Cervicogenic HeadacheNCT07526025
Comparative Effects Of Eye-Cervical Re-Education Exercises And Pressure Biofeedback Training Of Deep Cervical Flexors In Cervicogenic Headache
A study testing Eye cervical re-education exercises and Pressure biofeedback training group in people with Cervicogenic Headache, run by Foundation University Islamabad at 1 site in Pakistan.
Trial summary
Cervicogenic headache (CGH) is a secondary headache that originates from dysfunction in the upper cervical spine, particularly the atlanto-occipital and C1-C3 segments, and is perceived in one or more regions of the head and/or face. Read more about this study
- Who is it for?
- Ages 18 to 45 years
- Conditions the study is for
- Cervicogenic Headache
- What is being tested?
- Eye cervical re-education exercises and Pressure biofeedback training group
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 34 participants
- Where
- 1 sitePakistan
- Study dates
- 10 Feb 2026to 10 Jun 2026
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 45 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Age 18 to 45 years
- Both genders
- Limited cervical range of motion
- Unilateral neck pain and referred headache
- Headache is precipitated by neck movements or sustained positions.
- Positive cervical flexion rotation test
- Headache reproduced with provocation of the involved upper cervical segments.
- Restricted upper cervical segmental mobility.
Who cannot join
- • Cervical radiculopathy
- Known or suspected vestibular disorders such as BBPV (Benign Paroxysmal Positional Vertigo), vestibular neuritis, meniere's disease, labyrinthitis
- Visual problems such as occipital neuralgia
- History of traumatic neck injury/surgery or cervical instability
- Rheumatoid arthritis
- Osteoporosis
Show all 10Show fewer
- Metabolic disorders
- Spinal infection or tumors
- Vertebrobasilar insufficiency
- Other headache types such as tension headache, migraine etc
Trial locations and contacts
1 site in 1 country.
Pakistan1 site
Foundation University College of Physical Therapy
Islamabad, Punjab Province, 46000
About this study
Cervicogenic headache (CGH) is a secondary headache that originates from dysfunction in the upper cervical spine, particularly the atlanto-occipital and C1-C3 segments, and is perceived in one or more regions of the head and/or face. The underlying mechanism involves convergence of cervical and trigeminal afferents in the trigeminocervical nucleus. Structures innervated by the C1, C2, and C3 spinal nerves are capable of producing referred pain to the head. CGH is relatively common, accounting for approximately 15-20% of all chronic headaches. It typically worsens with neck movement and is often associated with limited cervical range of motion. One of the key impairments in individuals with CGH is disrupted cervical sensorimotor control, particularly affecting proprioception and deep cervical muscle coordination. Physical therapy is widely recognized as the first-line treatment for CGH, with emerging evidence supporting interventions aimed at improving cervical proprioception and neuromuscular control. This study aims to compare the effectiveness of two sensorimotor-based physical therapy approaches-eye-cervical re-education and pressure biofeedback training of deep cervical flexors (DCF)-in patients with CGH. The primary outcomes include pain intensity, functional disability, cervical range of motion (ROM), and cervical joint position sense (proprioception). Participants will be recruited using purposive sampling from Fauji Foundation Hospital and Foundation University College of Physical Therapy (FUCP), Islamabad. After providing written informed consent, eligible participants will be randomized into two groups. Group 1 will receive conventional physical therapy along with eye-cervical re-education exercises, while Group 2 will receive conventional therapy combined with pressure biofeedback DCF training. Data will be collected at baseline and after the 10th treatment session to assess within- and between-group changes in the outcome measures. This study aims to inform evidence-based physical therapy practice in the management of cervicogenic headache.
Read the detailed description
Conventional Physical Therapy Protocol:
Hot pack is placed on posterior cervical area for 10 minutes while the patient was relaxed prone lying position.
Isometric exercises are applied with sustain 5 sec in all cervical motion (flexion, extension, side bending and rotation) with ten repetitions for each direction while the patient sits in erect position and the therapist stood back of the patient.
SNAGS are applied for 5 to 6 times. The therapist applies the appropriate accessory zygapophyseal glide while the patient performs the symptomatic movement. This must result in full range pain free movement.
Eye cervical re-education exercises:
This program composed of ten exercises for re-training of proprioceptive input in the cervical spine through the three following phases: a) Ocular mobility without cervical movement phase b) Cervical mobility exercises phase c) Eye-cervical co-ordination exercise phase
Pressure Biofeedback training of deep cervical flexors:
It is performed in supine crook lying position. The neck is aligned in a neutral position. The pressure biofeedback unit is centered just below the occiput between the plinth and the back of the neck and inflated to a baseline of 20 mmHg. Each subject is asked to gently and slowly execute the head nodding action (as if they said yes) at five different levels of pressure (22, 24, 26, 28 and 30 mmHg) and to maintain each level for 10 seconds There was a 30-second rest period between each level. The test protocol ended when the subject is unable to hold the same pressure level for 10 sec or reached a peak level of 30 mmHg.
