Although headache is one of the most common neurological symptoms, it is still not fully
recognized and treated worldwide. The International Headache Society divides headaches
into primary and secondary categories. The International Headache Society classifies
cervicogenic headache as a secondary headache caused by a disorder of the cervical spine
and its components. The prevalence in the general population is estimated to be
approximately 0.17% to 4.1%.
Cervicogenic headache features are as follows;
observed in adulthood,
unilateral and does not change sides,
radiating from the back of the head and neck to the ear and cheekbone,
can be triggered mechanically by maneuvers,
characterized by compressive pain that starts seconds or 30 minutes after the
maneuver and lasts for several days to weeks
The diagnostic criteria for cervicogenic headache are as follows:
The headache developed at a time similar to the onset of the cervical disorder or
the appearance of the lesion
The headache has significantly decreased or disappeared in parallel with the
regression or complete healing of the cervical disorder or lesion
The cervical range of motion is reduced and the headache worsens significantly with
stimulating maneuvers
The headache disappears after the cervical structure or nerve source is blocked for
diagnosis
Studies show that physiotherapy and rehabilitation approaches such as manual therapy,
exercise training, and dry needling are effective in treating headaches.
Studies have shown that people with cervicogenic headaches have a high rate of C1-C2
dysfunction. The mechanism of Mulligan's movement mobilization technique (SNAG) is based
on the correction of joint position. Mulligan's SNAG technique is a gentle manual therapy
method. Some studies have shown that Mulligan mobilization increases the range of motion
and significantly reduces pain intensity and frequency in patients with cervicogenic
headaches
Another form of massage-type manual therapy, myofascial release, is widely used in
clinical practice. Previous studies have found that active myofascial trigger points
often trigger tension-type headaches and migraines with palpation. Therefore, treatment
of these myofascial trigger points may be an effective headache management.
In light of the literature data, this study aims to investigate and compare the
effectiveness of physiotherapy methods such as Mulligan Concept applications and
myofascial release technique on hand grip strength, pressure pain threshold, range of
motion, pain frequency, pain intensity, pain duration, number of medication use, daily
living activities and disability in patients with cervicogenic headache.
Hypotheses of this study are;
H0: There is no significant difference in favor of myofascial release technique or
Mulligan concept applications in terms of pressure pain threshold, neck joint range of
motion, handgrip strength, pain intensity, frequency and duration, number of medications
used, disability and daily living activities between myofascial release technique and
Mulligan concept applications in cervicogenic headache.
H1: There is a significant difference in favor of myofascial release technique between
myofascial release technique and Mulligan concept applications in terms of pressure pain
threshold, neck joint range of motion, handgrip strength, pain intensity, frequency and
duration, number of medications used, disability and daily living activities between
myofascial release technique and Mulligan concept applications in cervicogenic headache.
H2: There is a significant difference in favor of Mulligan concept applications between
myofascial release technique and Mulligan concept applications in terms of pressure pain
threshold, neck joint range of motion, handgrip strength, pain intensity, frequency and
duration, number of medications used, disability and daily living activities.
To determine whether the physiotherapy approach produces greater significant outcomes for
treating cervicogenic headaches, researchers will compare the Mulligan Concept with a
myofascial release technique.
The 40 individuals, consisting of women and men, who will participate in the study will
be randomly divided into two groups. These groups will consist of individuals who receive
the myofascial release method or the Mulligan concept technique. After the initial
evaluations, both groups will be applied to a 4-week treatment program consisting of 3
sessions per week and the evaluations will be repeated at the end of the 4 weeks. The
researcher who makes the evaluations will not know which treatment the individuals
received, in other words, will be blind to the groups.
The participants will be evaluated on their neck joint range of motion, pressure pain
threshold, hand grip strength, headache and functionality, and disability due to neck
problems. In addition, they will be evaluated on their pain frequency, intensity, and
duration. Participants will keep a diary of their symptoms and the number of times they
use a medication.