Effects of SNAGS Along With Thoracic Postural Correction Techniques in Patients With Chronic Cervicogenic Headache
Condition: Cervicogenic Headache
MeSH terms: Post-Traumatic Headache; Headache
Study type: Interventional

Summary: 
      The aim of this study is to find out the effects of Mulligan SNAGs along with thoracic
      postural correction techniques on patients with chronic cervicogenic headache. Patients
      suffering from cervicogenic headache are often associated with muscle imbalance. This study
      will be significant in determining the effects of SNAGs along with thoracic postural
      correction techniques to improve pain, level of disability and functional status in patients
      of cervicogenic headache.

      It will be Randomized controlled trial study design Data will be collected from Lady reading
      Hospital Peshawar Purposive sampling, group randomization using lottery method will be used
      in this study.
    

Detailed description: 
      Headaches are a common condition affecting 47% of the global population,1,2 with cervicogenic
      headaches (CGHs) accounting for 15-20% of all chronic and recurrent headaches. The
      International Headache Society has classified a cervicogenic headaches as a secondary
      headache with 'pain referred from a source in the neck and perceived in one or more regions
      of the head and/or face. In the case of cervicogenic headache, the cause is a disorder of the
      cervical spine and its component bone, disc and/or soft tissue elements. The term
      cervicogenic headache is commonly misused and does not simply apply to a headache associated
      with neck pain; many headache disorders, including migraine and tension-type headache, can
      have associated neck pain/tension. Rather, there must be evidence of a disorder or lesion
      within the cervical spine or soft tissues of the neck, known to be able to cause a headache
      (1). It is often worsened by neck movement, sustained awkward head position or external
      pressure over the upper cervical or occipital region the symptomatic side (2). The prevalence
      of Chronic headache has been reported to be between 0.4 and 20 % of the headache population
      (3). In recent years, there has been an increasing knowledge in the pathogenesis and better
      management of chronic headaches.

      Current scientific evidence supports the role of manual therapies in the management of
      tension type and cervicogenic headache (4). Individuals with Chronic headache are frequently
      treated with spinal manipulative therapy including both mobilization and manipulation. Spinal
      mobilization consists of slow, rhythmical, oscillating techniques (5) Cervical sustained
      natural apophyseal glides (SNAGs) are 'mobilization with movement' technique in which a
      sustained accessory facet glide is applied together with active physiological movement. The
      therapist may apply the glide over the spinous process (central SNAGs) or over the articular
      pillar on one side (unilateral SNAGs). SNAGs have been advocated for the treatment of neck
      pain and range of movement (ROM) restriction. SNAGs have been shown to be effective for the
      treatment of neck pain, cervicogenic headaches, and cervicogenic dizziness (6).mobilization
      with movement utilize the dual role of bot therapist force (accessory glides) and patient
      effort (active physiological or functional movement) and techniques are often carried out in
      a variety of weight bearing positions, with treatment belts, and either additional therapist,
      assistant or patient applied overpressure A thorough clinical examination is performed and
      appropriate level is identified, the glide is then performed parallel to the perceived facet
      plane and the degree of glide is determined by patient's active movement response (8). Many
      studies on the short-term effectiveness and manual therapy to the cervical spine
      (mobilization and manipulative therapy) have found it beneficial in reducing headache pain or
      disability, intensity, frequency, and duration.
    

Intervention name(s): sustained natural apophyseal glides; SNAGS with thoracic postural correction techniques
Intervention type(s): Other; Other
Intervention description(s): SNAGS will be applied in flexion, extension and rotation for a few seconds with 3 repetitions on the first day and 10 repetitions from the next visit.; thoracic extension in sitting, Wall angle stretch and Corner stretch, while the therapist-facilitated stretches will be seated mid-thoracic stretch and prone mid thoracic stretch. Stretches will be maintained for 15-20 seconds with 10 repetitions of each stretch per session
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: cervicogenic headache, thoracic posture correction, SNAGS