Cervicogenic Headache Research Articles

Effect of Extracorporeal Shock Wave on Upper Trapezius Trigger Points in Patients With Cervicogenic Headache: A Randomized Clinical Trial.

A recent study was designed to ascertain the impact of extracorporeal shock wave therapy on upper trapezius trigger points in cervicogenic headaches patients. A double-blinded randomized controlled trial study, in which 50 participants (11 male and 39 female) aged between 20-40 with cervicogenic headache were subdivided with randomization to group (A), which received traditional physical therapy and sham shock wave therapy, and group (B), which received traditional physical therapy and actual shock wave therapy. All assessments were performed by a therapist before and after the treatment program (4 wks). There was a significant difference of headache disability index, visual analog scale scores, and upper trapezius electromyographic characteristics with P value <0.05 in both groups, in favor of the shock wave group. Extracorporeal shock wave therapy could be used for clinical and research concerns because its positive effects on pain suppression, reduction of headache intensity, and restoration of muscle regular activity in cervicogenic headache patients.

Effectiveness of Nonpharmacological Measures on Improving Headache Score, Strength, Pain, and Quality of Life in Cervicogenic Headaches: A Systematic Review.

Cervicogenic headache (CGH) is a common condition affecting a significant portion of the population and is effectively managed through various interventions, including nonpharmacological approaches. Physical therapy plays a crucial role in CGH management, with numerous studies supporting its effectiveness. This systematic review aimed to evaluate the effectiveness of specific nonpharmacological physical therapy interventions for CGH. A comprehensive search was conducted across various databases (PubMed, Medline, PEDro, and Cochrane Library) for randomized controlled trials (RCTs) published between January 2017 and January 2023 investigating the effectiveness of specific nonpharmacological physical therapy interventions for CGH. We employed manual searches to capture potentially missed studies. Independent reviewers screened all studies based on predefined eligibility criteria. Extracted data included methodology, specific interventions, outcome measures (headache score, strength, pain, and quality of life (QOL)), and study conclusions. Eight RCTs were identified as meeting all inclusion criteria and were thus included in the data synthesis. The findings from these trials revealed a diverse range of nonpharmacological physical therapy interventions, including but not limited to manual therapy, exercise therapy, and multimodal approaches. Specifically, the interventions demonstrated significant improvements in headache scores, strength, pain levels, and overall QOL among individuals with CGH. These results underscore the multifaceted benefits of physical therapy in managing CGH and highlight its potential as a comprehensive treatment option. This review identified eight relevant RCTs investigating nonpharmacological interventions for CGH. Despite the promising findings, this review acknowledges several limitations, including the limited sample size and the heterogeneity of interventions across studies. These limitations emphasize the necessity for further research to elucidate optimal intervention strategies and refine treatment protocols. Nevertheless, the comprehensive analysis presented herein reinforces the pivotal role of physical therapy in not only alleviating pain but also enhancing function and improving the QOL for individuals suffering from CGH.

Myofascial Release for the Treatment of Tension-Type, Cervicogenic Headache or Migraine: A Systematic Review and Meta-Analysis.

