Cervicogenic HeadacheNCT07832968
Mulligan Technique Versus Proprioceptive Training in Cervicogenic Headache
A study testing Mulligan Technique, Proprioceptive Training and Conventional physical therapy program in people with Cervicogenic Headache, run by Cairo University at 1 site in Egypt.
Trial summary
This study will be conducted to compare the effectiveness of mulligan versus proprioceptive training on pain severity, headache disability, flexion rotation test, pain threshold, cervical joint position error in patients with cervicogenic headache. 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?
- Mulligan Technique, Proprioceptive Training and Conventional physical therapy program
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 48 participants
- Where
- 1 siteEgypt
- Study dates
- 24 Sep 2026to 31 Dec 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
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
- CGH pain intensity between 3 and 8 on 10-point pain scale.
- CGH due to cervical spine dysfunction.
- Reduced cervical motion.
- Neck pain followed by headache.
- Unilateral pain starting in the neck and radiating to the frontotemporal region.
- Reproduction of the headache on palpation of the upper cervical spine (C0 to C3).
Who cannot join
- Participants with other types of headache (migraine).
- Headache due to other causes (sinus, tumor, neural, or temporomandibular joint issues), and any type of physical therapy treatment in the past three months.
- Any contraindications to manual and manipulative therapy (fracture, instability, osteoporosis, arthropathy, or neural symptoms).
- Using analgesics or corticosteroids.
- Metastasis.
- Cardiac conditions (stroke, hypertension, or syncope).
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- Neurological conditions (radiculopathy, myelopathy, or disc problems).
- Spinal cord problem.
- Previous brain and spinal cord surgery.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Abdelgalil Allam Abdelgalil, PhD contact
Egypt1 site
Outpatient clinic of faculty of physical therapy Suez Canal university
Ismailia
Nada Helmy Mohamed, M.Sc, +20 11 15275306, Nadahelmy382@gmail.com
About this study
This study will be conducted to compare the effectiveness of mulligan versus proprioceptive training on pain severity, headache disability, flexion rotation test, pain threshold, cervical joint position error in patients with cervicogenic headache.
Read the detailed description
Cervicogenic headache (CGH) is a type of headache, and it occurs commonly due to neck dysfunctions. Many studies found positive association between the neck dysfunction and CGH. The prevalence of this problem is more common in women than men. Headache disorders are classified as primary, such as migraine or tension-type headache, or secondary, such as CGH. The one-year prevalence of CGH in the adult population varies between 0.2 and 2.2%.
It is severely impacts the general public, burdening public health and putting pressure on the local economy and community.
The International Classification of Headache Disorders (ICHD BETA 3) defined cervicogenic headache as "Headache caused by a disorder of the cervical spine and its component bony, disc and/or soft tissue elements, usually but not always accompanied by neck pain.
No drugs are effective for cervicogenic headache. Studies showed that treatment with manual therapy, specific exercises, or manual therapy plus exercises was significantly more effective at reducing headache frequency and intensity than was no treatment. Manual therapy alone, however, was not more effective than exercises alone, and combining the two interventions did not achieve better outcomes than either intervention alone. About 76% of patients achieved a more than 50% decrease in headache frequency and 35% achieved complete relief at the 7-week follow-up. At 12 months, 72% had a more than 50% decrease in headache frequency, but the proportion that had complete relief was not reported.
A recent systematic review concluded that manual therapy may be effective in the short term and neck exercise in the long term in treating adults with cervicogenic headache.
A popular method for mobilizing joints is the Mulligan Mobilization Technique (MMT), in which the patient moves actively as the therapist slides the affected joint. Efficacy of MMT has been proven in patients experiencing acute to subacute CGH for both short and long-term periods.
There is a link between proprioceptive afferent information and the ability to maintain body posture and good balance. Patients with neck pain have reduced proprioceptive abilities and balance training can improve deficits in proprioception and balance.
A correlation was seen between CGH and a rise in cervical reposition error as well as restricted range of motion as compared to healthy individuals. Patients with CGH should have their rehabilitation programs take these effects into account.
A case report shows that we can effectively enhance overall balance control when we combine balance training with conventional manual therapy methods for the treatment of cervicogenic headache.
Despite studies demonstrating the effectiveness of balance training regimens for cervicogenic dizziness, there is no studies done on patient with CGH except one case report and it seems to be effective. there is no current literature addressing the addition of a proprioceptive training added to mulligan mobilization for patients with cervicogenic headache. Therefore, the aim of this case study was to identify if proprioceptive training exercise in addition to mulligan mobilization had an impact on the headache frequency, pain, disability and overall quality of life in a patient with CGH.
- Conditions
- Cervicogenic Headache
- Being tested
- Mulligan Technique, Proprioceptive Training, Conventional physical therapy program
- 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.
