Ischemic Compression Technique Versus Jones Technique in Cervicogenic Headache Patients

Official title

Comparative Effects of Jones and Ischemic Compression Technique on Pain, Range of Motion and Disability in Patients With Cervicogenic Headache

Overview

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.

Detailed description

Cervicogenic headache (CGH) is a secondary headache caused by a disorder of the cervical spine and its disc or bony and/or periarticular components and is often accompanied by neck pain The prevalence cervicogenic headache of in the general population has been reported to be 2.2%-4.1% and appears to predominate in women four times more than in men. Noninvasive treatment techniques consist mainly of electrotherapy, manual therapy (MT), and exercise prescription. Myofascial Trigger Point (MTrP) activity is one of the leading causes of CGH. Jones technique and Ischemic compression ( IC) are two treatment options for trigger points. Cervicogenic headaches are a growing problem impacting daily life, research on cervicogenic headaches is crucial to understand the link between neck issues and headaches, and develop more effective long-term treatment options. In view of the above, the current study aims to evaluate the effectiveness of Physiotherapy interventions i.e. Jones and Ischemic compression technique for Myofascial Trigger Points (MTrPs) of Sternocleidomastoid and upper Trapezius in treating cervicogenic headache.

The current study will help us in determining whether use of these techniques has any significant advantage over conventional treatment for pan and disability in CGH patients. Understanding the most effective therapeutic approach can guide practitioners in selecting evidence-based interventions, ultimately improving the overall well-being of patients suffering from cervicogenic headache.

Interventions

• Other Jones technique
  In the Jones technique, pressure will be applied on the tender point and the patient's head will be flexed laterally to the side of the tender point, followed by a shoulder abduction of approximately 90 degrees. This position will be held for 90 s and then patient position will be passively returned to the initial position. This will be repeated three times in each session. Patients will receive two treatment sessions per week for 6 weeks
• Other Ischemic compression therapy
  Patients will receive ischemic compression of the trigger points of the upper trapezius and sternocleidomastoid muscle with hold time varying between 30 seconds to 1 minute repeated 3 to 5 times in each session. Patients will receive two treatment sessions per week for 6 weeks

Primary outcome measures

• Numeric Pain Rating Scale (NPRS) [Time frame: 6 weeks]
• Headache Disability index (HDI) [Time frame: 6 weeks]
• Flexion Rotation test (FRT) [Time frame: 6 weeks]

Eligibility criteria

Inclusion criteria

• Both males and females
• 25-35 years of age
• Individuals satisfying the Cervicogenic Headache criteria
• Positive Simon's criteria for trigger points

Exclusion criteria

• primary headaches (i.e., migraine, tension type headache)
• bilateral headache
• Presence of any red flags
• cervical spinal stenosis
• evidence of central nervous system involvement
• prior surgery to the head or neck

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Pakistan · 1 center

• Bahaval Victoria Hospital — Bahawalpur

Publications

• Page P. Cervicogenic headaches: an evidence-led approach to clinical management. Int J Sports Phys Ther. 2011 Sep;6(3):254-66. PMID 22034615
• Knackstedt H, Bansevicius D, Aaseth K, Grande RB, Lundqvist C, Russell MB. Cervicogenic headache in the general population: the Akershus study of chronic headache. Cephalalgia. 2010 Dec;30(12):1468-76. doi: 10.1177/0333102410368442. Epub 2010 May 19. PMID 20974607
• Bogduk N, Govind J. Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment. Lancet Neurol. 2009 Oct;8(10):959-68. doi: 10.1016/S1474-4422(09)70209-1. PMID 19747657
• Garcia JD, Arnold S, Tetley K, Voight K, Frank RA. Mobilization and Manipulation of the Cervical Spine in Patients with Cervicogenic Headache: Any Scientific Evidence? Front Neurol. 2016 Mar 21;7:40. doi: 10.3389/fneur.2016.00040. eCollection 2016. PMID 27047446
• Olesen J. International Classification of Headache Disorders. Lancet Neurol. 2018 May;17(5):396-397. doi: 10.1016/S1474-4422(18)30085-1. Epub 2018 Mar 14. No abstract available. PMID 29550365

Identifiers

NCT: NCT06875869 · REC/RCR & AHS/24/0152

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