To assess the effectiveness of myofascial release (MFR) techniques on the intensity of headache pain and associated disability in patients with tension-type headache (TTH), cervicogenic headache (CGH), or migraine. A systematic review and meta-analysis. Eight databases were searched on September 15, 2023, including PubMed, Scopus, Web of Science, CINAHL, Cochrane Library, Embase, CNKI, and Wanfang Database. The risk of bias was evaluated utilizing the Cochrane Risk of Bias 2 (RoB 2) tool. Pooled results showed that MFR intervention significantly reduces pain intensity [SMD = -2.01, 95% CI (-2.98, -1.03), I2 = 90%, P < 0.001] and improves disability [SMD = -1.3, 95% CI (-1.82, -0.79), I2 = 74%, P < 0.001]. Subgroup analysis based on the type of headache revealed significant reductions in pain intensity for CGH [SMD = -2.01, 95% CI (-2.73, -1.29), I2 = 63%, P < 0.001], TTH [SMD = -0.86, 95% CI (-1.52, -0.20), I2 = 50%, P=0.01] and migraine [SMD = -6.52, 95% CI (-8.15, -4.89), P < 0.001] and in disability for CGH [SMD = -1.45, 95% CI (-2.07, -0.83), I2 = 0%, P < 0.001]; TTH [SMD = -0.98, 95% CI (-1.32, -0.65), I2 = 0%, P < 0.001] but not migraine [SMD = -2.44, 95% CI (-6.04, 1.16), I2 = 97%, P=0.18]. The meta-analysis results indicate that MFR intervention can significantly alleviate pain and disability in TTH and CGH. For migraine, however, the results were inconsistent, and there was only moderate quality evidence of disability improvement for TTH and CGH. In contrast, the quality of other evidence was low or very low.

Management of Cervicogenic Headache - A Case Study

Purpose: To describe the use of manual therapy and muscle reeducation for an individual with cervicogenic headache. Background: This patient was a 30-year-old woman with complaint of headache. She was functionally limited with posture. She also demonstrated impairments in cervical mobility and muscular performance. Methods and measures: This patient was treated 8 sessions over a 8 week period. Study design: Case study Intervention: Intervention included manual upper cervical spine mobilization techniques, muscle re-education for deep neck flexors muscles and scapular stabilization exercises. Results: Following treatment, the patient demonstrated in an increase in cervical mobility, improved muscular performance, a decrease in headaches, and resolution of functional limitations. Statistical analysis of the data showed significant differences from pre to post intervention from Day 1 to Day 8. There was clinical and statistical significance found in ROM and functional ability. Conclusion: Findings suggest that the mulligans manual therapy with exercises is more effective in reducing headache, improving range of motion of cervical spine and functional ability in patients with Cervicogenic Headache. Keywords: Cervicogenic headache (CGH), mulligans mobilization, snags, manual therapy, sub occipital muscle release.

Effects of sustained natural apophyseal glides versus rocabado 6 × 6 program in subjects with cervicogenic headache

BackgroundCervicogenic headache is designated as the most common type of secondary headache that results from conditions affecting the neck’s bony components, muscles, and intervertebral discs rather than the head itself.ObjectiveThe purpose was to determine the effects of Sustained Natural Apophyseal Glides (SNAGs) versus the Rocabado 6 × 6 program in subjects with cervicogenic headaches.MethodsThis study was a randomized clinical trial. The sample size was 38, and participants aged 20–60 years (mean age 40.22 ± 9.66) suffering from cervicogenic headaches were randomly allocated using the lottery method into two groups with 19 participants in each group. Assessment of subjects was done before starting treatment and by the end of the 8th week for all the variables. Outcome measures were the Neck Disability Index (NDI), 6-item Headache Impact Test (HIT-6), Flexion-Rotation test (FRT) to assess the rotation range of motion at the level of C1-C2 (goniometer) and the Numeric Pain Rating Scale (NPRS) for the intensity of pain. Data analysis was done by SPSS (IBM) 25. To check the normality of the data the Shapiro-Wilk test was used.ResultsIn the Shapiro-Wilk test p-value of all the testing variables i.e. NDI, HIT-6 score, FRT and NPRS was > 0.05, data was normally distributed and parametric tests were used. Group A showed a considerable improvement (p < 0.05) in all variables compared to Group B, while within-group analysis of both groups shows that all outcome measures show significant results (p < 0.05).ConclusionIt was concluded that both SNAGs and Rocabado’s 6 × 6 exercises were effective for the treatment of cervicogenic headache but the effects of headache SNAG were superior and produced more improvement in intensity of headache, disability, frequency of headache, duration of headache as compared to Rocabado 6 × 6 exercises.Trial registration numberThis study was registered at ClinicalTrials.gov ID: NCT05865808 on date 19/05/2023.

