Manual Therapy vs. Multicomponent Exercise in Cervicogenic Headache

Effects of Manual Therapy Versus Multicomponent Exercise on Sensorimotor Function, Suboccipital Muscle Thickness, and Central Sensitization in Cervicogenic Headache: A Double-Blind Randomized Controlled Trial

The purpose of this study is to compare the effects of manual therapy and a multicomponent exercise program on suboccipital muscle thickness, joint position sense, pain, central sensitization, balance, and kinesiophobia in patients diagnosed with cervicogenic headache.

Cervicogenic headache is a common secondary headache originating from dysfunction in the upper cervical spine. Dysfunction in the deep neck muscles, impaired neck joint awareness, and heightened pain sensitivity (central sensitization) are frequently observed in these patients. While both manual therapy and targeted exercise are used in physiotherapy practice, evidence regarding their direct comparative effects on suboccipital muscle morphology and somatosensory parameters remains limited.

Participants will be randomly assigned to one of two treatment groups for a duration of 4 weeks (12 sessions total):

1. Manual Therapy Group: Receives joint mobilization, myofascial release, trigger point release, and suboccipital distraction targeting the cervical region.
2. Multicomponent Exercise Group: Receives deep cervical flexor strengthening, cervical proprioception training, head-eye coordination training, and progressive balance exercises.

The main questions the study aims to answer are:

• Do manual therapy and multicomponent exercise improve suboccipital muscle thickness and cervical joint position sense in patients with cervicogenic headache?
• Is there a significant difference between manual therapy and multicomponent exercise in reducing pain intensity, central sensitization, disability, and fear of movement (kinesiophobia)? It is hypothesized that both intervention protocols will yield significant clinical improvements, with specific synergistic adaptations in muscle structure, somatosensory system processing, and pain-related fear.

Inclusion Criteria:

• Diagnosis of cervicogenic headache by a specialist physician,
• Aged between 18 and 45 years,
• Ability to read and write (literate),
• Provision of signed informed consent to participate in the study.

Exclusion Criteria:

• History of head or neck surgery,
• History of spinal surgery,
• History of severe cardiac conditions or cardiac surgery that contraindicates exercise,
• History of ongoing or past malignancy,
• Diagnosis of psychiatric disorders,
• Diagnosis of migraine,
• Diagnosis of fibromyalgia,
• Having received medical (except analgesics), physical therapy, or other interventions (e.g., alternative medicine, massage therapy) for cervicogenic headache within the last 6 months,
• Engaging in regular exercise or attending an exercise facility within the last 6 months,
• Experiencing headaches strictly associated with the menstrual period,
• Investigator decision for exclusion based on ethical or clinical grounds,
• Communication problems interfering with evaluation and treatment.