Mulligan TechniqueOther
Mulligan Mobilization Technique will include Headache SNAG, Reverse Headache SNAG, and C1-C2 SNAG rotation. All techniques will be performed with the participant sitting in an erect posture. Headache SNAG and Reverse Headache SNAG will be applied at C2 for 10-30 seconds, with a maximum of 10 repetitions. C1-C2 SNAG rotation will be performed toward the restricted side for 10 repetitions with end-range overpressure and 30 seconds of rest between repetitions. The intervention will be administered in addition to the conventional physical therapy program for 12 sessions, 3 sessions per week for 4 weeks.
Proprioceptive TrainingOther
Proprioceptive training will include head relocation practice, cervical joint position retraining, and oculomotor exercises. Joint position sense will be trained using a head-mounted laser pointer with head movements and relocation to the neutral position, progressing from eyes open to eyes closed. Cervical joint position retraining will include tracing patterns with the laser. Oculomotor training will include eye-follow, saccades, gaze stability, and eye-head coordination exercises, with progression by increasing movement speed and range and modifying visual targets. The intervention will be administered in addition to the conventional physical therapy program for 12 sessions, 3 sessions per week for 4 weeks.
Conventional physical therapy programOther
The conventional physical therapy program will include hot pack application for 10 minutes, therapeutic ultrasound for 5 minutes on each side at an intensity of 1-1.5 W/cm² over the trapezius, upper cervical, and occipitovertebral regions, and low-load endurance exercises for the craniocervical and cervicoscapular muscles. The exercise program will include craniocervical flexion training using pressure biofeedback and scapular muscle endurance exercises. The conventional program will be administered to participants in both study arms.
| Study group | Role | What they receive |
|---|---|---|
| Mulligan Technique + Conventional physical therapy program | Experimental | Participants in this arm will receive Mulligan Mobilization Technique in addition to the conventional physical therapy program. Mulligan techniques will include Headache SNAG, Reverse Headache SNAG, and C1-C2 SNAG rotation. Treatment will be administered for 12 sessions, 3 sessions per week for 4 weeks. Receives: Other: Mulligan Technique; Other: Conventional physical therapy program |
| Proprioceptive Training + Conventional physical therapy program | Experimental | Participants in this arm will receive proprioceptive training in addition to the conventional physical therapy program. Proprioceptive training will include head relocation practice, cervical joint position retraining using a head-mounted laser pointer, and oculomotor exercises including gaze stability, eye-follow, saccades, and eye-head coordination exercises. Treatment will be administered for 12 sessions, 3 sessions per week for 4 weeks. Receives: Other: Proprioceptive Training; Other: Conventional physical therapy program |
What is being measured
The primary outcome is the main question the study is designed to answer.
Pain Intensity
Pain intensity will be assessed using the Visual Analogue Scale (VAS). Participants will rate their pain intensity on a 10-cm scale, where 0 indicates no pain and 10 indicates maximum intolerable pain.
Measured: 4 weeks
Headache Impact
Headache impact will be assessed using the Arabic version of the Headache Impact Test-6 (HIT-6). The total score ranges from 36 to 78, with higher scores indicating a greater impact of headache on daily functioning.
Measured: 4 weeks
Right Cervical Flexion-Rotation Range of Motion
Right cervical flexion-rotation range of motion will be assessed using the Cervical Range of Motion (CROM) instrument during the Flexion-Rotation Test (FRT). Rotation will be measured in degrees for the right side.
Measured: 4 weeks
Left Cervical Flexion-Rotation Range of Motion
Left cervical flexion-rotation range of motion will be assessed using the Cervical Range of Motion (CROM) instrument during the Flexion-Rotation Test (FRT). Rotation will be measured in degrees for the left side.
Measured: 4 weeks
Pressure Pain Threshold
Pressure pain threshold (PPT) will be assessed using a digital algometer. Measurements will be obtained over the upper trapezius muscle, C2-C3 zygapophyseal joint, suboccipital muscles bilaterally, and tibialis anterior muscle area. The mean of three trials at each measurement site will be used for analysis.
Measured: 4 weeks
Secondary outcomes (1)
Cervical Joint Position Error
Cervical proprioception will be assessed using the Cervical Joint Position Error Test (CJPET) with a head-mounted laser pointer. Participants will attempt to relocate the head to the neutral starting position without visual cues. Joint position error will be measured and converted to degrees using the formula: angle = tan-¹ [error distance/90 cm].