Effectiveness of Myofacial Release versus Proprioceptive Neuro Facilitation Technique on Pain and Range of Motion in Patients with Cervicogenic Headache

Background: Cervicogenic headache is a prevalent condition characterized by headaches caused by cervical musculoskeletal impairments. The effectiveness of Myofascial Release (MFR) and Proprioceptive Neuromuscular Facilitation (PNF) in managing this condition has been explored, with varying outcomes on pain intensity, cervical range of motion (ROM), and functional disability. Objective: To compare the efficacy of MFR and PNF techniques in reducing pain and improving ROM in patients with cervicogenic headache. Methods: This randomized control trial included 30 female participants diagnosed with cervicogenic headache. Participants were randomly assigned to receive either MFR or PNF treatments over a period of 4 weeks, with sessions conducted twice weekly. Outcome measures included pain intensity assessed by the Visual Analog Scale (VAS), cervical ROM measured using a universal goniometer, and functional disability evaluated through the Neck Disability Index (NDI). Data were analyzed using SPSS version 25, employing t-tests for within-group comparisons and ANOVA for between-group analyses. Results: Both MFR and PNF groups showed significant improvements post-treatment. The MFR group demonstrated a reduction in VAS scores from 6.73 ± 0.593 to 4.26 ± 0.703 (p&lt;0.001), and the PNF group from 6.73 ± 0.593 to 5.26 ± 0.432 (p&lt;0.001). Cervical ROM and NDI scores also significantly improved in both groups. Comparative analysis revealed MFR to be more effective in enhancing cervical rotation (MFR: 70.13 ± 3.020 to 80.20 ± 2.840; PNF: 60.33 ± 2.690 to 64.06 ± 2.548; p&lt;0.05) and reducing NDI scores (MFR: 48.33 ± 5.56 to 17.53 ± 5.46; PNF: 10.00 ± 2.267 to 8.93 ± 1.667; p&lt;0.001). Conclusion: Both MFR and PNF are effective in treating cervicogenic headache, significantly reducing pain intensity and improving cervical ROM and functional disability. MFR, however, exhibited a superior efficacy in enhancing cervical rotation and reducing NDI scores, suggesting it may offer additional benefits in the management of cervicogenic headache.

Comparison of deep friction massage and post isometric relaxation technique in cervicogenic headache: A randomised clinical trial

The study aimed to compare the effectiveness of Deep Neck Friction Massage (DNFM) and Post Isometric Relaxation Technique (PIR) in managing Cervicogenic Headache (CGH). A randomized clinical trial was conducted, with participants from the community with CGH.

A Novel Ultrasound-Guided "Three in One" Approach Plus Interfascial Plane Blocks for the Treatment of Cervicogenic Headache.

Cervicogenic headache (CEH) is a condition resulting from upper cervical spine dysfunction and associated structural and soft tissue abnormalities, significantly impacting patients' quality of life. To acquire better therapeutic results, we presented a novel ultrasound-guided "three in one" approach plus interfascial plane (IFP) blocks for the treatment of CEH. This approach allows for the modulation of C2 dorsal root ganglion (DRG), third occipital nerve (TON), and C3 medial branch with one-point puncture. Additionally, it allows for IFP blocks between the upper neck and occipital muscles within the same scanning plane. We evaluated patients diagnosed with CEH from July 2021 to December 2022 in our pain clinic. We included those who did not respond to conservative treatment and single occipital nerve block, therefore received nerve block or pulsed radiofrequency (PRF) using the "Three in One" approach plus IFP blocks. The accuracy of the ultrasound-guided C2 DRG puncture procedures was confirmed through fluoroscopy with C-arm and the sensory testing of PRF. The therapeutic effect of these interventions was assessed using the numerical rating scale (NRS) scores during telephone follow-ups at 1, 3, and 6 months. Utilizing the "Three in One" approach, a total of 5 patients diagnosed with CEH underwent nerve block plus IFP blocks, while 2 patients underwent PRF plus IFP blocks. Employing ultrasound-guided C2 DRG puncture procedures, the needle tip's correct placement was confirmed through both fluoroscopy and sensory testing of PRF. Notably, none of the cases experienced any complications associated with the approach. Subsequent follow-up assessments revealed an improvement in the NRS scores for CEH in all patients. The ultrasound-guided "Three in One" approach plus IFP blocks may be a potential effective method for the treatment of CEH.

