EFFECTIVENESS OF MCKENZIE PROTOCOL VERSUS MULLIGAN PROTOCOL IN TREATMENT OF CERVICOGENIC HEADACHE: A RANDOMIZED CONTROLLED TRIAL

Abstract

Background: Cervicogenic Headache is secondary type of headache that occurs due to dysfunctions in cervical spine, intervertebral discs, its soft tissue components. Physiotherapy interventions showed good results in managing cervicogenic headache. Mobilisation techniques showed good efficacy in many of the experimental studies. On the other hand, McKenzie Exercises which is based on the principle of centralisation of pain have also shown good effectiveness for treating cervical dysfunction, which in turn helps in decreasing cervicogenic headache intensity and frequency. Objective:  The objective of this study was to find and compare the effects of Mulligan Protocol versus the Mckenzie protocols to treat the Cervicogenic Headache. Methods: A randomized, controlled study was conducted on 132 participants at the Physiotherapy OPD, Chandigarh University. The participants were  divided into Mulligan Mobilization therapy group (MMT; n=66), and McKenzie Therapy group (MT; n = 66), they received the respective interventions for four weeks. The primary outcome CGH frequency, CGH pain intensity, CGH disability. The secondary outcomes are neck pain and upper cervical rotation, they were measured at baseline, and after 4 weeks. Results: Four weeks following the intervention, Mulligan and McKenzie protocols were effective, as all post-test values showed significant improvement compared to pre-test values (p < 0.001). However, between-group comparison showed important differences Mulligan Protocol (Group A) was more effective in reducing headache intensity (NPRS), headache disability (NDI), headache impact (HIT score) , duration of headache and improving cervical ROM .While McKenzie Protocol (Group B) showed slightly better improvement in frequency of headache episodes Conclusion: Overall, although both interventions were beneficial, the Mulligan Protocol demonstrated superior effectiveness in improving most clinical outcomes in patients with cervicogenic headache. Hence, it can be concluded that Mulligan Protocol is more effective than McKenzie Protocol for the management of cervicogenic headache in this study.