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The purpose of the current study is investigating the effect of integrated neuromuscular inhibition technique on adult females with cervicogenic headache.
Methods: Forty females with cervicogenic headache will be recruited. Patients will be randomly assigned into two groups, group A and group B . Patients in both groups will receive a traditional medical treatment, but group (B) will receive additional integrated neuromuscular inhibition technique.
Measurements will be taken for all participants before the start of treatment program then after the end of 4 weeks treatment program, then after another 4 weeks of follow up.all patients will be evaluated for headache pain intensity, cervicogenic headache frequency, cervicogenic headache duration, cervical range of motion in all directions, the isometric endurance capacity of sternocledomastoid and anterior scalene, kinesiophobia, neck disability, and headache impact test-6.
All patients will receive a traditional medical program by an experienced neurologist in the form of Muscle relaxants tizanidine ,4 mg to 32 mg, Three times a day.
Patients in experimental group (B) will receive the same program as control group (A) plus the INIT for upper trapezius and suboccipital muscles. The INIT program will be administrated three times a week for one month.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control group | Other | All patients will receive a traditional medical program by an experienced neurologist in the form of Muscle relaxants tizanidine ,4 mg to 32 mg, Three times a day. |
|
| experimental group | Experimental | Patients in experimental group (B) will receive the same program as control group (A) plus the INIT for upper trapezius and suboccipital muscles. The INIT program will be administrated three times a week for one month. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Muscle relaxants tizanidine | Drug | All patients will receive a traditional medical program by an experienced neurologist in the form of Muscle relaxants tizanidine ,4 mg to 32 mg, Three times a day for one month . |
| Measure | Description | Time Frame |
|---|---|---|
| headache pain intensity | headache pain intensity measured by 11-Numerical rating scale. Primary outcome updated to headache intensity to better reflect the study objective. | Baseline, 4 weeks and 8 weeks . |
| Measure | Description | Time Frame |
|---|---|---|
| kinesiophobia | kinesiophobia will be measured by Arabic Tampa scale | Baseline, 4 weeks and 8 weeks . |
| Isometric endurance capacity of sternocledomastoid and anterior scalene | The isometric endurance capacity of the sternocleidomastoid and anterior scalene will be assessed using an isometric test. |
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Inclusion Criteria:
1 - A diagnosis of CGH will be made by an experienced neurologist as per the International Classification of Headache Disorders 3rd edition (ICHD-3) , but not including occipital nerve blockage 2-Additional inclusion criteria will include female patients aged> 18 years and<60 years.
3-headache intensity ≥ 3 on eleven-point numerical rating scale at enrolment. 4-at least three-month history of headache with a mean frequency of > 1/week. 5-hypomobility of the upper cervical spine (C0 to C3) on manual examination; and reproduction of the headache on palpation of the upper cervical spine (C0 to C3).
6-In addition, patients should exhibit active trigger points within the suboccipital, and upper trapezius muscles, ipsilaterally over the symptomatic side reproducing their headache symptoms .
Exclusion Criteria:
Patients will be excluded if they have any of the following:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Khalid enb elwaleed polyclinic | Tanta | Algharbia | 6620010 | Egypt |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 42237665 | Derived | Karam M, El-Shamy FF, Elhosary EA, Mofreh A, Adel J. Efficacy of integrated neuromuscular inhibition technique in women with cervicogenic headache: a double-blind randomized controlled trial. Physiother Theory Pract. 2026 Jun 4:1-15. doi: 10.1080/09593985.2026.2683245. Online ahead of print. |
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| ID | Term |
|---|---|
| D051298 | Post-Traumatic Headache |
| ID | Term |
|---|---|
| D051271 | Headache Disorders, Secondary |
| D020773 | Headache Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
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| integrated neuromuscular inhibition technique | Other | Patients in experimental group (B) will receive the same program as control group (A) plus the INIT for upper trapezius and suboccipital muscles. The INIT program will be administrated three times a week for one month . |
|
|
| Baseline, 4 weeks and 8 weeks . |
| the impact of headaches on patients' lives | the impact of headaches on patients' lives measured by Arabic headache impact test-6. | Baseline, 4 weeks and 8 weeks . |
| neck disability | the neck disability will be measured by Arabic neck disability index | Baseline, 4 weeks and 8 weeks . |
| headache frequency | Cervicogenic headache frequency, which is a self-administered outcome variable, will be identified by asking patients to enter their CGH pain experience in a medical logbook every evening to find the number of painful days in the last week, ranging from 0 to 7 days. | Baseline, 4 weeks and 8 weeks |
| headache duration | Headache duration will be measured as the total hours of headache in the last week. | Baseline, 4 weeks and 8 weeks . |
| cervical ROM in all directions | Cervical right and left lateral flexion, extension, and flexion ROM will be measured using the iPhone clinometer application, whereas cervical right and left rotation ROM will be measured using the iPhone compass application. | Baseline, 4 weeks and 8 weeks . |
| D009422 | Nervous System Diseases |