Comparative Effects Of Eye-Cervical Re-Education Exercises And Pressure Biofeedback Training Of Deep Cervical Flexors In Cervicogenic Headache

NCT07526025 | Recruiting

• 1 other identifier: FUI/FUCP/CTR/03.26/MairaTafzel
• Study Type: interventional
• Target: 34
• Locations: 1 country
• Sites: 1

Brief 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. 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.

Conditions

Cervicogenic Headache

Outcome Measures

Primary Outcomes (1)

• Cervical Joint Proprioception

  It will be measured using cervical joint position error test

  Baseline and after 3rd week

Secondary Outcomes (3)

• Pain Intensity

  baseline and 3rd week of treatment

• Neck Disability

  Baseline and 3rd week of treatment

• Cervical Range of Motion

  Baseline and after 3rd week of treatment

Study Arms (2)

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

Procedure: Eye cervical re-education exercises

Pressure biofeedback training of deep cervical flexors

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)

Procedure: Pressure biofeedback training of deep cervical flexors

Interventions

Eye cervical re-education exercises PROCEDURE

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

Eye cervical re-education exercises

Pressure biofeedback training of deep cervical flexors PROCEDURE

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 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 30mmHg.

Pressure biofeedback training of deep cervical flexors

Eligibility Criteria

• Age: 18 Years - 45 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Age 18 to 45 years
• Both genders
• 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.

You may not qualify if:

• 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
• Metabolic disorders
• Spinal infection or tumors
• Vertebrobasilar insufficiency
• Other headache types such as tension headache, migraine etc

Sponsors & Collaborators

• Foundation University Islamabad: lead

Study Sites (1)

Foundation University College of Physical Therapy

Islamabad, Punjab Province, 46000, Pakistan

RECRUITING

MeSH Terms

Conditions

Post-Traumatic Headache

Condition Hierarchy (Ancestors)

Headache Disorders, Secondary; Headache Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases

Study Officials

• Maira Tafzeel, DPT

  Foundation University Islamabad

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Maira Tafzeel, DPT

CONTACT

0331-5955848; myratafzeel10@gmail.com

Quratulain Saeed, MS-OMPT

CONTACT

03315562889; quratulain.saeed@fui.edu.pk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: April 6, 2026
• First Posted: April 13, 2026
• Study Start: May 19, 2026
• Primary Completion: June 1, 2026
• Study Completion: June 15, 2026
• Last Updated: May 20, 2026

Record last verified: 2026-05

Locations

PA (1)