This study aims to investigate the effect of specific exercise programs on individuals suffering from cervicogenic headaches, a type of headache originating from neck problems. While traditional physiotherapy is the standard approach, this research examines whether the addition of specific "fascia-focused" exercises or "breathing exercises" provides improved relief.

Fascia is a thin, protective membrane layer surrounding every muscle and organ in the body. In this study, participants will be divided into three groups. All participants will receive standard neck exercises and posture training. One group will perform dynamic exercises targeting the body's connective tissue (fascia) to improve flexibility and coordination. Another group will practice specific breathing techniques to help reduce muscle tension and stress-related triggers. The exercises will be administered to participants for 12 weeks.

It is expected that fascia exercises and breathing exercises will have positive effects on headaches as a result of the applied treatments.

This study is designed as a prospective, three-arm, randomized controlled trial to evaluate the effectiveness of different exercise-based interventions in individuals with cervicogenic headache (CGH). CGH is a secondary headache resulting from dysfunction of the cervical spine and related structures, typically characterized by neck pain and restricted cervical mobility.

Participants diagnosed with CGH according to the International Classification of Headache Disorders (ICHD-3) criteria will be recruited from a physical therapy and rehabilitation clinic setting. Following informed consent, eligible participants will be randomly assigned to one of three study arms.

All participants will receive a standard physiotherapy program consisting of patient education and therapeutic exercises targeting cervical function. In addition to the basic protocol, intervention groups will receive either exercises that activate the thoracolumbar fascia or specific breathing exercises.

The primary outcome measure is the Headache Impact Test-6 (HIT-6). In addition, pain intensity, functional status, quality of life, and psychological status will be assessed using validated clinical instruments. Thoracolumbar fascia thickness will be evaluated using ultrasonography at predefined time points using a standardized measurement protocol to assess structural changes associated with the interventions.

Inclusion Criteria:

• Adults aged 18-60 years
• Diagnosis of cervicogenic headache according to the International Classification of Headache Disorders, 3rd edition (ICHD-3)
• Headache duration of at least 3 months
• Presence of headache associated with cervical movement limitation or provoked by neck movement
• Pain intensity of ≥3 on the Visual Analog Scale (VAS) at baseline
• Ability to understand and comply with the study procedures
• Willingness to participate and provision of written informed consent

Exclusion Criteria:

• Presence of other primary headache disorders (e.g., migraine, tension-type headache, cluster headache)
• Diagnosis of rheumatologic diseases (e.g., rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus)
• Serious cervical spine pathologies (e.g., cervical myelopathy, spinal stenosis)
• Presence of neurological deficits or central nervous system disorders
• Received physical therapy for the cervical region within the past 3 months
• Severe psychiatric disorders or cognitive impairment that may interfere with participation
• Pregnancy
• Cardiopulmonary conditions contraindicating exercise
• Musculoskeletal disorders that may interfere with exercise adherence

Outcome assessments will be performed by an assessor blinded to group allocation. Due to the nature of the interventions, participants and therapists cannot be blinded.