Efficacy of integrated neuromuscular inhibition technique in women with cervicogenic headache: a double-blind randomized controlled trial

Abstract

Background While systematic reviews support physiotherapy for cervicogenic headache (CGH), effects are often temporary with modest impact, emphasizing the need for more effective and lasting interventions.Objective To investigate the efficacy of the integrated neuromuscular inhibition technique (INIT) on pain, disability, and kinesiophobia in CGH.Methods In this double-blind randomized controlled trial, 40 women with CGH were randomized to an experimental group (n = 20) receiving INIT targeting trigger points in the upper trapezius and suboccipital muscles plus usual medical care, or a control group (n = 20) receiving usual care only. The primary outcome was headache intensity. Secondary outcomes: headache frequency, duration, daily impact, cervical range of motion (CROM), neck disability index (NDI), kinesiophobia, and neck flexion endurance. Measurements were taken at baseline, after 4 weeks of treatment, and after a 4-week follow-up without treatment.Results At 4 weeks, the INIT group showed a significantly greater reduction in headache intensity than controls (MD = –3.75, 95% CI: −4.471 to −3.029, p < 0.001; d = 3.331). Significant between-group differences with large effects (p < 0.001) were also observed for headache frequency, duration, impact, NDI, kinesiophobia, and neck flexion endurance. For CROM, significant improvements were observed post-treatment in right lateral flexion (p = 0.005), left lateral flexion (p = 0.008), and extension (p = 0.037), but not in flexion (p = 0.188), right rotation (p = 0.124), or left rotation (p = 0.303). At follow-up, all significant treatment effects persisted: p < 0.001 for most outcomes, p = 0.007 for extension, and p = 0.026 for right lateral flexion, whereas left lateral flexion was no longer significant (p = 0.118).Conclusion For women with CGH, adding INIT to usual medical care is associated with greater and sustained improvements in headache symptoms, neck function, and psychological factors compared to usual care alone.Clinical trial registration The trial was registered prospectively at clinicaltrials.gov (NCT07025187). https://clinicaltrials.gov/study/NCT07025187