Effects of SNAG mobilization combined with a self-SNAG home-exercise for the treatment of cervicogenic headache: a pilot study

Abstract

Introduction: Cervicogenic headache (CGH) may originate from the C1-C2 zygapophyseal joints. CGH is often associated with loss of range of motion (ROM), specific to this segment, and measurable by the cervical flexion-rotation test (CFRT). The main purposes of the study were: 1) to investigate the immediate effect of C1-C2 rotation SNAG mobilizations plus C1-C2 self-SNAG rotation exercise for patients with CGH and 2) to explore the link between the CFRT results and treatment response.

Methods: A prospective quasi-experimental single-arm design was used where patients with CGH received eight physical therapy treatments using a C1-C2 rotational SNAG technique combined with a C1-C2 self-SNAG rotation exercise over a four-week period. Outcome measures were pain intensity/frequency and duration, active cervical ROM, CFRT, neck-related and headache-related self-perceived physical function, fear-avoidance beliefs, pain catastrophizing and kinesiophobia.

Results: The intervention produced strong effects on pain intensity, CFRT, physical function and pain catastrophizing. Moderate improvement was noted on active cervical ROM and on fear-avoidance beliefs and kinesiophobia. No link was found between pre-intervention CFRT ROM and treatment response.

Conclusion: SNAG mobilization combined with a self-SNAG exercise resulted in favorable outcomes for the treatment of CGH on patient-important and biomechanical outcomes, as well as pain-related cognitive-affective factors.

Keywords: Cervicogenic headache; cervical flexion-rotation test; mobilization with movement; mulligan; snag.

Conflict of interest statement

No potential conflict of interest was reported by the authors.

Figures

Figure 1.

Figure 2.

Flowchart

Figure 3.

a. Pain intensity over time during the intervention period (expressed in median (IQR)), b. Headache frequency over time during the intervention period (expressed in median (IQR)), c. Headache duration over time during the intervention period (expressed in median (IQR))