Efficacy of lumbar motor control training in treatment of patients with cervicogenic headache

BackgroundCervicogenic headache (CGH), is a secondary headache arising from cervical disorders. Training core muscles have a corrective effect on the whole spine. Moreover, increased deep neck flexors (DNFs) activation is closely linked with balanced core stabilization of the global cervical-thoracic-lumbopelvic chains. This study aimed to investigate the effect of lumbar motor control training combined with cervical stabilization exercises compared to cervical stabilization exercises alone in CGH patients.MethodsFifty-two subjects of both genders with CGH and chronic mechanical neck pain (CMNP) participated in this study. They were recruited from the outpatient Physical Therapy Clinic at Mubarak Central Hospital, Giza, Egypt; their mean age was 28.1 ± 5.8 years and their BMI was 22.8 ± 1.6 kg/m2. They received treatment for three sessions per week for 4 weeks. Subjects were assigned randomly into two equal groups; the control group: received cervical stabilization exercises (axial elongation, cranio-cervical flexion, cervical extension, rowing, and Y-exercise). Study group: received cervical stabilization exercise in addition to lumbar motor control training (abdominal draw-in maneuver, side plank, and quadruped position), each exercise had a 4-week progression. Headache frequency, duration, intensity by visual analog scale (VAS), and neck functional disability by Neck Disability Index (NDI) were measured before the first session and after the last session of the 4 weeks of treatment.ResultsThere was a high statistically significant difference in post-treatment mean values of headache frequency, headache duration, headache intensity, and neck functional disability between the two groups in favor of the study group.ConclusionAdding lumbar motor control training to cervical stabilization exercise is more effective than cervical stabilization alone in decreasing headache frequency, duration, intensity, and neck functional disability in CGH patients with CMNP.Trial registrationNCT05952115. Registered 11 July 2023-retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/LoginUser?ts=1&cx=-jg9qo4.

Compare the Effectiveness of Ultrasound Versus Trigger Point Release on Cervicogenic Headache

Background: Cervicogenic headache is a unilateral, fixed, or side-locked headache that commonly affects adults.The studies had tried therapeutic and hands-on therapy for managing the Cervicogenic headache. The intent ofthis current study is to identify whether ultrasound or trigger point is more effective for Cervicogenic headaches.Purpose: To compare the effectiveness of ultrasound versus trigger point release on patients with cervicogenicheadache.Materials and Methods: This experimental study has been conducted from November 2022 to April 2023. 30cervicogenic headache subjects were taken from Shanthi physio clinic selected based on the criteria of inclusionand exclusion. Numerical pain rating scale (NPRS) was used to measure pain and Neck disability index (NDI) wasused to identify head and neck function of the participants. The subjects were divided into Group A (15 Subjects)and Group B (15 Subjects). Group A were treated with Trigger point release with trigger point localization andGroup B were treated with Ultrasound with trigger point localization.The treatments were given for 5 days perweek and continued for 4 weeks.Result: The pretest and post test values were analyzed ,results suggest that trigger point release with trigger pointlocalization has significant improvement when compared with ultrasound with trigger point localization with pvalue &lt;0.001.Conclusion: It is suggested that trigger point release with trigger point localization can be more effective forreducing the pain.

