Original Article
The Relationship between Cervicogenic Headache and Impairment Determined by the Flexion-Rotation Test

https://doi.org/10.1016/j.jmpt.2010.09.002Get rights and content

Abstract

Objective

This study evaluates the association between probable cervicogenic headache (CGH) and associated headache symptoms and cervical spine impairment identified by the flexion-rotation test (FRT).

Methods

This was an observational study. Ninety-two subjects were evaluated, 72 with probable CGH and 20 who were asymptomatic. Headache symptoms were evaluated by questionnaire. A single blind examiner conducted the FRT, reporting the test state (positive or negative) before measuring range of motion (ROM). Fifteen subjects reported headache during testing and were subsequently retested when pain-free. A paired t test was used to determine whether FRT mobility to the most restricted side differed when the subject was experiencing headache. Univariate linear regression analysis and multiple regression analysis were used to examine the relationship between subject and headache characteristics, and range of motion during the FRT. Logistic regression analysis was used to examine relationships between subject and headache characteristics and whether the FRT was positive or negative.

Results

Mean ROM was significantly reduced (P < .01) by 6° in the presence of headache, but this did not influence test interpretation. Regression analysis revealed that half the variance in FRT ROM was explained by an index of headache severity or component parts but not by other headache characteristics.

Conclusions

These findings indicate a relationship between cervical movement impairment and the presence and severity of CGH.

Section snippets

Methods

In this observational study, the relationship between the presence and severity of CGH symptoms or associated factors and FRT mobility and examiner interpretation of the FRT was investigated. The Curtin University Human Research Ethics Committee approved this study. Written informed consent was obtained before the study commencement and subjects were able to withdraw at any time.

Results

Of 154 subjects screened for headache, 82 were rejected for the following reasons; 5 constant headache, 10 no associated neck pain, and 67 with diagnostic features of tension type headache or migraine. Accordingly, 72 subjects with CGH (20 males; mean age, 39 years; range, 21-66 years; SD, 12.8 years) and 20 without neck pain or CGH (age, 35 years; range, 22-61 years; SD, 9.2 years) were evaluated and completed this study.

The headache characteristics of the 72 headache subjects are presented in

Discussion

This is the first study to examine in subjects with CGH the relationship between the presence and severity of headache symptoms and the FRT. The study findings of a clear association between range of motion and headache severity, frequency, and duration, together with lack of association with other headache symptoms, and stability of the test in the presence of pain, will assist clinicians to refine and better interpret the FRT. Values recorded during the FRT were similar to previous reports

Conclusions

Subjects with CGH demonstrated an inverse relationship between an index of headache severity and range of motion measures taken during the FRT. Furthermore, headache frequency, intensity, and duration were the most significant predictors of range of motion measured by the FRT. Although the presence of headache during testing significantly reduces range during the FRT by 6°, it does not influence identification of a positive test. It does however suggest caution is warranted when using the FRT

Funding Sources and Potential Conflicts of Interest

No funding was used for this study. Three of the authors of this article (KB, KWR, TMH) provide postgraduate education for physiotherapists for which they receive a teaching fee.

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