Combined use of cervical headache snag and cervical snag half rotation techniques in the treatment of cervicogenic headache

Abstract

[Purpose] Cervicogenic headache is a major problem in patients with upper cervical dysfunction. However, its physical therapy management is a topic of debate. This study aims to determine the effect of C1-C2 Mulligan sustained natural apophyseal glide mobilizations on cervicogenic headache and associated dizziness. [Participants and Methods] This study included 48 patients with cervicogenic headache, who were randomly assigned to three equal groups: Group A (Headache SNAG), group B (C1-C2 SNAG rotation), and group C (combined). Neck Disability Index was used to examine neck pain intensity and cervicogenic headache symptoms. The 6-item Headache Impact Test scale was used to examine headache severity and its adverse effects on social life and functions. Flexion-Rotation Test was used to assess rotation range of motion at the level of C1-C2 and confirmed by a cervical range of motion device. Dizziness Handicap Inventory scale was used to evaluate dizziness. The evaluation was done pre- and post-treatment and compared between the groups. [Results] Group C showed significant improvement in all variables compared with groups A and B. [Conclusion] Sustained natural apophyseal glide mobilizations used in the study were effective in reducing cervicogenic headache and dizziness in all groups with a greater improvement in the combined group. The use of cervical SNAG mobilizations is encouraged as a noninvasive intervention depending on the therapist’s assessment, findings, and clinical reasoning.

Immediate and Short-Term Effects of Upper Cervical High-Velocity, Low-Amplitude Manipulation on Standing Postural Control and Cervical Mobility in Chronic Nonspecific Neck Pain: A Randomized Controlled Trial

“…Our baseline data (lower than 32° on the CFRT) agree with other authors on C1-C2 mobility restriction for patients with cervicogenic headache [ 38 , 39 , 40 , 43 , 55 ], migraines [ 52 , 56 ], or neck pain [ 34 ]. However, they do not agree with other studies with values above 33° in low neck pain [ 38 ], migraines [ 39 ], or in asymptomatic patients [ 39 , 56 ].…”

“…They are similar to those published by Malo-Urries et al [ 57 ], with an increase in the CFRT of 7.3° after upper cervical translatoric mobilization, and also similar to those published by Dunning et al [ 34 ], where they obtained a change between 5.9° and 8.4° with upper cervical and upper thoracic manipulation, versus non-thrust mobilization with smaller changes (between 2.5° and 3.5°). However, those last data with mobilization technique do not agree with those obtained by Mohamed et al [ 55 ] with the SNAG rotation technique on C1-C2 and a 15.3° increase immediately after the intervention.…”

The effectiveness of headache treatment using manual therapy techniques according to the Brian Mulligan concept

“…In our study, we obtained a similar result-the analgesic effect of the SNAG technique lasted for at least four weeks. Mohamed et al conducted a study on 48 patients with cervicogenic headache [1]. The subjects were divided into three groups: the first (A) was treated with SNAG techniques for headache, the second (B) with SNAG C1 and C2 rotation and group (C) with combined techniques.…”

Effectiveness of manual therapy in the treatment of cervicogenic headache: A systematic review

“…therapy (SMT), [16][17][18] four studied the efficacy of Mulligan's Sustained Natural Apophyseal Glides (SNAGs), [19][20][21][22] and four evaluated muscle techniques (ischemic compression of trigger points, 23 streching, 24 suboccipital muscle relaxation, 25 and Jones strain/counterstrain technique, which is a positional release technique 26 ). In addition, one study evaluated translatory vertebral mobilization, 27 one compared the self-acupressure pillow with a combination of MT techniques, 28 and another study compared the efficacy of personalized versus non-personalized treatment with MT.…”