- Conditions
- Cervicogenic Headache
- Being tested
- Eye cervical re-education exercises, Pressure biofeedback training group
- Medical subject headings
- Post-Traumatic Headache
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Eye cervical re-education exercisesProcedure or surgery
Eye cervical re education exercises targeting cervical pain, ROM, neck disability index and joint proprioception. Conventional Physical Therapy Protocol:
Hot pack Isometric exercises are applied with sustain 5 sec in all cervical motion with ten repetitions for each direction while the patient sits in erect position and the therapist stood back of the patient.
SNAGS are applied for 5 to 6 times.
Eye cervical re-education exercises:
This program composed of ten exercises for re-training of proprioceptive input in the cervical spine through the three following phases: a) Ocular mobility without cervical movement phase b) Cervical mobility exercises phase c) Eye-cervical co-ordination exercise phase
Pressure biofeedback training groupProcedure or surgery
It is performed in supine crook position. The neck is aligned in a neutral position. The pressure biofeedback unit is centered just below the occiput between the plinth and the back of the neck and inflated to a baseline of 20 mmHg. Each subject is asked to gently and slowly execute the head nodding action (as if they said yes) at five different levels of pressure (22, 24, 26, 28 and 30 mmHg) and to maintain each level for 10 seconds There was a 2 minutes rest period between each level. The test protocol ended when the subject is unable to hold the same pressure level for 10 sec or reached a peak level of 30mmHg.
| Study group | Role | What they receive |
|---|---|---|
| Eye cervical re-education exercises | Experimental | 1. Hotpack
2. Isometric exercises
3. SNAGs
4. Eye cervical re-education exercises
1. Ocular mobility without cervical movement phase
2. Cervical mobility exercises phase c) Eye-cervical co-ordination exercise phase Receives: Procedure: Eye cervical re-education exercises |
| Pressure biofeedback training group | Experimental | 1. Hotpack
2. Isometric exercises
3. SNAGs
4. Deep cervical flexor activation using pressure biofeedback training at different levels (22,24,26,28,30mmof Hg) Receives: Procedure: Pressure biofeedback training group |
What is being measured
The primary outcome is the main question the study is designed to answer.
Cervical Joint Proprioception
It will be measured using cervical joint position error test
Measured: Baseline and after 3rd week
Secondary outcomes (3)
Pain Intensity
It will be measured using numeric pain rating scale. '0' shows no pain whereas '10' represents worst pain.
Measured: baseline and 3rd week of treatment
Neck Disability
It will be measured using neck disability index. It is a 10 item questionnaire with 6 options to choose from.
Measured: Baseline and 3rd week of treatment
Cervical Range of Motion
Cervical ROM will be assessed using a bubble inclinometer.
Measured: Baseline and after 3rd week of treatment
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted13 Apr 2026
- Study start10 Feb 2026
- Primary completion30 May 2026
- Study completion10 Jun 2026
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Cervicogenic HeadacheStudies of the same condition, open and under way.
- More trials run by Foundation University IslamabadThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 34 participants (actual)
Sponsor and investigators
- Lead sponsor
- Foundation University Islamabad
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Maira Tafzeel, DPT, Principal investigator, Foundation University Islamabad
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07526025
- Sponsor's protocol ID
- FUI/FUCP/CTR/03.26/MairaTafzel
- Status last verified
- May 2026
- First submitted
- 6 Apr 2026
- Last updated
- 4 Sep 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 4 Sep 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Comparative Effects Of Eye-Cervical Re-Education Exercises And Pressure Biofeedback Training Of Deep Cervical Flexors In Cervicogenic Headache
- ClinicalTrials.gov ID
- NCT07526025
- Acronym / sponsor ID
- FUI/FUCP/CTR/03.26/MairaTafzel
- Conditions
- Cervicogenic Headache
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 34 participants (actual)
- Lead sponsor
- Foundation University IslamabadUniversity, hospital or other
- Study start
- 10 Feb 2026 (actual)
- Primary completion
- 30 May 2026 (actual)
- Study completion
- 10 Jun 2026 (actual)
- First posted
- 13 Apr 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Cervicogenic headache (CGH) is a secondary headache that originates from dysfunction in the upper cervical spine, particularly the atlanto-occipital and C1-C3 segments, and is perceived in one or more regions of the head and/or face. The underlying mechanism involves convergence of cervical and trigeminal afferents in the trigeminocervical nucleus. Structures innervated by the C1, C2, and C3 spinal nerves are capable of producing referred pain to the head. CGH is relatively common, accounting for approximately 15-20% of all chronic headaches. It typically worsens with neck movement and is often associated with limited cervical range of motion. One of the key impairments in individuals with CGH is disrupted cervical sensorimotor control, particularly affecting proprioception and deep cervical muscle coordination. Physical therapy is widely recognized as the first-line treatment for CGH, with emerging evidence supporting interventions aimed at improving cervical proprioception and neuromuscular control. This study aims to compare the effectiveness of two sensorimotor-based physical therapy approaches-eye-cervical re-education and pressure biofeedback training of deep cervical flexors (DCF)-in patients with CGH. The primary outcomes include pain intensity, functional disability, cervical range of motion (ROM), and cervical joint position sense (proprioception). Participants will be recruited using purposive sampling from Fauji Foundation Hospital and Foundation University College of Physical Therapy (FUCP), Islamabad. After providing written informed consent, eligible participants will be randomized into two groups. Group 1 will receive conventional physical therapy along with eye-cervical re-education exercises, while Group 2 will receive conventional therapy combined with pressure biofeedback DCF training. Data will be collected at baseline and after the 10th treatment session to assess within- and between-group changes in the outcome measures. This study aims to inform evidence-based physical therapy practice in the management of cervicogenic headache.
