Smartphone Addiction in Cervicogenic Headache

Smartphone Addiction as a Modifiable Factor in Cervicogenic Headache: Effects on Pain, Function, Mood, and Sleep

Cervicogenic headache is a secondary headache disorder that originates from the cervical spine and often presents with pain radiating from the neck to the head, reduced functional capacity, and impaired quality of life. In modern society, prolonged smartphone use and dependence are increasingly recognized as potential contributors to musculoskeletal problems, poor posture, psychological distress, and sleep disturbances.

This study was designed as a case-control investigation to explore the relationship between smartphone addiction (problematic smartphone use) and clinical characteristics of cervicogenic headache in comparison with healthy individuals. Participants were evaluated in the outpatient clinics of Physical Medicine and Rehabilitation and Neurology at Yozgat Bozok University.

A structured sociodemographic form was administered, and each participant completed a set of validated assessment tools. Smartphone use behavior was assessed with the Smartphone Addiction Scale-Short Form. Headache-related disability was measured with the Headache Impact Test. Cervical function was evaluated with the Neck Disability Index. Psychological status was assessed using the Hospital Anxiety and Depression Scale. Sleep quality was examined with the Jenkins Sleep Scale. Health-related quality of life was measured using the 12-item Short Form Health Survey, and pain intensity was evaluated with the Visual Analog Scale.

The study was conducted in accordance with the Declaration of Helsinki. Approval was obtained from the Clinical Research Ethics Committee, and written informed consent was provided by all participants prior to enrollment.

Study Overview

• Status: Completed
• Conditions: Cervicogenic Headache; Smartphone Addiction

Detailed Description

Cervicogenic headache is a secondary headache that arises from dysfunction or pathology of the cervical spine and associated structures. It is characterized by unilateral head and neck pain, which may radiate to the frontal or temporal regions and is often aggravated by neck movements. Cervicogenic headache is known to cause substantial functional disability, emotional distress, and reduced quality of life.

With the rapid increase in smartphone use worldwide, attention has been drawn to its possible musculoskeletal and psychological consequences. Prolonged forward head posture, repetitive neck movements, and excessive screen time may contribute to cervical dysfunction and exacerbate symptoms of cervicogenic headache. In addition, behavioral dependence on smartphones has been associated with mood disorders, sleep disturbances, and impaired daily functioning. Understanding the potential role of smartphone addiction as a modifiable factor in cervicogenic headache is therefore of clinical importance.

The present study was designed as a case-control observational protocol to investigate the association between smartphone addiction and clinical outcomes in individuals with cervicogenic headache compared with healthy controls. Data were collected in the outpatient clinics of Physical Medicine and Rehabilitation and Neurology at Yozgat Bozok University.

A standardized sociodemographic form was administered, followed by a comprehensive set of validated assessment instruments. These included the Smartphone Addiction Scale-Short Form to evaluate problematic smartphone use, the Headache Impact Test to measure the burden of headaches on daily life, the Neck Disability Index to assess functional limitations related to cervical spine disorders, the Hospital Anxiety and Depression Scale to screen for symptoms of anxiety and depression, the Jenkins Sleep Scale to evaluate sleep quality and disturbances, the 12-item Short Form Health Survey to assess physical and mental aspects of health-related quality of life, and the Visual Analog Scale to record the intensity of pain.

All assessments were performed face-to-face by trained professionals in a clinical setting. The study protocol was approved by the Clinical Research Ethics Committee. Written informed consent was obtained from each participant before enrollment, and all procedures were carried out in accordance with the principles of the Declaration of Helsinki.

• Study Type: Observational
• Enrollment (Actual): 78

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Yozgat
    • Yozgat, Yozgat, Turkey (Türkiye), 66100
      • Yozgat Bozok University Faculty of Medicine, Department of Physical Medicine and Rehabilitation

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Patients diagnosed with cervicogenic headache according to the International Classification of Headache Disorders, third edition, confirmed by a neurologist, were recruited from the outpatient clinics of the Departments of Physical Medicine and Rehabilitation and Neurology at Yozgat Bozok University. Age- and sex-matched healthy volunteers were recruited from the same community.

Description

Inclusion Criteria:

Adults aged 18-65 years

Literate and cognitively capable of completing questionnaires

Willing to participate and provide written informed consent

For the patient group: Diagnosis of cervicogenic headache based on the International Classification of Headache Disorders, third edition, confirmed by a neurologist

For the control group: Healthy volunteers with no known medical conditions or active complaints, age- and sex-matched with patients

Exclusion Criteria:

Comorbidities that may affect pain perception or mood, including diabetes mellitus, thyroid dysfunction, malignancy, chronic kidney disease, neurological diseases associated with neuropathic pain, rheumatoid arthritis, ankylosing spondylitis, or fibromyalgia

