Proprioceptive training reduces headache burden and center of pressure path length in patients with cervicogenic headache: A randomized controlled trial

Mohamed, Mohamed Abdelaziz Emam and Ramadan, Magda and Ragab, Salma and Horváth, András Attila and Amin, Fatma S. (2026) Proprioceptive training reduces headache burden and center of pressure path length in patients with cervicogenic headache: A randomized controlled trial. PHYSIOLOGY INTERNATIONAL, 113 (1). pp. 97-113. ISSN 2498-602X

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Abstract

Background: Cervicogenic headache (CGH) is frequently associated with altered cervical sensorimotor control, reduced range of motion and impaired postural stability. Prior work has shown that proprioceptive retraining with gaze direction recognition (GDR) can reduce pain and improve postural stability in CGH and chronic neck pain. Purpose: To examine whether adding a GDR-based proprioceptive training to standard physiotherapy reduces headache frequency and duration and improves postural balance (COP path length) in CGH patients. Methods: Thirty-eight participants with CGH (aged 35–49 years) were randomly assigned to receive either standard physiotherapy (Control, n 5 19) or physiotherapy plus GDR proprioceptive training (Treatment, n 5 19) for 8 weeks (3 sessions/week). Outcomes measured preand post-intervention included headache frequency (attacks/month), headache duration (hours/attack), and center-of-pressure (COP) path length during quiet standing. Results: Multivariate analyses revealed significant effects of time and group 3 time interaction (Wilks’ Λ 5 0.142, F (3,30) 5 60.55, P < 0.001; Wilks’ Λ 5 0.193, F (3,30) 5 41.77, P < 0.001), indicating greater improvements in the treatment group. Follow-up ANOVAs showed significant time and interaction effects for COP path length (F (1,32) 5 186.0, P < 0.001; F (1,32) 5 130.0, P < 0.001), headache duration (F (1,32) 5 16.0, P 5 0.00035; F (1,32) 5 7.43, P 5 0.010), and headache frequency (F (1,32) 5 11.7, P 5 0.002; F (1,32) 5 7.61, P 5 0.010). Groups did not differ at baseline. Conclusion: Adding GDR-based proprioceptive training to standard physiotherapy produced greater improvements in headache burden and markedly improved postural balance compared with standard physiotherapy alone.

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