Cervicospinal Posture and Pain in Cervicogenic Headache

Is it Possible to Distinguish Cervicogenic Headache From Neck Pain With Cervicospinal Posture?: A Single-blind, Prospective Cross-sectional Trial

Cervicogenic headache (CEH) is a type of symptomatic headache that is characterized by chronic unilateral headache secondary to cervical spine dysfunction. Generally, it gets worse by neck movements, continuous placement of the head in an awkward position and exposure to external pressure on the upper cervical or occipital region.

The pain was demonstrated to originate from lower cervical disc prolapse and spinal nerve roots in some studies, while it is suggested in some others to occur due to the upper cervical region as well. Although disturbed cervical alignment has been determined in tension headache and migraine, there are few studies with controversial results in the literature investigating the effects of the change in cervical lordosis on CEH. These contradictory results strongly influence the decision of whether exercise should be added to the treatment protocol in CEH and also the creation of an appropriate treatment program by the clinicians. In light of this background, the aim of this study was to compare the cervical radiographs of patients with CEH and patients with neck pain without a headache.

Study Overview

• Status: Completed
• Conditions: Neck Pain; Cervicogenic Headache
• Intervention / Treatment: Diagnostic test: Lateral radiography

Detailed Description

The general demographics, pain status and cervical radiological evaluations of the patients was performed in this prospective, cross-sectional, single-blind study evaluating two different disease groups compatible in age and gender and the two groups were compared.

For inclusion in the Cervicogenic Headache group, inclusion criteria determined by the Cervicogenic Headache International Study Group (CHISG) were used.

Symptoms of all patients were questioned in detail and physical examinations were performed. After obtaining demographic information such as age, height and weight, severity and duration of pain were asked to the patients and Neck Disability Index (NDI) and Visual Analogue Scale (VAS) were used for pain assessment Cervical radiographic analysis was evaluated measuring general cervical lordosis and upper cervical lordosis on lateral standing X-rays using Surgimap®. General cervical lordosis and Upper cervical lordosis measurements were performed on the lateral cervical graph.

• Study Type: Observational
• Enrollment (Actual): 90

Contacts and Locations

Study Locations

• Turkey
  • Çorum, Turkey, 19000
    • Hitit University Erol Olcok Training and Research Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 50 years (ADULT)
• Accepts Healthy Volunteers: N/A
• Genders Eligible for Study: Female

• Sampling Method: Probability Sample

Study Population

It was included 45 women with cervicogenic headaches with an age of 18-50 years and 45 women with only neck pain in the same ages who presented to the Neurosurgery outpatient clinic.

Description

Inclusion Criteria:

For Cervicogenic headache group

• Unilateral headache, starting from the upper neck/occipital region and spreading to the oculofrontotemporal area on the symptomatic side
• Pain triggered by neck movements and/or continuous awkward positions
• Decreased joint range of motion in the cervical vertebra

Exclusion Criteria:

For Cervicogenic headache group

• Previously diagnosed to have any other syndromes of headache (Migraine, Tension headache, etc.)
• Presence of bilateral headache; For the neck pain group,
• Presence of 2 or more neurological symptoms (decreased upper extremity muscle strength, decreased reflexes and hypoesthesia compatible with the dermatome regions)
• Suggesting nerve root compression (radiculopathy, plexopathy); for both groups,
• Presence of any signs suspicious of central nervous system involvement (hyperreflexia, nystagmus, decreased vision, etc)
• Reluctance to participate in the study.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Cervicogenic headache; The group with cervicogenic headaches	Diagnostic test: Lateral radiography; The lordosis angles were measured on the lateral cervical graphs of all patients.
Neck pain; The group with isolated neck pain	Diagnostic test: Lateral radiography; The lordosis angles were measured on the lateral cervical graphs of all patients.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
General cervical lordosis	General cervical lordosis is basically measured by the "Cobb" method. In the lateral graph, the angle between the two lines drawn perpendicular to the lines passing on the inferior end plate of the C2 and C7 vertebrae is considered as the "General cervical lordosis angle".	3 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Upper cervical lordosis	For the measurement of upper cervical lordosis, a line is drawn from the uppermost posterior point of the odontoid process to the lowermost posterior point of C2. The second line is drawn to pass between the lowermost-posterior portions of the C3 and C4 cervical vertebrae. The angle between these two lines is considered the "upper cervical lordosis angle"	3 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Neck disability index	The NDI is the most widely used questionnaire to investigate the disability associated with neck pain.	3 months
Visual analog scale	The VAS pain scale is used to measure and monitor pain severity.	3 months

Collaborators and Investigators

• Sponsor: Hitit University

Publications and helpful links

General Publications

• Dunning JR, Butts R, Mourad F, Young I, Fernandez-de-Las Penas C, Hagins M, Stanislawski T, Donley J, Buck D, Hooks TR, Cleland JA. 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;17:64. doi: 10.1186/s12891-016-0912-3.
• Farmer PK, Snodgrass SJ, Buxton AJ, Rivett DA. An investigation of cervical spinal posture in cervicogenic headache. Phys Ther. 2015 Feb;95(2):212-22. doi: 10.2522/ptj.20140073. Epub 2014 Oct 9.
• Knackstedt H, Krakenes J, Bansevicius D, Russell MB. Magnetic resonance imaging of craniovertebral structures: clinical significance in cervicogenic headaches. J Headache Pain. 2012 Jan;13(1):39-44. doi: 10.1007/s10194-011-0387-4. Epub 2011 Sep 27.

Study record dates

Study Major Dates

• Study Start (ACTUAL): March 20, 2019
• Primary Completion (ACTUAL): July 20, 2019
• Study Completion (ACTUAL): September 20, 2019

Study Registration Dates

• First Submitted: January 22, 2020
• First Submitted That Met QC Criteria: January 22, 2020
• First Posted (ACTUAL): January 27, 2020

Study Record Updates

• Last Update Posted (ACTUAL): January 27, 2020
• Last Update Submitted That Met QC Criteria: January 22, 2020
• Last Verified: January 1, 2020

More Information

Terms related to this study

• Keywords: Pain; Disability; Cervicogenic headache
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Pain; Neurologic Manifestations; Headache Disorders; Headache Disorders, Secondary; Neck Pain; Headache; Post-Traumatic Headache
• Other Study ID Numbers: 19-KAEK-064

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No