Effect of Mechanism-Based Cervical Sensorimotor Rehabilitation on Cervical Muscle Activation, Joint Position Error, and Migraine Burden in Patients With Chronic Migraine: A Randomized Controlled Trial
Trial Snapshot
- Phase
- Not Applicable
- Status
- Not yet recruiting
- Sponsor
- Beni-Suef University
- Enrollment
- 80
- Primary Endpoint
- cervical joint position error
Study Overview
Brief Summary
To investigate the effectiveness of mechanism-based cervical sensorimotor rehabilitation on cervical muscle activation, cervical proprioception, and migraine burden.
Detailed Description
Chronic migraine is a disabling neurological disorder characterised by headache occurring on at least 15 days per month for more than three months, with migraine features on at least eight days per month according to the International Classification of Headache Disorders (ICHD-3). In addition to headache symptoms, individuals with chronic migraine frequently exhibit cervical musculoskeletal impairments, including reduced cervical range of motion, impaired cervical proprioception, altered neuromuscular control, and increased activity of superficial cervical muscles. These impairments are thought to be associated with altered sensorimotor integration and dysfunction of the trigeminocervical complex, potentially contributing to headache persistence and disability.
Although several studies have reported beneficial effects of cervical rehabilitation in patients with migraine, the underlying neuromuscular mechanisms remain insufficiently understood. In particular, few randomized controlled trials have simultaneously investigated changes in cervical muscle activation, cervical joint position error, and migraine-related outcomes following a structured cervical sensorimotor rehabilitation programme. Understanding these mechanisms may improve clinical decision-making and facilitate the development of targeted rehabilitation strategies. This study is a prospective, assessor-blinded, parallel-group randomized controlled trial designed to investigate the effectiveness of a mechanism-based cervical sensorimotor rehabilitation programme in patients with chronic migraine.
A total of 80 participants diagnosed with chronic migraine according to the International Classification of Headache Disorders, Third Edition (ICHD-3) will be recruited from the outpatient clinics of the Faculty of Physical Therapy, Beni-Suef University. Participants will be randomly allocated in a 1:1 ratio to either an experimental group or a control group using a computer-generated randomization sequence with concealed allocation.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Single (Outcomes Assessor)
Masking Description
This is a parallel group randomized controlled trial with two arms receiving different interventions
Eligibility Criteria
- Ages
- 18 Years to 55 Years (Adult)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Male or female adults aged 18-55 years. Diagnosed with chronic migraine according to the International Classification of Headache Disorders, Third Edition (ICHD-3), defined as headache occurring on ≥15 days per month for more than 3 months, with migraine features present on at least 8 days per month.
- •History of migraine for at least 12 months prior to enrolment. Experiencing chronic migraine during the previous three months, confirmed through clinical history and/or headache diary.
- •Presence of cervical sensorimotor impairment, demonstrated by at least one of the following:
- •Increased cervical joint position error. Reduced cervical range of motion. Impaired cervical motor control. Neck pain or cervical dysfunction associated with migraine.
Exclusion Criteria
- •• Diagnosis of headache disorders other than chronic migraine (e.g., cervicogenic headache, cluster headache, or medication-overuse headache).
- •Previous cervical spine surgery, fracture, or significant cervical trauma. Cervical radiculopathy, myelopathy, or severe cervical spine pathology. Neurological disorders other than migraine (e.g., stroke, multiple sclerosis, Parkinson's disease).
- •Vestibular disorders affecting balance or proprioception. Inflammatory or systemic musculoskeletal diseases (e.g., rheumatoid arthritis, ankylosing spondylitis).
- •Pregnancy or breastfeeding. Physiotherapy, chiropractic treatment, acupuncture, or cervical rehabilitation within the previous 3 months.
- •Botulinum toxin injections or cervical pain interventions within the previous 3-4 months.
- •Changes in migraine preventive medication within the previous 4 weeks. Skin conditions preventing surface EMG electrode placement. Inability to comply with the study protocol or provide informed consent.
Arms & Interventions
expermintal
he experimental group will receive an eight-week mechanism-based cervical sensorimotor rehabilitation programme consisting of deep cervical flexor training, cervical motor control exercises, laser-guided cervical joint position error retraining, eye-head coordination exercises, scapular neuromuscular stabilization exercises, and a structured home exercise programme. Treatment will be delivered three sessions per week, with each session lasting approximately 40 minutes.
Intervention: cervical sensorimotor rehabilitation (Other)
expermintal
he experimental group will receive an eight-week mechanism-based cervical sensorimotor rehabilitation programme consisting of deep cervical flexor training, cervical motor control exercises, laser-guided cervical joint position error retraining, eye-head coordination exercises, scapular neuromuscular stabilization exercises, and a structured home exercise programme. Treatment will be delivered three sessions per week, with each session lasting approximately 40 minutes.
Intervention: conventional physiotherapy programme (Other)
control group
The control group will receive conventional physiotherapy, including cervical range of motion exercises, stretching exercises, postural education, and a home exercise programme, with the same treatment frequency and duration as the experimental group.
Intervention: conventional physiotherapy programme (Other)
Outcomes
Primary Outcomes
cervical joint position error
Time Frame: after the 8-week intervention, and at the 3-month follow-up
Cervical Joint Position Error (JPE) will be assessed to evaluate cervical proprioception using the Head Repositioning Accuracy Test. A lightweight laser pointer will be securely attached to the participant's head using an adjustable headband. Participants will be seated comfortably at a distance of 90 cm from a target grid mounted on a wall at eye level. At the beginning of each trial, participants will be instructed to identify and memorise their neutral head position while visually focusing on the centre of the target. They will then close their eyes and actively move their head to the end range of the required movement (flexion, extension, right rotation, left rotation, right lateral flexion, or left lateral flexion, depending on the testing protocol) before attempting to return to the original neutral position without visual feedback.The distance between the original target position and the repositioned laser point will be recorded and converted into angular error (degrees). Thre
Secondary Outcomes
- Headache Impact Test (HIT-6)(after the 8-week intervention (Week 8), and at the 3-month follow-up)
- Surface electromyographic (sEMG)(baseline of 8-week intervention, and at the 3-month follow-up)
Investigators
mohamed naeem
Assistant professor, Basic science department, faculty of physical therapy, Beni Suef university
Beni-Suef University