Efficacy of Sustained Natural Apophyseal Glides in Improving Pain, Cervical Range of Motion, and Enhancing Quality of Life in Cervicogenic Headache: A Systematic Review

Introduction: Cervicogenic headaches originates from cervical region issues, causing one-sided head pain, neck stiffness, and shoulder discomfort worsened by movement. Sustained Natural Apophyseal Glides (SNAG) mobilisation, a manual therapy technique, applies targeted pressure to dysfunctional spinal segments, aiming to alleviate pain and enhance cervical mobility, potentially offering relief and restoring normal function. Aim: To systematically review the existing literature to determine the efficacy of SNAGs as a treatment intervention for cervicogenic headache, with a focus on evaluating their impact on pain severity, cervical range of motion, and quality of life outcomes. Materials and Methods: A systematic litertaure search was performed using PubMed, Physiotherapy Evidence Database (PEDro) AND Ovid, from 2014 to February 2024. The search terms “SNAG” OR “Sustained Natural Apophyseal Glides” OR “Mulligan” AND “Cervicogenic headache” AND “pain” OR “range of motion” OR “disability” OR “quality of life” were used according to PRISMA guidelines. The study included total 1757 articles, from which eight articles met the inclusion criteria which includes 432 participants with cervicogenic headache. The methodological quality of the included studies were analysed using the PEDro scale. Results: Majority of the articles provide evidence that SNAG has a significant positive effect on the cervicogenic headache. A total of six studies shows positive effect of SNAG on ROM and pain, two studies showed significant improvement in improving quality of life and ROM. Conclusion: SNAG is safe and effective technique that manages cervicogenic headaches.

Effectiveness of Mulligan Therapy in Patients with Cervicogenic Headache: A Systematic Review of Randomised Control Trials

Introduction: Cervicogenic headache is a type of headache that presents as unilateral pain which starts in neck. It originates from C1-C2 zygapophyseal joints. Mulligan therapy is a technique that utilises pain-free low velocity joint mobilisations that includes active component. Aim: To find out effectiveness of mulligan therapy in patients with cervicogenic headache. Materials and Methods: A systematic review of articles searched from PubMed central, Google scholar, ResearchGate until 2023 were undertaken. Among 70 articles, only 10 articles which were according to inclusion and exclusion criteria, were reviewed. The article was reviewed based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Physiotherapy Evidence Database (PEDro) guidelines. Patients with cervicogenic headache, studies reporting influence of mulligan therapy, study design including only randomised control trials were included. Conclusion: Mulligan therapy specifically Natural Apophyseal Glides (NAGs) and Sustained Natural Apophyseal Glides (SNAGs) had an effect on decreasing pain intensity level, improving functional cervical range of motion in patients with cervicogenic headache.

Impact of Class IV LASER Therapy and Conventional Exercise on Young Adults with Cervicogenic Headache: A Randomised Clinical Trial Protocol

Introduction: A Cervicogenic Headache (CGH) is characterised by unilateral neck pain that originates in the bony or soft tissues of the neck and refers to the head. Light Amplification by Stimulated Emission of Radiation (LASER) therapy is frequently employed in clinical settings to treat musculoskeletal diseases. Need for the study: Authors anticipate cervicogenic headache (CGH) treatment with Class IV LASER therapy will lead to statistically significant reduction in both neck pain and headache compared to baseline measurement. Adverse events related to Class IV LASER on CGH is minimal. The anticipated result of the present protocol will provide valuable insight into the efficacy and safety of Class IV LASER in the management of headache and neck pain. Aim: To determine the efficacy of Class IV LASER therapy in young adults with CGH. Materials and Methods: A randomised clinical trial protocol will be conducted on a total of 44 patients having age range between 20- 39 years with cervicogenic headache were recruited by convenience sampling method. Recruited individuals with cervicogenic headache will be randomly divided into two groups: Treatment Group A (Class IV LASER therapy with conventional exercises) and Treatment Group B (Conventional exercises). Treatment time for group A will be calculated by dividing the total energy delivered by the average total output. Each patient received six sessions in total alternative days. Group B also received same session as group A. The visual analogue scale, neck disability index, algometer, and headache impact test are outcome measures that will be recorded as a baseline and of the two-week post-intervention period.

