Comparison of the Eficacy of Mulligan Mobilization and Myofascial Release in Patients With Cervicogenic Headache

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.

Study Overview

• Status: Recruiting
• Conditions: Cervicogenic Headache
• Intervention / Treatment: Other: Mulligan mobilization therapy; Other: Myofascial release therapy; Other: Exercise therapy

Detailed Description

This study is designed as a prospective, case-control, hospital-based study. Ninety patients aged 18-65 years who present to our hospital with cervicogenic headaches lasting at least 3 months will be included in the study.

Participants will be given full information about the procedure and will provide written informed consent.

The study will be conducted in accordance with the principles outlined in the Helsinki Declaration.

All participants will undergo a comprehensive medical history and a detailed physical examination.

Sociodemographic and clinical data, including age, gender, height, weight, education level, employment status, and income level, will be collected through standardized questionnaires.

A total of 90 patients diagnosed with cervicogenic headache will be randomly assigned to three groups.

Group 1 (n=30) will receive mulligan mobilization therapy three times a week for four weeks (12 sessions total) and a home exercise program.

Group 2 (n=30) will receive myofascial release therapy three times a week for four weeks (12 sessions total), in addition to a home exercise program.

Group 3 (n=30) will receive only a home exercise program three times a week for four weeks (12 sessions total).

All patients will be evaluated at three different time points: before treatment, immediately after treatment is completed, and one month after treatment.

The following assessments will be made during the evaluation process:

To determine the frequency of cervicogenic headaches, patients were given a headache diary.

Head and neck pain in the individuals included in the study was evaluated using the visual analog scale (VAS) before and after treatment.

Participants' functional status was assessed using the headache impact test (HIT-6).

The headache disability inventory/index (HDI) was used to measure the impact of headaches on daily life.

The short form-12 (SF-12) questionnaire was used to assess the patients' quality of life.

• Study Type: Interventional
• Enrollment (Estimated): 90
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: BURCU VURAL; Phone Number: +905389507278; Email: burcuvural97@gmail.com

Study Locations

• Turkey (Türkiye)
  • Konya, Turkey (Türkiye), 42060
    • Recruiting
    • Konya Beyhekim Eğitim ve Araştırma Hastanesi
    • Contact: Konya, Selçuklu, Türkiye (Türkiye), 42060 Konya Beyhekim Eğitim ve Araştırma Hastanesi

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion criteria:

• Individuals aged 18-65
• Having experienced neck or headache for 3 months

• Meeting the diagnostic criteria for cervicogenic headache;

  • Unilateral pain
  • Reduced range of motion in the neck
  • Ipsilateral shoulder discomfort
  • Ipsilateral arm discomfort
  • Pain that worsens with different neck movements and is painful on palpation

Exclusion criteria:

• Migraine
• Cluster headache
• Cervical radiculopathy
• Entrapment neuropathy
• Myelopathy
• Rheumatoid arthritis
• Undergoing cervical spinal surgery
• Pregnant women
• Those who received physical therapy within 6 months
• Those with a history of major psychiatric illness
• Those with a history of uncontrolled systemic diseases (cardiovascular, pulmonary, hepatic, renal, hematological)
• Those with a history of uncontrolled systemic endocrine diseases (dm, hyperthyroidism)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Mulligan mobilization technique; In addition to mulligan mobilization therapy, which will be given three times a week for four weeks (12 sessions in total), a home exercise program will be provided.	Other: Mulligan mobilization therapy; Each patient was asked to sit comfortably, and the therapist performing the treatment stood beside them. The patient's head was free and positioned between the therapist's right forearm and body, with the therapist standing to the patient's right. The therapist then placed their right index, middle, and ring fingers on the base of the occiput and held their right little finger on the spinous process of C2. Next, gentle pressure was applied ventrally and upward (45 degrees) to the lateral edge of the left thenar process and the right little finger. The gliding motion was applied rhythmically (three times per second) ten times. The therapist continuously slid the joint and actively asked the patient to move their head towards the side where the dysfunction and pain were located. He held the SNAG technique for 10 seconds. This technique was repeated 10 times over approximately 8 minutes.
Experimental: Myofascial release therapy; In addition to myofascial release therapy, which will be given three times a week for four weeks (12 sessions in total), a home exercise program will be provided.	Other: Myofascial release therapy; The procedure was performed on the upper part of the trapezius muscle and the levator scapulae muscle. The patient was in a seated position, hips higher than knees, feet slightly in front of the knees and in full contact with the ground. The therapist stood behind the patient. Myofascial release of the trapezius was performed unilaterally with a soft fist, while the patient lowered their head forward and slowly rotated, creating a tension line from the middle of the trapezius towards the acromion process. During this time, the patient was asked to turn their head to the opposite side. Then, the therapist applied resistance to the opposite side of the rotation for 10 seconds. MGT was repeated 5 times on the trapezius. The therapist applied the same unilateral contraction, but the tension line was slightly laterally towards the lower edge of the scapula. The therapist then asked the patient to tilt their head forward to increase resistance on the levator scapula for 10 seconds.
Active Comparator: A home workout program; A home workout program will be provided three times a week for four weeks (12 sessions in total).	Other: Exercise therapy; All patients were given a home exercise program consisting of neck joint range of motion exercises, trapezius stretches, and isometric strengthening exercises for the neck muscles. The home exercise program was initiated with 3 sets of 10 repetitions per day. The exercises were demonstrated practically by the physician, and all patients were given a printed sheet showing how to perform the exercises. Patients were contacted by phone once a week to inquire about their adherence to the exercise program and were encouraged to follow it. Patients with exercise adherence below 75-80% were excluded from the study.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Frequency of cervicogenic headache	To determine the frequency of cervicogenic headaches, patients were given a headache diary.	Beginning, week 4, and week 8
assessment of pain intensity VAS pain (0-10)	0 no pain, 10 unbearable/maximum pain	Beginning, week 4, and week 8

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Headache impact scale (HIT)	This scale was used to assess how much headaches affected patients' school, home, and social lives. The score range is 36-78. Higher scores indicate that headaches have a greater impact on your life.	Beginning, week 4, and week 8
Headache disability inventory/indexi ( HDI )	This 25-item questionnaire helps assess the impact of headaches and their treatment on daily life. Patients answer the questions on the questionnaire with yes (4 points), sometimes (2 points), and no (0 points). The total score is calculated out of 0-100. The results are classified as follows: 0-14 points no/very mild disability, 15-36 points mild, 37-60 points moderate, and 61-100 points severe disability.	Beginning, week 4, and week 8
Assessment of quality of life short form-12	It consists of 12 questions, and the answers to these questions are used to calculate a series of subscales and an overall general health score. Subscale scores are graded on a scale of 0 to 100. As the score increases from 0 (zero) to 100 (one hundred), it means the health condition is improving.	Beginning, week 4, and week 8

Collaborators and Investigators

• Sponsor: Konya Beyhekim Training and Research Hospital

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2025
• Primary Completion (Actual): December 1, 2025
• Study Completion (Estimated): December 1, 2026

Study Registration Dates

• First Submitted: December 25, 2025
• First Submitted That Met QC Criteria: March 30, 2026
• First Posted (Actual): April 2, 2026

Study Record Updates

• Last Update Posted (Actual): April 2, 2026
• Last Update Submitted That Met QC Criteria: March 30, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Rehabilitation; Massage therapy; Neck pain; Complementary therapies; Musculoskeletal diseases; Musculoskeletal manipulation
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Headache Disorders; Headache Disorders, Secondary; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Musculoskeletal Diseases; Neck Pain; Post-Traumatic Headache; Therapeutics; Complementary Therapies; Physical Therapy Modalities; Patient Care; Rehabilitation; Aftercare; Continuity of Patient Care; Therapy, Soft Tissue; Musculoskeletal Manipulations; Massage; Exercise Therapy; Myofascial Release Therapy
• Other Study ID Numbers: 15520 (REB)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

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