Illiteracy or impaired communication

Current use of medications that may interfere with outcome measures

Withdrawal of consent at any stage

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Cervicogenic Headache Group; Adults between 18 and 65 years of age diagnosed with cervicogenic headache based on the International Classification of Headache Disorders, third edition were eligible for inclusion. Exclusion criteria included systemic diseases such as diabetes mellitus, thyroid disorders, chronic kidney disease, malignancy, neurological conditions associated with neuropathic pain, and rheumatic diseases including rheumatoid arthritis, ankylosing spondylitis, or fibromyalgia. Participants with communication difficulties, illiteracy, or those who declined participation were also excluded.
Healthy Control Group; Age- and sex-matched adults without cervicogenic headache or other chronic medical conditions served as controls. Controls were between 18 and 65 years of age, cognitively intact, literate, and willing to participate. Exclusion criteria were the same as for the cervicogenic headache group, including systemic, neurological, or rheumatological diseases, illiteracy, or refusal to participate.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Smartphone Addiction Scale - Short Form	Ten-item self-report questionnaire scored on a six-point Likert scale ranging from 1 to 6. The total score ranges from 10 to 60, with higher scores indicating a greater risk of smartphone addiction. Sex-specific cut-off values are 31 or higher for males and 33 or higher for females. A Turkish validated version is available.	At baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Headache Impact Test with 6 items	Patient-reported questionnaire assessing the impact of headache on pain, vitality, role limitations, and emotional function. Each of the six items is scored from 6 to 13, producing a total score between 36 and 78. Higher scores indicate a greater negative impact of headache. A Turkish validated version is available.	At baseline
Neck Disability Index	Self-reported questionnaire with ten items scored from 0 to 5. The total score is converted into a percentage ranging from 0 to 100 percent. Higher percentages indicate greater disability related to neck pain. A Turkish validated version is available.	At baseline
Hospital Anxiety and Depression Scale	Fourteen-item questionnaire with two subscales assessing anxiety and depression, each scored from 0 to 21. Higher scores indicate more severe symptoms. Cut-off scores are defined as 0 to 7 for normal, 8 to 10 for mild, 11 to 14 for moderate, and 15 to 21 for severe symptoms. A Turkish validated version is available.	At baseline
Jenkins Sleep Scale	Four-item questionnaire assessing sleep quality and sleep disturbances. The total score ranges from 0 to 20, with higher scores indicating poorer sleep quality. A score greater than 15 indicates clinically relevant poor sleep. A Turkish validated version is available.	At baseline
Short Form-12 Health Survey	Twelve-item questionnaire assessing physical and mental components of health-related quality of life. It provides physical and mental component scores scaled from 0 to 100, with higher scores indicating better perceived quality of life. A Turkish validated version is available	At baseline

Collaborators and Investigators

• Sponsor: Gulseren Demir Karakilic
• Investigators: Principal Investigator: Gülseren Demir Karakılıç, Yozgat Bozok University

Publications and helpful links

General Publications

• Telci EA, Karaduman A, Yakut Y, Aras B, Simsek IE, Yagli N. The cultural adaptation, reliability, and validity of neck disability index in patients with neck pain: a Turkish version study. Spine (Phila Pa 1976). 2009 Jul 15;34(16):1732-5. doi: 10.1097/BRS.0b013e3181ac9055.
• Soylu C, Kutuk B. Reliability and Validity of the Turkish Version of SF-12 Health Survey. Turk Psikiyatri Derg. 2022 Summer;33(2):108-117. doi: 10.5080/u25700. English, Turkish.
• Dikmen PY, Bozdag M, Gunes M, Kosak S, Tasdelen B, Uluduz D, Ozge A. Reliability and Validity of Turkish Version of Headache Impact Test (HIT-6) in Patients with Migraine. Noro Psikiyatr Ars. 2020 Apr 24;58(4):300-307. doi: 10.29399/npa.24956. eCollection 2021.
• Aydemir, O., Hastane anksiyete ve depresyon olcegi Turkce formunun gecerlilik ve guvenilirligi. Turk Psikiyatri Derg., 1997. 8: p. 187-280.
• NOYAN, C.O., et al., Akıllı Telefon Bağımlılığı Ölçeğinin Kısa Formunun üniversite öğrencilerindeTürkçe geçerlilik ve güvenilirlik çalışması. Anatolian Journal of Psychiatry/Anadolu Psikiyatri Dergisi, 2015. 16.
• Duruoz MT, Erdem D, Gencer K, Ulutatar F, Baklacioglu HS. Validity and reliability of the Turkish version of the Jenkins Sleep Scale in psoriatic arthritis. Rheumatol Int. 2018 Feb;38(2):261-265. doi: 10.1007/s00296-017-3911-2. Epub 2017 Dec 18.

Study record dates

Study Major Dates

• Study Start (Actual): June 19, 2025
• Primary Completion (Actual): October 3, 2025
• Study Completion (Actual): October 3, 2025

Study Registration Dates

• First Submitted: December 5, 2025
• First Submitted That Met QC Criteria: December 5, 2025
• First Posted (Estimated): December 18, 2025

Study Record Updates

• Last Update Posted (Actual): December 29, 2025
• Last Update Submitted That Met QC Criteria: December 20, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: Quality of Life; Sleep Disturbance; Neck Disability; Anxiety and Depression; Headache Impact; Smartphone Use
• Additional Relevant MeSH Terms: Technology Addiction; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Mental Disorders; Behavioral Symptoms; Headache Disorders; Sleep Wake Disorders; Behavior, Addictive; Compulsive Behavior; Impulsive Behavior; Headache Disorders, Secondary; Behavior; Internet Addiction Disorder; Anxiety Disorders; Parasomnias; Depression; Post-Traumatic Headache
• Other Study ID Numbers: 2025-GOKAEK-2512_2025.06.18_50

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: De-identified individual participant data collected for this study, including questionnaire scores and demographic variables, will be available upon reasonable request.
• IPD Sharing Time Frame: The datasets will be available beginning 6 months after publication of the study results and will remain accessible for 5 years thereafter.
• IPD Sharing Access Criteria: Researchers who provide a methodologically sound proposal may request access to the de-identified datasets. Data will be shared after approval of the proposal and signing of a data access agreement. Requests should be directed to the corresponding author via the institutional email address.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF

Drug and device information, study documents

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