A randomized double blinded controlled trial will be conducted to determine and compare the effects of low and medium dose radial extracorporeal shock wave therapy on upper trapezius trigger points in patients with cervicogenic headache. Data will be collected at base line and at the end of the treatment program. Participants will be assigned randomly into three groups Group (A) will receive 2000 shock waves at frequency 10 MHz and 0.045 mj/mm2 flux density plus strengthening and stretching exercise for upper trapezius muscle. Group (B) will receive 2000 shock waves at frequency 10 MHz and 0.18 mj/mm2 energy flux density plus strengthening and stretching exercise for upper trapezius muscle. Group (C) will receive sham shock wave therapy plus strengthening and stretching exercise for upper trapezius muscle.
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Henry Ford Hospital Headache disability inventory (HDI)
Timeframe: before the first session and after the last session (Four weeks)
Upper trapezius electromyographic activity
Timeframe: before the first session and after the last session (Four weeks)