Additional Effects of Sternocleidomastoid Release With SNAGS in the Management of Cervicogenic Headache

Cervicogenic headache is a common type of headache in adults which causes disability and difficulty in everyday activities. According to the latest International Headache Society model, cervicogenic headache (CGH) is a secondary headache having C1-C2 dysfunction. SNAGs are highly effective in the treatment approach for these patients. Sternocleidomastoid muscle receive overactive tension from forward neck posture, increasing muscular fatigue and tone of muscles. This tension in SCM causes referred pain in the head and neck region. SNAGs are very effective but musculoskeletal impairments especially the tightness of sternocleidomastoid muscle still persist and can exacerbate symptoms. Manual therapy targeted to the SCM muscle may be effective for reducing headache and neck pain intensity and increasing performance of deep cervical flexors. Findings of this study will aid the therapists in choosing which technique to use while treating the patients. This will save therapist's time and effort as they will not be using the less effective treatment protocol. Furthermore, patient's time and investment will be used in the right direction.

Study Overview

• Status: Active, not recruiting
• Conditions: Cervicogenic Headache
• Intervention / Treatment: Procedure: Electrotherapy and physical agents; Procedure: Headache SNAGs; Procedure: Sternocleidomastoid Release

• Study Type: Interventional
• Enrollment (Estimated): 38
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab
    • Rawalpindi, Punjab, Pakistan, 46000
      • Foundation University College of Physical Therapy

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Age group: 18-45 years old
• Both males and females
• Unilateral headache with no shift of side
• C1-C2 Dysfunction
• Positive flexion rotation test (Rotation restriction is greater than 10 degrees)
• Headache at least once a month in the last 3 months
• Headache with at least 4 score in NPRS (Sign and Symptoms of Neck Involvement)
• Headache with restriction of ROM in the neck
• Headache precipitated by:

Sustained neck movements, and awkward head positioning. External Pressure over upper cervical or occipital region

Headache Characteristics:

• Moderate-severe, non-throbbing pain, usually starting in the neck.
• Episodes of varying duration, or: fluctuating, continuous pain

Exclusion Criteria:

• Headache of non-cervical origin
• Diagnosed Cases of:Cervical spondylosis,Cervical radiculopathy/ nerve root involvement/ disc herniation,Cervical instability/ fracture,Vertebrobasilar insufficiency ,Cervical spine surgery,Cervical spondylolisthesis,Spinal infection or tumors,Osteoporosis,History of trauma,Rheumatoid Arthritis,Inflammatory Arthritis

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Conventional physical therapy Group; Both Group A and Group B will receive this conventional physical therapy protocol for cervicogenic headache.; Moist heat therapy: Frequency: 15 minutes, 3 times per week (alternatively) for 2 weeks.; TENS application: Frequency: 15 minutes, 3 times per week (alternatively) for 2 weeks. In addition to this, they will receive Headache SNAGs (Sustained Natural Apophyseal Glides) 5 sets of 10 repetitions. Each repetition will be given with a 10 second hold. • Frequency: 3 times a week for 2 weeks. 6 sessions in total.	Procedure: Electrotherapy and physical agents; Moist heat therapy: Frequency: 15 minutes, 3 times per week (alternatively) for 2 weeks. • TENS application: Frequency: 15 minutes, 3 times per week (alternatively) for 2 weeks.; Procedure: Headache SNAGs; Headache SNAGs (Sustained Natural Apophyseal Glides) 5 sets of 10 repetitions. Each repetition will be given with a 10 second hold. • Frequency: 3 times a week for 2 weeks. 6 sessions in total.
Experimental: Conventional physical therapy with sternocleidomastoid release; Both Group A and Group B will receive this conventional physical therapy protocol for cervicogenic headache.; Moist heat therapy: Frequency: 15 minutes, 3 times per week (alternatively) for 2 weeks.; TENS application: Frequency: 15 minutes, 3 times per week (alternatively) for 2 weeks. Headache SNAGs: In addition to the conventional physical therapy protocol, they will receive Headache SNAGs (Sustained Natural Apophyseal Glides) 5 sets of 10 repetitions. Each repetition will be given with a 10 second hold.; Frequency: 3 times a week for 2 weeks. 6 sessions in total. Sternocleidomastoid Release: Group B will also receive Sternocleidomastoid release in addition with headache SNAGs. Release to the sternocleidomastoid muscle will be given once per session for 5-8 minutes.; Frequency: 3 times a week for 2 weeks. 6 sessions in total.	Procedure: Electrotherapy and physical agents; Moist heat therapy: Frequency: 15 minutes, 3 times per week (alternatively) for 2 weeks. • TENS application: Frequency: 15 minutes, 3 times per week (alternatively) for 2 weeks.; Procedure: Headache SNAGs; Headache SNAGs (Sustained Natural Apophyseal Glides) 5 sets of 10 repetitions. Each repetition will be given with a 10 second hold. • Frequency: 3 times a week for 2 weeks. 6 sessions in total.; Procedure: Sternocleidomastoid Release; Sternocleidomastoid Release: Group B will also receive Sternocleidomastoid release in addition with headache SNAGs. Release to the sternocleidomastoid muscle will be given once per session for 5-8 minutes.Frequency: 3 times a week for 2 weeks. 6 sessions in total.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain intensity	Pain will be measured on the basis of Numeric Pain Rating Scale score.	2 weeks
Range of motion	Cervical rotation will be measured through CROM device	2 weeks
Headache Disability	Headache Disability Index will be used	2 weeks
Cervical Proprioception	Joint Position Error Test will be used	2 weeks

Collaborators and Investigators

• Sponsor: Foundation University Islamabad

Study record dates

Study Major Dates

• Study Start (Actual): June 10, 2024
• Primary Completion (Estimated): December 10, 2024
• Study Completion (Estimated): December 30, 2024

Study Registration Dates

• First Submitted: July 30, 2024
• First Submitted That Met QC Criteria: July 30, 2024
• First Posted (Actual): August 2, 2024

Study Record Updates

• Last Update Posted (Actual): August 2, 2024
• Last Update Submitted That Met QC Criteria: July 30, 2024
• Last Verified: July 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Pain; Neurologic Manifestations; Headache Disorders; Headache Disorders, Secondary; Headache; Post-Traumatic Headache
• Other Study ID Numbers: FUI/CTR/2024/17

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No