EFFECT OF DURAL TUBE RELEASE VERSUS 3D MYOFASCIAL RELEASE ON PAIN, POSTERIOR MYOFASCIAL CHAIN TRIGGER POINTS AND FLEXION ROTATION RANGE IN INDIVIDUALS WITH CERVICOGENIC HEADACHE: RANDOMIZED CLINICAL TRIAL

Background: Cervicogenic headache (CGH) is a secondary headache disorder originating from dysfunction of cervical spine structures, including muscles, joints and the dural tube. Manual therapy is commonly used for CGH management; however, evidence comparing dural tube release (DTR) and three-dimensional myofascial release (3D-MFR) remains limited. Hence this study aims to determine and compare the effect of DTR and 3D-MFR on pain intensity, posterior myofascial chain trigger point sensitivity and cervical flexion–rotation range (CFRR) in individuals with cervicogenic headache.
Methods: This double blinded randomized clinical trial included 48 participants aged 30–55 years diagnosed with CGH. Participants were randomly allocated to receive either DTR or 3D-MFR. Both interventions were administered for 30 minutes per session, five sessions per week for two weeks. Outcome measures included pain intensity assessed using the visual analogue scale (VAS), trigger point sensitivity measured by pressure pain threshold (PPT) and CFRR. Assessments were performed at baseline and after the tenth treatment session.
Results: Within-group analysis demonstrated significant improvements in pain intensity, pressure pain threshold, and cervical flexion–rotation range in both groups following intervention (p < 0.001). Between-group analysis revealed significantly greater improvements in the DTR group compared with the 3D-MFR group for all outcome measures post-intervention (p < 0.05). The magnitude of change in both groups exceeded the minimal clinically important difference for VAS, PPT, and CFRR, with large effect sizes observed, particularly favoring dural tube release.
Conclusions: DTR and 3D-MFR proved to be effective interventions for reducing pain, decreasing trigger point sensitivity and increasing CFRR in individuals with CGH. However, dural tube release demonstrated superior clinical outcomes, suggesting that interventions targeting dural mechanics may provide enhanced benefits in CGH management.