Manual Therapy vs. Multicomponent Exercise in Cervicogenic Headache

The purpose of this study is to compare the effects of manual therapy and amulticomponent exercise program on suboccipital muscle thickness, joint position sense,pain, central sensitization, balance, and kinesiophobia in patients diagnosed withcervicogenic headache.Cervicogenic headache is a common secondary headache originating from dysfunction in theupper cervical spine. Dysfunction in the deep neck muscles, impaired neck jointawareness, and heightened pain sensitivity (central sensitization) are frequentlyobserved in these patients. While both manual therapy and targeted exercise are used inphysiotherapy practice, evidence regarding their direct comparative effects onsuboccipital muscle morphology and somatosensory parameters remains limited.Participants will be randomly assigned to one of two treatment groups for a duration of 4weeks (12 sessions total): 1. Manual Therapy Group: Receives joint mobilization, myofascial release, trigger pointrelease, and suboccipital distraction targeting the cervical region. 2. Multicomponent Exercise Group: Receives deep cervical flexor strengthening, cervicalproprioception training, head‐eye coordination training, and progressive balanceexercises.The main questions the study aims to answer are: ‐ Do manual therapy and multicomponent exercise improve suboccipital muscle thicknessand cervical joint position sense in patients with cervicogenic headache? ‐ Is there a significant difference between manual therapy and multicomponent exercisein reducing pain intensity, central sensitization, disability, and fear of movement(kinesiophobia)? It is hypothesized that both intervention protocols will yieldsignificant clinical improvements, with specific synergistic adaptations in musclestructure, somatosensory system processing, and pain‐related fear.