Clinical Research Directory

Inclusion Criteria: * The patients will be included in our study if they meet the following criteria: * Age between 25-45 years old for both genders. * No physiotherapy intervention for the last three months. * Intermittent headaches of varying duration and pain level at the rate of one headache per week for greater than 2 months. * Ipsilateral neck, shoulder, or arm pain. * Provocation of usual head pain by neck movement, sustained awkward neck positions or external pressure over the upper cervical or occipital region on the symptomatic side. * Limited neck ROM \> 10 degrees confirmed by a positive Flexion Rotation Test. * Active trigger points (TrPs) within the suboccipital, upper trapezius or sternocleidomastoid muscles. The diagnosis of active TrPs will be based on the major criteria proposed by): * Presence of a palpable taut band in a skeletal muscle * presence of a hypersensitive point in the taut band * local twitch response elicited by the snapping palpation of the taut band * reproduction of the referred pain in response to compression * patient recognition of the referred pain as a familiar symptom Exclusion Criteria: * The patients will be excluded if they have: * Cervical radiculopathy. * History of neck, shoulder trauma or surgery. * Physical therapy intervention in the neck and shoulder region in the previous 3 months. * Vertebrobasilar insufficiency or vestibular dysfunctions. * Evidence of cognitive deficits. * Presence of any needle contraindication. * Presence of any cupping contraindication.