hospital, Bahawalpur. Group A will receive Jones technique of trigger points of the upper trapezius and sternocleidomastoid muscle while Group B will receive ischemic compression of the trigger points of the upper trapezius and sternocleidomastoid muscle. Patients of both groups will receive two treatment sessions per week for 6 weeks. Both groups will receive hot pack for 10 minutes, TENS for 15 minutes and strengthening exercises for deep neck flexors (chin tuck and head raise with ten repetitions of 10-second duration, with a 10-second rest interval between each contraction) as baseline treatment protocol. NPRS, HDI and FRT will be used as outcome measure tools. Data will be analyzed using SPSS version 25.0 with the p-value of \<0.05 taken as significant difference.

The primary objective of this study is to compare effects of SCS and METs on reduction of neck pain intensity and improvement in functional disability in individuals with CGH. The secondary objective is to assess the impact of both techniques on ROM in cervical spine

The study will be conducted: To investigate the effect of high-power laser on myoelectrical activities of suboccipital muscles in patients with cervicogenic headache. * To investigate the effect of high-power laser on pain in patients with cervicogenic headache. * To investigate the effect of high-power laser on quality of life in patients with cervicogenic headache.

This study will be designed to determining whether there is a relationship between CGH and cervical posture which may potentially provide physical therapists with evidence supporting the assessment and treatment of abnormal posture in this patient group.

This study is a randomised control trial and the purpose of this study is to determine the "Additional effects of sternocleidomastoid release along with suboccipital muscle release in management of cervicogenic headache".