The purpose of the study is to explore the effectiveness of Suboccipital muscle inhibition technique vs Rocabado exercises on cervicogenic headache. A randomized control trial was conducted at National Institute of Rehabilitation Medicine, Alees Medical Centre Islamabad. The sample size was 40 calculated through G-power 3.1. The participants were divided into two interventional groups each having 20 participants. The study duration was six months. Sampling technique applied was non-probability purposive sampling for recruitment and group randomization using flip coin method. Only 20 to 50 years participants with chronic cervicogenic headache were included in the study. Tools used in this study are Digital Inclinometer, Numeric Pain Rating Scale, Romberg Test and HIT-6 Questionnaire. Data was collected at baseline, and at the end of 2nd week. Data analyzed through SPSS version 27.
Participants with a history of chronic CGH (>3 months)
CGH pain intensity between 3 and 8 on NPRS
Participants who had a unilateral headache that do not shift side (ipsilateral neck pain/stiffness)
Pain at least once a week in the previous three months, chronic, episodic, and duration one hour to weeks (non-throbbing pain starts in the neck).
Participants with other types of headache migraine, sinus, tumor, neural, or temporomandibular joint issues)
Cervicogenic headache patients with mixed headache or any diagnosed serious pathology of alar ligament and vertebra basilar artery insufficiency
Any contraindications to manual and manipulative therapy (fracture, instability, osteoporosis, arthropathy, or neural symptoms)
Using analgesics or corticosteroids
Parallel
Suboccipital Muscle Inhibition
Other interventionWith the patient in the supine position and the eyes closed, the therapist sits behind the subject's head and place the palms of his/her hands beneath it, resting the pads of his/her fingers on the projection of the posterior arch of the atlas. Pressure is exerted upward and toward the therapist. The pressure is maintained for 2 minutes until tissue relaxation had been achieved. The physiotherapist progressively increased the pressure exerted during the 10 minutes of treatment.
Rocabado 6x6 Exercises
Other interventionRocabado created 6X6 program for the management of CGH which includes 6 fundamental components, one session under supervision and remaining five sessions by the subject at home. These components are: * Rest position of the tongue * Control of TMJ rotation * Rhythmic stabilization technique * Stabilized head flexion * Axial extension of the neck * Shoulder posture
Changes from baseline in Numeric Pain Rating Scale
Change from baseline the NPRS score and 2nd week. NPRS is the ideal to measure pain intensity of pain. It has scale of 0-10 ("0" = no pain and "10" = worst imaginable pain).
Changes from baseline in cervical range of motion
ROM Cervical Spine (Flexion) Changes from the Baseline ROM range of Motion of Cervical spine flexion was taken with the Help of Digital Inclinometer ROM Cervical Spine (extension) Changes from the Baseline ROM range of Motion of Cervical spine extension was taken with the Help of Digital Inclinometer ROM Cervical Spine (Right side flexion) Changes from the Baseline ROM range of Motion of Cervical spine right side flexion was taken with the Help of Digital Inclinometer ROM Cervical Spine (left side Flexion) Changes from the Baseline ROM range of Motion of Cervical spine left side flexion was taken with the Help of Digital Inclinometer ROM Cervical Spine (right rotation) Changes from the Baseline ROM range of Motion of Cervical spine right rotation was taken with the Help of Digital Inclinometer ROM Cervical Spine (left rotation) Changes from the Baseline ROM range of Motion of Cervical spine left rotation was taken with the help of Digital Inclinometer.
Changes from baseline in HIT-6 Questionnaire
Changes from baseline in HIT-6 Questionnaire were taken.The HIT-6, a 6-item questionnaire, designed to measure patient's severity and frequency of headache and impact on daily life.
Changes from baseline in Romerg's Test
The changes from baseline were taken with the help of Romberg test which is a simple clinical assessment used to evaluate a person's balance and proprioception. The patient stands with feet together, arms at the sides, first with eyes open, then closed. A positive test-marked by increased swaying or loss of balance with eyes closed-indicates impaired proprioceptive or vestibular function.
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