Measured: 4 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted22 Sep 2026
- Study start24 Sep 2026 (estimated)
- Primary completion24 Dec 2026 (estimated)
- Study completion31 Dec 2026 (estimated)
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 Cairo UniversityThe 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
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 48 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Cairo University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Nada helmy mohamed, Cairo University
- Investigators
- Salwa Fadl, PhD, Study chair, Professor, Cairo UniversityMohamed Ali Sarhan, PhD, Study director, Ass. Professor, Cairo UniversityAbdelgalil Allam Abdelgalil, PhD, Study director, Lecturer, Cairo University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07832968
- Sponsor's protocol ID
- P.T.REC/012/006418
- Status last verified
- Sep 2026
- First submitted
- 16 Sep 2026
- Last updated
- 22 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 22 Sep 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Mulligan Technique Versus Proprioceptive Training in Cervicogenic Headache
- ClinicalTrials.gov ID
- NCT07832968
- Acronym / sponsor ID
- P.T.REC/012/006418
- Conditions
- Cervicogenic Headache
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 48 participants (estimated)
- Lead sponsor
- Cairo UniversityUniversity, hospital or other
- Study start
- 24 Sep 2026 (estimated)
- Primary completion
- 24 Dec 2026 (estimated)
- Study completion
- 31 Dec 2026 (estimated)
- First posted
- 22 Sep 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.
This study will be conducted to compare the effectiveness of mulligan versus proprioceptive training on pain severity, headache disability, flexion rotation test, pain threshold, cervical joint position error in patients with cervicogenic headache.
Detailed description
Cervicogenic headache (CGH) is a type of headache, and it occurs commonly due to neck dysfunctions. Many studies found positive association between the neck dysfunction and CGH. The prevalence of this problem is more common in women than men. Headache disorders are classified as primary, such as migraine or tension-type headache, or secondary, such as CGH. The one-year prevalence of CGH in the adult population varies between 0.2 and 2.2%.
It is severely impacts the general public, burdening public health and putting pressure on the local economy and community.
The International Classification of Headache Disorders (ICHD BETA 3) defined cervicogenic headache as "Headache caused by a disorder of the cervical spine and its component bony, disc and/or soft tissue elements, usually but not always accompanied by neck pain.
No drugs are effective for cervicogenic headache. Studies showed that treatment with manual therapy, specific exercises, or manual therapy plus exercises was significantly more effective at reducing headache frequency and intensity than was no treatment. Manual therapy alone, however, was not more effective than exercises alone, and combining the two interventions did not achieve better outcomes than either intervention alone. About 76% of patients achieved a more than 50% decrease in headache frequency and 35% achieved complete relief at the 7-week follow-up. At 12 months, 72% had a more than 50% decrease in headache frequency, but the proportion that had complete relief was not reported.
A recent systematic review concluded that manual therapy may be effective in the short term and neck exercise in the long term in treating adults with cervicogenic headache.
A popular method for mobilizing joints is the Mulligan Mobilization Technique (MMT), in which the patient moves actively as the therapist slides the affected joint. Efficacy of MMT has been proven in patients experiencing acute to subacute CGH for both short and long-term periods.
There is a link between proprioceptive afferent information and the ability to maintain body posture and good balance. Patients with neck pain have reduced proprioceptive abilities and balance training can improve deficits in proprioception and balance.
A correlation was seen between CGH and a rise in cervical reposition error as well as restricted range of motion as compared to healthy individuals. Patients with CGH should have their rehabilitation programs take these effects into account.
A case report shows that we can effectively enhance overall balance control when we combine balance training with conventional manual therapy methods for the treatment of cervicogenic headache.
Despite studies demonstrating the effectiveness of balance training regimens for cervicogenic dizziness, there is no studies done on patient with CGH except one case report and it seems to be effective. there is no current literature addressing the addition of a proprioceptive training added to mulligan mobilization for patients with cervicogenic headache. Therefore, the aim of this case study was to identify if proprioceptive training exercise in addition to mulligan mobilization had an impact on the headache frequency, pain, disability and overall quality of life in a patient with CGH.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Mulligan Technique + Conventional physical therapy program | Experimental | Other: Mulligan Technique, Other: Conventional physical therapy programParticipants in this arm will receive Mulligan Mobilization Technique in addition to the conventional physical therapy program. Mulligan techniques will include Headache SNAG, Reverse Headache SNAG, and C1-C2 SNAG rotation. Treatment will be administered for 12 sessions, 3 sessions per week for 4 weeks. |
| Proprioceptive Training + Conventional physical therapy program | Experimental | Other: Proprioceptive Training, Other: Conventional physical therapy programParticipants in this arm will receive proprioceptive training in addition to the conventional physical therapy program. Proprioceptive training will include head relocation practice, cervical joint position retraining using a head-mounted laser pointer, and oculomotor exercises including gaze stability, eye-follow, saccades, and eye-head coordination exercises. Treatment will be administered for 12 sessions, 3 sessions per week for 4 weeks. |
Who may qualify
- Ages
- 18 to 45 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (6 listed)
- CGH pain intensity between 3 and 8 on 10-point pain scale.
