ORIGINAL ARTICLE: Efficacy of C1-C2 Sustained Natural Apophyseal Glide (SNAG) Versus Posterior Anterior Vertebral Mobilization (PAVMs) in the Management of Cervicogenic Headache


 Cervicogenic Headache, Sustained Natural Apophyseal Glide, Posterior Anterior Vertebral Mobilization, Mulligan Mobilization.

How to Cite

Muhammad Khan, Syed Shahzad Ali, & Rabail Rani Soomro. (2014). ORIGINAL ARTICLE: Efficacy of C1-C2 Sustained Natural Apophyseal Glide (SNAG) Versus Posterior Anterior Vertebral Mobilization (PAVMs) in the Management of Cervicogenic Headache. Journal of Basic & Applied Sciences, 10, 226–230. https://doi.org/10.6000/1927-5129.2014.10.31


Objectives: To determine the effect of a C1-C2 sustained natural apophyseal glide (SNAG) as compare to posterior anterior (PA) vertebral mobilization on cervicogenic headache.
Study Design: Randomized Control Trial.
Method: The study was conducted on 60 patients with CGH. In this study, patients were divided into two groups, group A and group B equally. Group A of 30 patients received SNAG and at the same time Group B of 30 patients were treated with PAVMs. A pre tested and structured questionnaire was used to collect data. Data was entered and analyzed by using SPSS 19.
Outcome Measures: Pain and disability was measured on Visual Analog Scale (VAS) (0-10) and Neck Disability Index (NDI) before and after the treatment.
Results: The study showed significant results for both the interventions in the treatment of CGH but SNAG mobilization has been more effective in reducing pain in CGH patients.
Conclusions: On the basis of this study, it is proved that cervical SNAGS is more effective for the treatment of cervicegenic headaches as compared to PAVMs.



Umar M, Naeem A, Badshah M, Zaidi S. A randomized control trial to review the effectiveness of cervical mobilization combined with stretching exercises in cervicogenic headache. J Public Health Biolo Sci 2012; 1(1): 09-13.

Page P. Clinical suggestion cervicogenic headaches: an evidence based approach to clinical management. Int J Sports Phys Ther 2011; 6 (3): 254-66.

Hall T, Briffa K, Hopper D. Clinical Evaluation of Cervicogenic Headache: A Clinical Perspective. J Man Manip Ther 2008; 16(2): 73-80.

Penzien DB, Andrasik F, Freidenberg BM, Houle TT, Lake AE 3rd, Lipchik GL, et al. Guidelines for Trials of Behavioral Treatments for Recurrent Headache, First Edition: American Headache Society Behavioral Clinical Trials Workgroup. Headache 2005; 45(2): 110-32. http://dx.doi.org/10.1111/j.1526-4610.2005.4502004.x

Hall T, Briffa K, Hopper D, Robinson K. Long-Term Stability and Minimal Detectable Change of the Cervical Flexion-Rotation Test. J Orthop Sports Phys Ther 2010; 40(4): 225-9. http://dx.doi.org/10.2519/jospt.2010.3100

Haldeman S, Dagenais S. Choosing a treatment for cervicogenic headache: when? what? how much? Spine J 2010; 10(1): 169-71. http://dx.doi.org/10.1016/j.spinee.2009.10.013

Exelby L. The Mulligan concept: Its application in the management of spinal conditions. Man Ther 2002; 7(2): 64-70. http://dx.doi.org/10.1054/math.2001.0435

Petersen SM. Articular and Muscular Impairments in Cervicogenic Headache: A Case Report. J Orthop Sports Phys Ther 2003; 33(1): 21-30. http://dx.doi.org/10.2519/jospt.2003.33.1.21

Bryans R. Decina P. Clinical Practice Guideline for the Management of Headache Disorders in Adults. Canadian Chiropractic Association and the Canadian Federation of Chiropractic Regulatory and Education Accrediting Boards 2012.

Fleming R, Forsythe S, Cook C. Influential Variables Associated with Outcomes in Patients with Cervicogenic Headache. J Man Manip Ther 2007; 15(3): 155-64. http://dx.doi.org/10.1179/106698107790819846

Hall T, Chan HT, Christensen L, Odenthal B, Wells C, Robinson K. Efficacy of a C1-C2 Self-sustained Natural Apophyseal Glide (SNAG) in the Management of Cervicogenic Headache. J Orthop Sports Phys Ther 2007; 37(3): 101-07. http://dx.doi.org/10.2519/jospt.2007.2379

Schoensee SK, Jensen G, Nicholson G, Gossman M, Katholi C. The effects of mobilizations on cervical headache. J Orthop Sports Phys Ther 1995; 21(4): 184-96. http://dx.doi.org/10.2519/jospt.1995.21.4.184

Ylinen J, Nikander R, Nykänen M, Kautiainen H, Häkkinen A. Effect of neck exercises on cervicogenic headache: a randomized controlled trial. J Rehabil Med 2010; 42(1): 344-49. http://dx.doi.org/10.2340/16501977-0527

Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine 2002; 27: 1835-1843. http://dx.doi.org/10.1097/00007632-200209010-00004

Jensen OK, Nielsen FF, Vosmar L. An open study comparing manual therapy with the use of cold packs in the treatment of post-traumatic headache. Cephalalgia 1990; 10: 241-250. http://dx.doi.org/10.1046/j.1468-2982.1990.1005241.x

Nilsson N, Christensen HW, Hartvigsen J. The effect of spinal manipulation in the treatment of cervicogenic headache. J Manipulative Physiol Ther 1997; 20: 326-330.

Zito G, Jull G, Story I. Clinical tests of musculoskeletal dysfunction in the diagnosis of cervicogenic headache. Man Ther 2006; 11: 118-129. http://dx.doi.org/10.1016/j.math.2005.04.007

Hall T, Robinson K. The flexion-rotation test and active cervical mobility: A comparative measurement study in cervicogenic headache. Man Ther 2004; 9: 197-202. http://dx.doi.org/10.1016/j.math.2004.04.004

Dvorak J, Antinnes JA, Panjabi M, Loustalot D, Bonomo M. Age- and gender-related normal motion of the cervical spine. Spine 1992; 17(Suppl 10): 393-398. http://dx.doi.org/10.1097/00007632-199210001-00009

Wright A. Hypoalgesia post-manipulative therapy: a review of a potential neurophysiological mechanism. Man Ther 1995; 1: 11-16. http://dx.doi.org/10.1054/math.1995.0244

Sterling M, Jull G, Wright A. Cervical mobilisation: concurrent effects on pain, sympathetic nervous system activity and motor activity. Man Ther 2001; 6: 72-81. http://dx.doi.org/10.1054/math.2000.0378

Vicenzino B, Collins D, Benson H, Wright A. An investigation of the interrelationship between manipulative therapy-induced hypoalgesia and sympathoexcitation. J Manipulative Physiol Ther 1998; 21: 448-453.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Copyright (c) 2014 Muhammad Khan, Syed Shahzad Ali, Rabail Rani Soomro