Cervicogenic HeadacheNCT07132047
Mulligan SNAG Versus Active Release Technique in Cervicogenic Headache
A study testing Mulligan Mobilization SNAG with Home Exercise and Active Release Technique with Home Exercise in people with Cervicogenic Headache, run by University of Lahore at 1 site in Pakistan.
Trial summary
This study is designed to compare two different manual therapy approaches for individuals with cervicogenic headaches, a type of headache that originates from the neck. Participants will be randomly assigned to one of two groups. Read more about this study
- Who is it for?
- Ages 20 to 50 years
- Conditions the study is for
- Cervicogenic Headache
- What is being tested?
- Mulligan Mobilization SNAG with Home Exercise and Active Release Technique with Home Exercise
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 72 participants
- Where
- 1 sitePakistan
- Study dates
- 1 Jul 2025to 29 Aug 2025
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 20 to 50 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- * 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.
Who cannot join
- * 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.
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Mulligan Mobilization Sustained Natural Apophyseal Glide Versus Active Release Technique in Cervicogenic Headache
This study is designed to compare two different manual therapy approaches for individuals with cervicogenic headaches, a type of headache that originates from the neck. Participants will be randomly assigned to one of two groups.
The first group will receive Mulligan mobilization using sustained natural apophyseal glides (SNAG) along with a home program of Mobilization self-SNAG exercises.
The second group will receive the Active Release Technique (ART) combined with a home program of stretching and strengthening exercises for the neck and shoulder muscles. Each participant will attend treatment sessions three times per week for four weeks. Pain levels, headache impact, and neck function will be evaluated at the start, after four weeks of treatment, and again at eight weeks to determine which method provides better outcomes.
Read the detailed description
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.
- Conditions
- Cervicogenic Headache
- Being tested
- Mulligan Mobilization SNAG with Home Exercise, Active Release Technique with Home Exercise
- Keywords
- Mulligan mobilization, Active release Technique, Cervicogenic headache, physiotherapy, Neck pain, Manual therapy, Sustained natural apophyseal glide SNAG, range of motion, Articular
- Medical subject headings
- Post-Traumatic Headache, Neck Pain
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Mulligan Mobilization SNAG with Home ExerciseOther
Also called Mulligan Mobilization SNAG, Self-SNAG Exercise Program
This intervention combines manual mobilization and self-exercise. The therapist applies sustained postero-anterior glides to the second cervical vertebra for 10-30 seconds, up to six repetitions if pain decreases. The home program involves C1-C2 self-SNAG with a towel, maintaining end-range rotation for 10 seconds before returning to neutral. Exercises are completed twice daily for 10 repetitions each session. Participants receive illustrated instructions to promote correct execution and compliance.
Active Release Technique with Home ExerciseOther
Also called Active Release Technique with Cervical and Shoulder Exercise Program, Soft Tissue Release and Postural Exercise
This approach integrates manual soft tissue release with targeted exercise. ART is applied to the neck and shoulder region, focusing on pectoralis major, upper trapezius, and levator scapulae. Exercises include wall angles, doorway stretches, Brugger's stretch, and head/neck retractions. Strengthening activities target rhomboids, deep neck flexors, and serratus anterior. The home routine consists of neck stretches, chin tucks, and postural drills, performed regularly to enhance muscle balance, posture, and headache relief.