- CGH due to cervical spine dysfunction.
- Reduced cervical motion.
- Neck pain followed by headache.
- Unilateral pain starting in the neck and radiating to the frontotemporal region.
Key exclusion criteria (9 listed)
- Participants with other types of headache (migraine).
- Headache due to other causes (sinus, tumor, neural, or temporomandibular joint issues), and any type of physical therapy treatment in the past three months.
- Any contraindications to manual and manipulative therapy (fracture, instability, osteoporosis, arthropathy, or neural symptoms).
- Using analgesics or corticosteroids.
- Metastasis.
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 |
|---|---|---|
| Mulligan TechniqueMulligan Mobilization Technique will include Headache SNAG, Reverse Headache SNAG, and C1-C2 SNAG rotation. All techniques will be performed with the participant sitting in an erect posture. Headache SNAG and Reverse Headache SNAG will be applied at C2 for 10-30 seconds, with a maximum of 10 repetitions. C1-C2 SNAG rotation will be performed toward the restricted side for 10 repetitions with end-range overpressure and 30 seconds of rest between repetitions. The intervention will be administered in addition to the conventional physical therapy program for 12 sessions, 3 sessions per week for 4 weeks. | Other | Mulligan Technique + Conventional physical therapy program |
| Proprioceptive TrainingProprioceptive training will include head relocation practice, cervical joint position retraining, and oculomotor exercises. Joint position sense will be trained using a head-mounted laser pointer with head movements and relocation to the neutral position, progressing from eyes open to eyes closed. Cervical joint position retraining will include tracing patterns with the laser. Oculomotor training will include eye-follow, saccades, gaze stability, and eye-head coordination exercises, with progression by increasing movement speed and range and modifying visual targets. The intervention will be administered in addition to the conventional physical therapy program for 12 sessions, 3 sessions per week for 4 weeks. | Other | Proprioceptive Training + Conventional physical therapy program |
| Conventional physical therapy programThe conventional physical therapy program will include hot pack application for 10 minutes, therapeutic ultrasound for 5 minutes on each side at an intensity of 1-1.5 W/cm² over the trapezius, upper cervical, and occipitovertebral regions, and low-load endurance exercises for the craniocervical and cervicoscapular muscles. The exercise program will include craniocervical flexion training using pressure biofeedback and scapular muscle endurance exercises. The conventional program will be administered to participants in both study arms. | Other | Mulligan Technique + Conventional physical therapy program, Proprioceptive Training + Conventional physical therapy program |
Primary outcome
Pain Intensity
Time frame: 4 weeks
Pain intensity will be assessed using the Visual Analogue Scale (VAS). Participants will rate their pain intensity on a 10-cm scale, where 0 indicates no pain and 10 indicates maximum intolerable pain.
Headache Impact
Time frame: 4 weeks
Headache impact will be assessed using the Arabic version of the Headache Impact Test-6 (HIT-6). The total score ranges from 36 to 78, with higher scores indicating a greater impact of headache on daily functioning.
Right Cervical Flexion-Rotation Range of Motion
Time frame: 4 weeks
Right cervical flexion-rotation range of motion will be assessed using the Cervical Range of Motion (CROM) instrument during the Flexion-Rotation Test (FRT). Rotation will be measured in degrees for the right side.
Left Cervical Flexion-Rotation Range of Motion
Time frame: 4 weeks
Left cervical flexion-rotation range of motion will be assessed using the Cervical Range of Motion (CROM) instrument during the Flexion-Rotation Test (FRT). Rotation will be measured in degrees for the left side.
Pressure Pain Threshold
Time frame: 4 weeks
Pressure pain threshold (PPT) will be assessed using a digital algometer. Measurements will be obtained over the upper trapezius muscle, C2-C3 zygapophyseal joint, suboccipital muscles bilaterally, and tibialis anterior muscle area. The mean of three trials at each measurement site will be used for analysis.
1 secondary outcome
Cervical Joint Position Error
Time frame: 4 weeks
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 22 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.
Abdelgalil Allam Abdelgalil, PhD contact
Salwa Fadl, PhD study chair
Professor, Cairo University
Mohamed Ali Sarhan, PhD study director
Ass. Professor, Cairo University
Abdelgalil Allam Abdelgalil, PhD study director
Lecturer, Cairo University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Mulligan Technique, Proprioceptive Training and Conventional physical therapy program in people with Cervicogenic Headache, run by Cairo University at 1 site in Egypt.
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 6 inclusion and 9 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: opening soon, as of the sponsor's last update on 22 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 Egypt. 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?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Nada Helmy Mohamed, M.Sc (+20 11 15275306, Nadahelmy382@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Pain Intensity (time frame: 4 weeks). The study lists 5 primary outcomes in all. 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 22 Sep 2026.