PPIVMs for Cervicogenic Headache

NCT07617051 | Completed

• 1 other identifier: 73/148/2022
• Study Type: interventional
• Target: 64
• Locations: 1 country
• Sites: 1

Brief Summary

Cervicogenic headache is a type of headache that originates from problems in the neck, particularly the upper cervical spine. It may cause headache pain, neck pain, reduced neck movement, disability, emotional distress, and reduced quality of life. Physiotherapy management commonly includes therapeutic exercise and manual therapy techniques. This randomized clinical trial examined whether adding Passive Physiological Intervertebral Movements to a structured therapeutic exercise program was more effective than therapeutic exercise alone in patients with cervicogenic headache. Participants diagnosed with cervicogenic headache were randomly assigned to one of two groups. The intervention group received Passive Physiological Intervertebral Movements targeting the upper cervical joints, in addition to therapeutic exercises. The control group received the same therapeutic exercise program without Passive Physiological Intervertebral Movements. Both groups received eight supervised treatment sessions over four weeks, with each session lasting approximately 15 to 20 minutes. The exercise program included cervical flexion exercises, scapular retraction, stretching exercises, and active neck mobility exercises. Participants were also encouraged to perform the exercises at home. The study was conducted between May 2022 and August 2025 at the outpatient physiotherapy departments of Jordan University of Science and Technology and King Abdullah University Hospital. Outcomes were assessed at baseline, immediately after the four-week intervention, and at three-month follow-up. The outcomes included headache pain intensity, headache frequency, neck pain intensity, neck disability, depression, anxiety, stress, and quality of life. These were measured using validated tools, including the Numeric Pain Rating Scale, Neck Disability Index, Depression Anxiety Stress Scale-21, and Short Form-12 quality of life questionnaire. The study aimed to determine whether adding Passive Physiological Intervertebral Movements to exercise provides additional benefits for patients with cervicogenic headache compared with exercise alone. The trial included 64 participants.

Conditions

Cervicogenic Headache

Keywords

Cervicogenic headache; Neck Pain; Passive physiological intervertebral movements; Therapeutic exercise; Manual therapy

Outcome Measures

Primary Outcomes (1)

• Headache Pain Intensity Measured by Numeric Pain Rating Scale

  Headache pain intensity was assessed using the 11-point Numeric Pain Rating Scale. Scores range from 0 to 10, where 0 indicates no pain and 10 indicates the worst pain imaginable. Higher scores indicate greater headache pain intensity.

  Baseline, 4 weeks, and 3 months

Secondary Outcomes (7)

• Headache Frequency Per Week

  Baseline, 4 weeks, and 3 months

• Neck Pain Intensity Measured by Numeric Pain Rating Scale

  Baseline, 4 weeks, and 3 months

• Neck Disability Measured by Neck Disability Index

  Baseline, 4 weeks, and 3 months

• Stress Symptoms Measured by Depression Anxiety Stress Scale-21

  Baseline, 4 weeks, and 3 months

• Anxiety Symptoms Measured by Depression Anxiety Stress Scale-21

  Baseline, 4 weeks, and 3 months

Study Arms (2)

Passive Physiological Intervertebral Movements plus Therapeutic Exercise

EXPERIMENTAL

Participants received Passive Physiological Intervertebral Movements targeting the upper cervical joints in addition to a structured therapeutic exercise program.

Procedure: Passive Physiological Intervertebral Movements; Procedure: Therapeutic Exercise

Therapeutic Exercise Alone

ACTIVE COMPARATOR

Participants received the same structured therapeutic exercise program without Passive Physiological Intervertebral Movements.

Procedure: Therapeutic Exercise

Interventions

Passive Physiological Intervertebral Movements PROCEDURE

Manual therapy technique applied to the upper cervical spine, targeting C0-C1, C1-C2, and C2-C3 mobility.

