The Safety and Feasibility of tDCS Combined With Conservative Treatment for Cervicogenic Headaches
Cervicogenic Headache
About this trial
This is an interventional treatment trial for Cervicogenic Headache focused on measuring Transcranial Direct Current Stimulation, Physiotherapy
Eligibility Criteria
Inclusion Criteria:
- Diagnosed with cervicogenic headaches based on International Headache Society Guidelines lasting greater than 12 weeks
- The International Headache Society Guidelines are as follows: A) Presence of a headache fulfilling criterion C; B) Clinical and/or imaging evidence of a disorder or lesion within the cervical spine or soft tissues of the neck, known to be able to cause headache; C) Evidence of causation demonstrated by at least two of the following: (a) Headache has developed in temporal relation to the onset of the cervical disorder or appearance of the lesion; (b) Headache has significantly improved or resolved in parallel with improvement in or resolution of the cervical disorder or lesion; (c) Cervical range of motion is reduced and headache is made significantly worse by provocative maneuvers; (d) Headache is abolished following diagnostic blockade of a cervical structure or its nerve supply.
- Average pain score ≥ 4/10 and Neck Disability score ≥ 28/50
Exclusion Criteria:
- Presence of primary or mixed headaches (ie. Migraines and tension type headaches)
- Known spinal pathology (tumour, fracture, etc)
- Nerve root pain/sensory loss
- Muscular or joint inflammatory conditions
- Neurological or psychiatric conditions
- Undergone recent surgery (within prior year)
- Have contraindications to tDCS (metal or electronic implants in the brain/skull; metal or electronic implants in other sites on the body; surgical procedures involving the head or spinal cord; skin problems such as dermatitis, psoriasis or eczema; epilepsy or a previous convulsion/seizure; fainting spells or syncope; pregnancy or any chance of pregnancy; previous electrical or magnetic stimulation)
Sites / Locations
- University of CalgaryRecruiting
Arms of the Study
Arm 1
Arm 2
Experimental
Sham Comparator
Active tDCS with physiotherapy
Sham tDCS with physiotherapy
Patients will engage in a six-week treatment protocol with 3 sessions per week (18 treatments). This was chosen to minimize discomfort and ensure the number of sessions is consistent with previous migraine literature. The primary motor cortex (M1) will be the treatment target to reduce pain sensitivity and improve motor learning. M1 will be found through measurements of the head: the point halfway between the nasion and inion and halfway between the left and right tragus will be found, we will then move down 20% of the inter-tragi distance and place the anode there. The cathode will then be placed over the super orbital region. Each electrode will be held in place with a strap and will make as much contact with the skin as possible. tDCS will be delivered via two 35cm2 surface sponge electrodes at an intensity of 2mA in the active group.
In the sham condition, the number of sessions, placement of electrodes, and types of electrodes used will be the same, however, only a 30 second ramp up period will be administered to emulate active tDCS therapy. Patients will be able to hear the sounds of the device and will feel slight tingling for the first 30 seconds but will receive no active stimulation. Previous sham studies have demonstrated efficacy of the blinding method.