Clinical efficacy of dexamethasone combined with isoniazid in the treatment of tuberculous meningitis and its effect on peripheral blood T cell subsets.

To investigate the clinical efficacy of dexamethasone (Dex) combined with isoniazid in tuberculous meningitis (TBM) and its effect on peripheral blood T cell subsets. A total of 235 patients with TBM were divided into the control group (117 cases) and the observation group (118 cases). Both groups were given conventional treatment, the control group was further given isoniazid, and the observation group was further given Dex combined with isoniazid. The therapeutic effect and improvement of clinical symptoms were evaluated, peripheral blood T lymphocyte subsets and neurological function were observed, and patients' prognosis was evaluated. The total effective rate of the observation group was higher. The recovery time of cerebrospinal fluid (CSF) pressure, CSF protein content, CSF cell count, and hospital stays in the observation group were shorter. The duration of cervicogenic headache, fever, vomiting, and coma in the observation group was shorter. CD3+ and CD4+/CD8+ proportions in the observation group were higher, and CD8+ proportion was lower. The NIHSS score and MRS score of the observation group were lower, as well as the incidence of adverse reactions. Dex combined with isoniazid alleviates clinical symptoms and neurological abnormalities and regulates peripheral blood T cell subsets in TBM.

Treatment of Cervicogenic Headache by Horizontal Penetration Needling Method Combined with Dialectical Point Selection

Treatment of Cervicogenic Headache by Horizontal Penetration Needling Method Combined with Dialectical Point Selection

Структура головных болей у пациентов молодого и среднего возраста с дисплазией соединительной ткани

The purpose — to study the structure of headaches in patients with connective tissue dysplasia (CTD). Material and methods. 100 patients of both sexes aged from 18 to 55 years old with clinical manifestations of CTD and headache were examined. The control group consisted of 30 patients with headache without CTD. Results. Patients with CTD have higher prevalence of chronic migraine, headache associated with temporomandibular joint dysfunction (TMJD). There is a trend towards a higher incidence of cervicogenic headache in combination with TMJD. Also, primary and secondary headaches in patients with CTD were accompanied by predominant blocking of the spinal motion segments of the cervical spine and the upper thoracic spine, against the background of instability and violation of the statics of the cervical spine. Also, a predominant localization of myofascial trigger points in the area of the trapezius and pericranial muscles was found. There is a trend towards higher scores on the central sensitization scale of patients with CTD.

Effectiveness of Percutaneous Radiofrequency Cervical Zygapophyseal Neurotomy in Improving Chronic Cervicogenic Headache

Effectiveness of Percutaneous Radiofrequency Cervical Zygapophyseal Neurotomy in Improving Chronic Cervicogenic Headache

Prevalence of Cervicogenic Headache and Its Association with Upper Crossed Syndrome in Dentists

Cervicogenic headaches refer to a type of headache that originates from the cervical spine can be exacerbated by certain neck movements. Recognizing the link between cervicogenic headaches and Upper Cross Syndrome allows for targeted diagnostic assessments. Objective: To examine the relationship between cervicogenic headaches and USC in dental professionals and deeper understanding of the impact of occupational factors on the occurrence and severity of these headaches. Methods: This cross-sectional study was conducted on 180 participants selected through purposive sampling technique. Inclusion Criteria was both genders between 20 and 50 years age dentist · Having sitting duration of 3 hour or more than 3 hours. Exclusion Criteria was any malignancy related to soft tissues and joints. Study ran from 1 March 2022 to 30 September 2022. Results: The cervical flexion rotation test was positive in 40.7% i.e. 44 participants and is negative in 59.3% i.e. 64 participants. The pectoralis major contracture test was positive in 45.4% i.e. 45 participants and is negative in 54.6% i.e. 59 participants and there is a relation between cervicogenic headache and upper crossed syndrome and in dentists. Conclusions: The findings of this research highlight a substantial prevalence of cervicogenic headache among dentists 45.4% and emphasize a significant association between cervicogenic headache and the presence of upper crossed syndrome. These results provide valuable insights for dental professionals, clinicians, and policymakers to implement appropriate interventions and ergonomic strategies to mitigate the burden of cervicogenic headache in dental practice.

