How Chiropractors Can Help Patients Conquer Headaches with SNAG Mobilizations
Headaches remain one of the most common reasons patients seek chiropractic care, and research continues to show that chiropractors play a key role in relieving them.
A 2025 network meta-analysis of over 1,200 patients confirmed that SNAG mobilizations (sustained natural apophyseal glides) are among the most effective conservative treatments for cervicogenic headaches (CGH). (1) These mobilizations help reduce headache frequency, improve cervical range of motion, and decrease associated disability, outperforming massage, general exercise, and even some alternative therapies.
This blog will summarize the latest research, demonstrate the most effective SNAG techniques, and show how to easily deliver these customized, research-backed exercises to your patients using ChiroUp.
Why SNAGs Matter for Cervicogenic Headaches
SNAG is a manual therapy technique developed by Brian Mulligan to improve cervical mobility and decrease pain. (2) Unlike passive mobilizations, SNAGs often involve active patient movement, making them ideal for at-home exercises and self-care programs.
What makes SNAGs effective?
Encourages pain-free cervical motion
Provides gentle overpressure at the end range
Targets restricted C1-C2 rotation, often responsible for CGH symptoms
Improves both pain and functional outcomes
Multiple randomized controlled trials and systematic reviews, including the 2025 meta-analysis, show that SNAGs outperform massage, exercise, and some traditional therapies for CGH. (1, 3-5)
Spinal Manipulation for Headaches & Migraines
While SNAGs are an effective tool, spinal manipulation remains a foundational treatment for headache patients. Here’s what the research says:
Cervicogenic Headaches
80% of chiropractors use <10 visits over 6-8 weeks for recent-onset headaches. (6)
6-8 SMT sessions deliver positive results for CGH. (7)
A major Spine Journal study found that SMT cuts symptomatic days in half, with a linear dose-response for improvement. (8)
Migraine Relief
A meta-analysis found that spinal manipulation reduces migraine days by about two per month when combined with usual medical care. (9)
A randomized controlled trial found that 22% of patients receiving spinal manipulation reported a greater than 90% reduction in migraine attacks after two months of care. (10)
By combining evidence-based spinal manipulation with targeted SNAG exercises, chiropractors can build comprehensive care plans for headache sufferers.
How to Perform the Two Most Effective SNAG Exercises
Headache SNAG
To perform the Headache SNAG, start by sitting or standing upright with good posture. Grasp a towel at both ends and position it behind your upper neck, just below the base of your skull. While gently pulling the towel forward, tuck your chin to create a “double chin” position. At the same time, imagine elongating your spine by “growing taller” through the top of your head. Hold this position for one second, then relax and return to the starting position.
SNAG Rotation (C1-C2 Focus)
For the SNAG rotation, begin seated or standing in a neutral, upright posture. Wrap a towel behind your neck, holding one end with the hand on your unaffected side at chest level. Rotate your head toward the side where you feel symptoms until you reach a restriction point. Then, gently overpressure with the towel to guide your head into slightly more rotation. Hold this position for one second before returning to the starting position.
Simplify Your Treatment Plans with ChiroUp
When it comes to headaches, chiropractors have powerful tools at their disposal. By combining spinal manipulation, targeted SNAG exercises, and customized care plans, you can help your headache patients get better, faster.
Want to make implementation easier?
With ChiroUp, you can create customized treatment plans and deliver them to your patients via print, email, or mobile app. See how in the interactive demo below!
Start streamlining your headache treatment plans with ChiroUp today!
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Xu X., Ling Y. Comparative safety and efficacy of manual therapy interventions for cervicogenic headache: a systematic review and network meta-analysis. Frontiers in Neurology. May 16, 2025;16:1566764. doi:10.3389/fneur.2025.1566764.
Mulligan BR: Mobilisations with movement and other techniques, 4th ed. Brühl: H. Müller-Frank, 1999, p 1145. Racicki S, Gerwin S, Diclaudio S, et al.: Conservative physical therapy management for the treatment of cervicogenic headache: a systematic review. J Manual Manip Ther, 2013, 21: 113–124.
De Pauw R, Dewitte V, de Hertogh W, Cnockaert E, Chys M, Cagnie B. Consensus among musculoskeletal experts for the management of patients with headache by physiotherapists? A delphi study. Musculoskelet Sci Pract. 2021 Jan 26;52:102325. doi: 10.1016/j.msksp.2021.102325. Epub ahead of print. PMID: 33548766.
Paquin JP, Tousignant-Laflamme Y, Dumas JP. Effects of SNAG mobilization combined with a self-SNAG home-exercise for the treatment of cervicogenic headache: a pilot study. J Man Manip Ther. 2021 Feb 5:1-11. doi: 10.1080/10669817.2020.1864960. Epub ahead of print. PMID: 33541242.
Mohamed AA, Shendy WS, Semary M, Mourad HS, Battecha KH, Soliman ES, Sayed SHE, Mohamed GI. Combined use of cervical headache snag and cervical snag half rotation techniques in the treatment of cervicogenic headache. J Phys Ther Sci.2019 Apr;31(4):376-381.
Moore C, Leaver A, Sibbritt D, Adams J. The management of common recurrent headaches by chiropractors: a descriptive analysis of a nationally representative survey. BMC Neurol. 2018;18(1):171. Published 2018 Oct 17.
Dunning JR, et al. Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC Musculoskelet Disord. 2016 Feb 6;17(1):64
Haas M. et al. Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial. Spine J. 2018 Feb 23.
Chaibi A, Russell MB. Spinal manipulative therapy for migraine: a systematic review and meta-analysis. Cephalalgia. 2017;37(5): 456-472. doi:10.1177/0333102416677029
Tuchin PJ, Pollard H, Bonello R. A randomized controlled trial of chiropractic spinal manipulative therapy for migraine. J Manipulative Physiol Ther. 2000 Oct;23(9):504-511. doi:10.1067/mmt.2000.110267