Cervicogenic headache is a type of secondary headache that originates from cervical spine
dysfunction, particularly involving the upper cervical segments. It is frequently
unilateral and is often accompanied by neck stiffness and reduced cervical range of
motion. The pain typically radiates from the occipital or suboccipital region to the
frontotemporal or retro-orbital areas. It is commonly described as dull and
non-throbbing. Cervicogenic Headache constitutes about 14-18% of all chronic headaches,
making it a significant concern in musculoskeletal and neurologic clinical practice. The
condition often leads to impaired quality of life and mild to moderate disability. Manual
therapy and therapeutic exercises are widely used in physiotherapy for management.
The suboccipital region plays a crucial role in postural stability and dural tension
regulation due to the presence of myodural bridges between the suboccipital muscles and
the dura mater. Dysfunction in these structures can contribute to pain and sensorimotor
disturbances in Cervicogenic headache. Suboccipital Muscle Inhibition is a manual
technique aimed at relieving tension in these muscles and restoring balance. The
technique involves sustained pressure applied to the suboccipital area, helping reduce
nociceptive input and improving cerebral spinal fluid flow. Studies have found
Suboccipital Muscle Inhibition effective for headache relief and postural improvement. It
is recognized for promoting muscular relaxation and decreasing headache intensity.
However, more comparative evidence is needed.
Cervical postural alignment plays a significant role in managing musculoskeletal
conditions such as cervicogenic headaches. Poor posture, particularly forward head
posture, can place excessive strain on the upper cervical spine, contributing to headache
symptoms and muscular imbalance. To address these postural deficits, Dr. Mariano Rocabado
developed the 6×6 exercise protocol, a structured program aimed at restoring proper
cranio-cervical alignment. The protocol includes six exercises performed six times per
session, repeated six times daily. These exercises target key elements such as tongue
posture, cervical spine control, axial extension, and scapular stabilization. By
promoting postural awareness and neuromuscular coordination, the protocol supports
improved cervical mechanics. It has been shown to be effective in reducing tension,
enhancing movement control, and optimizing cervical posture in individuals with postural
dysfunctions.
This study aims to compare the effectiveness of the Suboccipital Muscle Inhibition
technique and Rocabado 6×6 exercises in managing cervicogenic headaches. It hypothesizes
that both interventions will produce improvements, but one may yield superior outcomes in
terms of pain reduction, cervical range of motion, and balance. A randomized clinical
trial will be conducted involving 40 participants divided equally into two groups. One
group will receive SMI with conventional therapy, and the other will perform Rocabado
exercises alongside conventional treatment. The treatment duration will consist of six
sessions over two weeks. Both subjective and objective outcome measures will be employed
to assess changes.
Participants will be assessed using tools like the Numeric Pain Rating Scale for pain
intensity, the Flexion Rotation Test for cervical rotation dysfunction, and the HIT-6 for
headache-related disability. Balance will be evaluated using the Romberg test, and
cervical Range of motion will be measured with a digital inclinometer. Participants
eligible for the study will include adults aged 24-50 years with a history of
Cervicogenic headache for over three months. Strict inclusion and exclusion criteria will
be followed to ensure sample validity. Patients using pain medication or having
contraindications to manual therapy will be excluded. The outcome will be measured before
and after the intervention.
Both groups will receive the same conventional treatments such as moist heat, cervical
stretching, strengthening exercises, and manual traction. Group A will additionally
receive the Suboccipital Muscle Inhibition technique applied for 10 minutes in each
session. Group B will perform the Rocabado 6×6 protocol, with one supervised session and
five sessions conducted independently each day. All treatments are expected to alleviate
pain and restore cervical biomechanics. The hypothesis is that direct dural and postural
modulation through Suboccipital Muscle Inhibition may show faster effects, while
Rocabado's protocol may offer long-term neuromuscular control benefits. Comparative
effectiveness will be analyzed using SPSS software with appropriate statistical tests.
The research is expected to fill the gap in literature regarding the comparative
effectiveness of these two distinct but relevant approaches in treating Cervicogenic
headache. A clearer understanding of their benefits can guide clinicians in personalizing
care for patients with Cervicogenic headache, potentially combining the strengths of both
methods. The study also aims to provide cost-effective, non-pharmacological management
options that reduce headache recurrence, enhance cervical function, and improve patient
quality of life. By establishing evidence-based guidelines, this research may influence
future physical therapy protocols and headache rehabilitation strategies, ensuring
optimized outcomes for Cervicogenic headache sufferers.