| Study group | Role | What they receive |
|---|---|---|
| 1. Mulligan Mobilization SNAG with Home Exercise | Experimental | Participants in this arm will receive Headache SNAG Mulligan mobilization, a postero-anterior mobilization of the second cervical vertebra sustained for 10-30 seconds to reduce headache intensity. A maximum of six repetitions will be performed if headache reduction occurs during the first application. In addition, participants will follow a home exercise program consisting of C1-C2 self-SNAG in rotation using a towel to apply pressure to the posterior arch of C1 while actively rotating the cervical spine. Each position will be held for 10 seconds and repeated 10 times twice daily. Written instructions will be provided to ensure compliance. Receives: Other: Mulligan Mobilization SNAG with Home Exercise |
| Active Release Technique with Home Exercise | Experimental | Participants will receive Active Release Technique (ART) targeting neck and shoulder soft tissues. The program includes sitting chair stretch, Brugger's stretch, wall angles, and doorway stretches for pectoralis major, upper trapezius, and levator scapulae. Additional movements include head and neck retractions and strengthening of rhomboids, deep neck flexors, and serratus anterior through the Kibler squeeze. A home program of neck stretches hold 20 to 30 sec, 3 times and chin tucks hold 5 sec, 10 times for 2 to 3 sets. posture-improving exercises will be performed to relieve tension, improve alignment, and lessen headache symptoms. Receives: Other: Active Release Technique with Home Exercise |
What is being measured
The primary outcome is the main question the study is designed to answer.
Neck Disability Index (NDI) score
The purpose of the Neck Disability Index (NDI) questionnaire is to gather data on how your neck pain has impacted your capacity to function in daily life. The NDI is divided into ten categories, each of which is rated from 0 to 5, where 5 represents "worst imaginable pain" and 0 represents "no pain". The sum of the points determines the final score, with 0 denoting no activity constraints and 50, or 100%, denoting entire activity limitations.
Measured: Baseline, 4 weeks, and 8 weeks after start of intervention
Secondary outcomes (2)
Numeric Pain Rating Scale (NPRS) score.
In the segmented numerical version of the NPRS, a respondent chooses a whole number (0-10 integers) that most accurately represents the level of pain they are experiencing. A horizontal bar or line is the standard format. It takes less than a minute to finish the NPRS. Greater pain intensity is indicated by higher scores, which range from 0 to 10.
Measured: Baseline, 4 weeks, and 8 weeks after start of intervention
Headache Disability Index (HDI) score
The Henry Ford Hospital Headache Disability Inventory/Index (HDI) was created to measure how headaches affect day to day functioning. A 25-item headache questionnaire that was developed from the case history answers of individuals who had headaches was divided into functional and emotional subscales to evaluate how headaches and their management affected daily activities.
Measured: Baseline, 4 weeks, and 8 weeks after start of intervention
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted20 Aug 2025
- Study start1 Jul 2025
- Primary completion29 Aug 2025
- Study completion29 Aug 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Cervicogenic HeadacheStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 72 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Lahore
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07132047
- Sponsor's protocol ID
- UOL/IREB/25/09/0028
- Status last verified
- Aug 2025
- First submitted
- 12 Aug 2025
- Last updated
- 18 Nov 2025
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 18 Nov 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Mulligan Mobilization Sustained Natural Apophyseal Glide Versus Active Release Technique in Cervicogenic Headache
- ClinicalTrials.gov ID
- NCT07132047
- Acronym / sponsor ID
- UOL/IREB/25/09/0028
- Conditions
- Cervicogenic Headache
- Keywords
- Mulligan mobilization, Active release Technique, Cervicogenic headache, physiotherapy, Neck pain, Manual therapy, Sustained natural apophyseal glide SNAG, range of motion, Articular
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 72 participants (actual)
- Lead sponsor
- University of LahoreUniversity, hospital or other
- Study start
- 1 Jul 2025 (actual)
- Primary completion
- 29 Aug 2025 (actual)
- Study completion
- 29 Aug 2025 (actual)
- First posted
- 20 Aug 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study is designed to compare two different manual therapy approaches for individuals with cervicogenic headaches, a type of headache that originates from the neck. Participants will be randomly assigned to one of two groups.
The first group will receive Mulligan mobilization using sustained natural apophyseal glides (SNAG) along with a home program of Mobilization self-SNAG exercises.
The second group will receive the Active Release Technique (ART) combined with a home program of stretching and strengthening exercises for the neck and shoulder muscles. Each participant will attend treatment sessions three times per week for four weeks. Pain levels, headache impact, and neck function will be evaluated at the start, after four weeks of treatment, and again at eight weeks to determine which method provides better outcomes.