Passive Physiological Intervertebral Movements plus Therapeutic Exercise

Therapeutic Exercise PROCEDURE

Structured exercise program including cervical flexion/chin tuck exercises, scapular retraction, stretching, and active neck mobility exercises.

Passive Physiological Intervertebral Movements plus Therapeutic Exercise; Therapeutic Exercise Alone

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Were diagnosed with cervicogenic headache using a standardized clinical diagnostic protocol based on history and physical examination.
• Had a positive Cervical Flexion-Rotation Test, defined as reduced cervical rotation by ≥10° on the symptomatic side compared with the asymptomatic side, or total rotation \<32°.
• Had referred pain originating from the cervical spine, confirmed by mechanical provocation such as manual palpation or pressure over the C1-C3 zygapophysial joints reproducing typical headache symptoms.
• Had pain behavior consistent with cervicogenic headache, such as symptoms worsened by sustained neck posture or specific neck movements.
• Had other primary headache disorders excluded based on clinical history and symptom characteristics.

You may not qualify if:

• Diagnosed with disc herniation and stenosis of the spinal canal.
• Clinically diagnosed as a case of cervical radiculopathy or myelopathy.
• Subjects with conditions or diseases that are contraindicated for mobilization treatment: rheumatoid arthritis, ankylosing spondylitis, spondylolistheses, cervical fractures, osteoporosis, osteomyelitis, malignancy, and pregnancy
• Have received manual therapy or exercise by a physical therapist in the last six months.
• Patients diagnosed with cognitive dysfunction, psychological disorder, or communication/cognitive deficits.

Sponsors & Collaborators

• Jordan University of Science and Technology: lead

Study Sites (1)

Jordan University of Science and Technology

Irbid, 22110, Jordan

Location

Related Publications (4)

• Malo-Urries M, Tricas-Moreno JM, Estebanez-de-Miguel E, Hidalgo-Garcia C, Carrasco-Uribarren A, Cabanillas-Barea S. Immediate Effects of Upper Cervical Translatoric Mobilization on Cervical Mobility and Pressure Pain Threshold in Patients With Cervicogenic Headache: A Randomized Controlled Trial. J Manipulative Physiol Ther. 2017 Nov-Dec;40(9):649-658. doi: 10.1016/j.jmpt.2017.07.007.

  PMID: 29229055 BACKGROUND

• Hall T, Chan HT, Christensen L, Odenthal B, Wells C, Robinson K. Efficacy of a C1-C2 self-sustained natural apophyseal glide (SNAG) in the management of cervicogenic headache. J Orthop Sports Phys Ther. 2007 Mar;37(3):100-7. doi: 10.2519/jospt.2007.2379.

  PMID: 17416124 BACKGROUND

• Dunning JR, Butts R, Mourad F, Young I, Fernandez-de-Las Penas C, Hagins M, Stanislawski T, Donley J, Buck D, Hooks TR, Cleland JA. Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC Musculoskelet Disord. 2016 Feb 6;17:64. doi: 10.1186/s12891-016-0912-3.

  PMID: 26852024 BACKGROUND

• Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, Emberson J, Marschner I, Richardson C. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine (Phila Pa 1976). 2002 Sep 1;27(17):1835-43; discussion 1843. doi: 10.1097/00007632-200209010-00004.

  PMID: 12221344 BACKGROUND

MeSH Terms

Conditions

Post-Traumatic Headache; Neck Pain

Interventions

Exercise Therapy

Condition Hierarchy (Ancestors)

Headache Disorders, Secondary; Headache Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Rehabilitation; Aftercare; Continuity of Patient Care; Patient Care; Therapeutics; Physical Therapy Modalities

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Study Record Dates

• First Submitted: May 20, 2026
• First Posted: June 1, 2026
• Study Start: May 2, 2022
• Primary Completion: August 7, 2025
• Study Completion: August 7, 2025
• Last Updated: June 1, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will not share

Locations

JO (1)