Review of craniofacial pain syndromes involving the greater occipital nerve: relevant anatomy, clinical findings, and interventional management.

Craniofacial pain syndromes exhibit a high prevalence in the general population, with a subset of patients developing chronic pain that significantly impacts their quality of life and results in substantial disabilities. Anatomical and functional assessments of the greater occipital nerve (GON) have unveiled its implication in numerous craniofacial pain syndromes, notably through the trigeminal-cervical convergence complex. The pathophysiological involvement of the greater occipital nerve in craniofacial pain syndromes, coupled with its accessibility, designates it as the primary target for various interventional procedures in managing craniofacial pain syndromes. This educational review aims to describe multiple craniofacial pain syndromes, elucidate the role of GON in their pathophysiology, detail the relevant anatomy of the greater occipital nerve (including specific intervention sites), highlight the role of imaging in diagnosing craniofacial pain syndromes, and discuss various interventional procedures such as nerve infiltration, ablation, neuromodulation techniques, and surgeries. Imaging is essential in managing these patients, whether for diagnostic or therapeutic purposes. The utilization of image guidance has demonstrated an enhancement in reproducibility, as well as technical and clinical outcomes of interventional procedures. Studies have shown that interventional management of craniofacial pain is effective in treating occipital neuralgia, cervicogenic headaches, cluster headaches, trigeminal neuralgia, and chronic migraines, with a reported efficacy of 60-90% over a duration of 1-9months. Repeated infiltrations, neuromodulation, or ablation may prove effective in selected cases. Therefore, reassessment of treatment response and efficacy during follow-up is imperative to guide further management and explore alternative treatment options. Optimal utilization of imaging, interventional techniques, and a multidisciplinary team, including radiologists, will ensure maximum benefit for these patients.

Is device guided training targeted to the craniocervical flexor and extensor muscles efficacious? A preliminary randomized controlled trial in a cervicogenic headache population

BackgroundSpecific neck exercise is effective in the management of cervicogenic headache (CH). The Spinertial device was designed to facilitate craniocervical flexion and extension training, but its efficacy, judged on change in headache impact, has not been tested. ObjectiveTo compare guided and progressive resisted specific neck exercise targeted to the craniocervical flexors and extensors (SNE-fe) performed with Spinertial device to progressive SNE-fe without the device in a cohort with CH. DesignRandomised controlled trial. MethodsTwenty-eight participants with CH were randomly allocated to the Spinertial group (SG) or SNE-fe exercise group without the device (EG). Both groups performed 12 sessions of SNE-fe over six-weeks. The primary outcome was headache impact (HIT-6). Secondary outcomes were the craniocervical flexion test (CCFT), upper cervical (UCS) and lower cervical range of movement, flexion rotation test (FRT) analysed as more or less restricted side (MRS, LRS), the self-reported global rating of change (GROC-scale) and satisfaction with the exercise program (PACES). Outcomes were measured at baseline, post-intervention (T1) and after 1-month (T2). ResultsSignificant between-groups differences were found favouring the SG for HIT-6 (T1 p = 0.010, d = 0.5; T2 p < 0.004, d = 0.4), CCFT, UCS ROM, FRT MRS, FRT LRS, PACES and GROC-scale (T1: all p < 0.01; T2: all p < 0.01). Effects sizes were large (>0.8) at T1 and T2. No between-groups differences were found for lower cervical ROM. ConclusionTraining with the Spinertial was more effective than SNE without the device for improving the impact of headache, the endurance of deep neck flexors and UCS ROM in participants with CH.