Detailed description
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.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| 1. Mulligan Mobilization SNAG with Home Exercise | Experimental | Other: Mulligan Mobilization SNAG with Home ExerciseParticipants in this arm will receive Headache SNAG Mulligan mobilization, a postero-anterior mobilization of the second cervical vertebra sustained for 10-30 seconds to reduce headache intensity. A maximum of six repetitions will be performed if headache reduction occurs during the first application. In addition, participants will follow a home exercise program consisting of C1-C2 self-SNAG in rotation using a towel to apply pressure to the posterior arch of C1 while actively rotating the cervical spine. Each position will be held for 10 seconds and repeated 10 times twice daily. Written instructions will be provided to ensure compliance. |
| Active Release Technique with Home Exercise | Experimental | Other: Active Release Technique with Home ExerciseParticipants will receive Active Release Technique (ART) targeting neck and shoulder soft tissues. The program includes sitting chair stretch, Brugger's stretch, wall angles, and doorway stretches for pectoralis major, upper trapezius, and levator scapulae. Additional movements include head and neck retractions and strengthening of rhomboids, deep neck flexors, and serratus anterior through the Kibler squeeze. A home program of neck stretches hold 20 to 30 sec, 3 times and chin tucks hold 5 sec, 10 times for 2 to 3 sets. posture-improving exercises will be performed to relieve tension, improve alignment, and lessen headache symptoms. |
Who may qualify
- Ages
- 20 to 50 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (5 listed)
- * Aged between 20-50 years
Key exclusion criteria (5 listed)
- * History of inflammatory disorders (e.g Rheumatoid Arthritis).
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Mulligan Mobilization SNAG with Home ExerciseAlso: Mulligan Mobilization SNAG, Self-SNAG Exercise ProgramThis intervention combines manual mobilization and self-exercise. The therapist applies sustained postero-anterior glides to the second cervical vertebra for 10-30 seconds, up to six repetitions if pain decreases. The home program involves C1-C2 self-SNAG with a towel, maintaining end-range rotation for 10 seconds before returning to neutral. Exercises are completed twice daily for 10 repetitions each session. Participants receive illustrated instructions to promote correct execution and compliance. | Other | 1. Mulligan Mobilization SNAG with Home Exercise |
| Active Release Technique with Home ExerciseAlso: Active Release Technique with Cervical and Shoulder Exercise Program, Soft Tissue Release and Postural ExerciseThis approach integrates manual soft tissue release with targeted exercise. ART is applied to the neck and shoulder region, focusing on pectoralis major, upper trapezius, and levator scapulae. Exercises include wall angles, doorway stretches, Brugger's stretch, and head/neck retractions. Strengthening activities target rhomboids, deep neck flexors, and serratus anterior. The home routine consists of neck stretches, chin tucks, and postural drills, performed regularly to enhance muscle balance, posture, and headache relief. | Other | Active Release Technique with Home Exercise |
Primary outcome
Neck Disability Index (NDI) score
Time frame: Baseline, 4 weeks, and 8 weeks after start of intervention
The purpose of the Neck Disability Index (NDI) questionnaire is to gather data on how your neck pain has impacted your capacity to function in daily life. The NDI is divided into ten categories, each of which is rated from 0 to 5, where 5 represents "worst imaginable pain" and 0 represents "no pain". The sum of the points determines the final score, with 0 denoting no activity constraints and 50, or 100%, denoting entire activity limitations.
2 secondary outcomes
Numeric Pain Rating Scale (NPRS) score.
Time frame: Baseline, 4 weeks, and 8 weeks after start of intervention
Headache Disability Index (HDI) score
Time frame: Baseline, 4 weeks, and 8 weeks after start of intervention
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 18 Nov 2025.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Mulligan Mobilization SNAG with Home Exercise and Active Release Technique with Home Exercise in people with Cervicogenic Headache, run by University of Lahore at 1 site in Pakistan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 18 Nov 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Neck Disability Index (NDI) score (time frame: Baseline, 4 weeks, and 8 weeks after start of intervention). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Nov 2025.