Mulligan SNAG Versus Active Release Technique in Cervicogenic Headache

Cervicogenic headache is a form of secondary headache caused by dysfunction in the cervical spine. It is often associated with neck pain, restricted mobility, and limitations in daily activities. Manual therapy, combined with targeted exercises, is frequently used in rehabilitation to reduce pain and improve neck function. This randomized controlled trial aims to compare the effectiveness of Mulligan mobilization with sustained natural apophyseal glides (SNAG) versus the Active Release Technique (ART) in the treatment of cervicogenic headache.

Group A - Mulligan Mobilization SNAG and Home Exercise:

Participants in this group will receive the Headache SNAG technique, which involves a gentle, sustained postero-anterior glide of the second cervical vertebra for 10 to 30 seconds to help reduce headache intensity. If relief is noted, up to six repetitions may be performed. In addition, each participant will be prescribed a home program consisting of C1-C2 self-SNAG rotation using a towel to apply pressure on the posterior arch of C1 during active cervical rotation. The exercise will be completed twice daily, with 10 repetitions per session. Written instructions will be given to ensure correct performance and better compliance.

Group B - Active Release Technique and Home Exercise Program:

Participants allocated to this group will receive the Active Release Technique (ART), a hands-on treatment aimed at releasing tight muscles and improving soft tissue mobility. During ART, controlled pressure is applied to specific muscles while the neck is moved to restore normal function and reduce discomfort. Target muscles include the pectoralis major, upper trapezius, levator scapulae, rhomboids, deep neck flexors, and serratus anterior.

The intervention will also include a structured exercise program designed to stretch and strengthen the neck and shoulder muscles, reduce tension, and enhance posture. Stretches will consist of sitting chair stretch, Brugger's stretch, wall angles, and doorway stretches. Strengthening activities such as the Kibler squeeze and head/neck retractions will also be incorporated. The home program will begin with gentle neck stretches, such as tilting the head toward one shoulder and holding the position for 20-30 seconds, repeating three times on each side. Chin tucks will be performed by gently retracting the chin without tilting the head, holding for 5 seconds, and repeating 10 times for 2-3 sets. These exercises aim to relieve muscle tightness, improve alignment, and help alleviate headache symptoms.

Inclusion criteria

• * Aged between 20-50 years

• Both Male and females
• Individuals diagnosed with neck pain accompanied by headaches.
• Individuals with Unilateral or Bilateral cervicogenic headache.
• Headache at least 3 times during the last 3 months.

Exclusion criteria

• * History of inflammatory disorders (e.g Rheumatoid Arthritis).

• History of trauma to the cervical region.
• History of Neurological conditions (myelopathy, radiculopathy or disc problems).
• Taking medications for headache.
• Pregnancy.