Detailed description
Conventional Physical Therapy Protocol:
Hot pack is placed on posterior cervical area for 10 minutes while the patient was relaxed prone lying position.
Isometric exercises are applied with sustain 5 sec in all cervical motion (flexion, extension, side bending and rotation) with ten repetitions for each direction while the patient sits in erect position and the therapist stood back of the patient.
SNAGS are applied for 5 to 6 times. The therapist applies the appropriate accessory zygapophyseal glide while the patient performs the symptomatic movement. This must result in full range pain free movement.
Eye cervical re-education exercises:
This program composed of ten exercises for re-training of proprioceptive input in the cervical spine through the three following phases: a) Ocular mobility without cervical movement phase b) Cervical mobility exercises phase c) Eye-cervical co-ordination exercise phase
Pressure Biofeedback training of deep cervical flexors:
It is performed in supine crook lying position. The neck is aligned in a neutral position. The pressure biofeedback unit is centered just below the occiput between the plinth and the back of the neck and inflated to a baseline of 20 mmHg. Each subject is asked to gently and slowly execute the head nodding action (as if they said yes) at five different levels of pressure (22, 24, 26, 28 and 30 mmHg) and to maintain each level for 10 seconds There was a 30-second rest period between each level. The test protocol ended when the subject is unable to hold the same pressure level for 10 sec or reached a peak level of 30 mmHg.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Eye cervical re-education exercises | Experimental | Procedure: Eye cervical re-education exercises1. Hotpack 2. Isometric exercises 3. SNAGs 4. Eye cervical re-education exercises 1. Ocular mobility without cervical movement phase 2. Cervical mobility exercises phase c) Eye-cervical co-ordination exercise phase |
| Pressure biofeedback training group | Experimental | Procedure: Pressure biofeedback training group1. Hotpack 2. Isometric exercises 3. SNAGs 4. Deep cervical flexor activation using pressure biofeedback training at different levels (22,24,26,28,30mmof Hg) |
Who may qualify
- Ages
- 18 to 45 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (8 listed)
- Age 18 to 45 years
- Both genders
- Limited cervical range of motion
- Unilateral neck pain and referred headache
- Headache is precipitated by neck movements or sustained positions.
Key exclusion criteria (10 listed)
- • Cervical radiculopathy
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Eye cervical re-education exercisesEye cervical re education exercises targeting cervical pain, ROM, neck disability index and joint proprioception. Conventional Physical Therapy Protocol: Hot pack Isometric exercises are applied with sustain 5 sec in all cervical motion with ten repetitions for each direction while the patient sits in erect position and the therapist stood back of the patient. SNAGS are applied for 5 to 6 times. Eye cervical re-education exercises: This program composed of ten exercises for re-training of proprioceptive input in the cervical spine through the three following phases: a) Ocular mobility without cervical movement phase b) Cervical mobility exercises phase c) Eye-cervical co-ordination exercise phase | Procedure or surgery | Eye cervical re-education exercises |
| Pressure biofeedback training groupIt is performed in supine crook position. The neck is aligned in a neutral position. The pressure biofeedback unit is centered just below the occiput between the plinth and the back of the neck and inflated to a baseline of 20 mmHg. Each subject is asked to gently and slowly execute the head nodding action (as if they said yes) at five different levels of pressure (22, 24, 26, 28 and 30 mmHg) and to maintain each level for 10 seconds There was a 2 minutes rest period between each level. The test protocol ended when the subject is unable to hold the same pressure level for 10 sec or reached a peak level of 30mmHg. | Procedure or surgery | Pressure biofeedback training group |
Primary outcome
Cervical Joint Proprioception
Time frame: Baseline and after 3rd week
It will be measured using cervical joint position error test
3 secondary outcomes
Pain Intensity
Time frame: baseline and 3rd week of treatment
Neck Disability
Time frame: Baseline and 3rd week of treatment
Cervical Range of Motion
Time frame: Baseline and after 3rd week of treatment
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 4 Sep 2026.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Maira Tafzeel, DPT principal investigator
Foundation University Islamabad
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Eye cervical re-education exercises and Pressure biofeedback training group in people with Cervicogenic Headache, run by Foundation University Islamabad at 1 site in Pakistan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 8 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 4 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Cervical Joint Proprioception (time frame: Baseline and after 3rd week). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Sep 2026.