Effects of Sustained Natural Apophyseal Glides Along With Thoracic Postural Correction Techniques in Patients With Chronic Cervicogenic Headache

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.