title: The Prevalence of Cervicogenic Headache in a Random Population Sample of 20–59 Year Olds Intertester reliability and diagnostic validity of the cervical flexion-rotation test. The flexion-rotation test and active cervical mobility--a comparative measurement study in cervicogenic headache. Clinical tests of musculoskeletal dysfunction in the diagnosis of cervicogenic headache. Reinvestigation of the dysfunction in neck and shoulder girdle muscles as the reason of cervicogenic headache among office workers
abstract: Study Design From a r and om population sample , those experiencing frequent headaches were identified . They were examined to determine how many fulfilled the 1990 international Headache Society classification criteria for cervicogenic headache . Objective To estimate the prevalence of cervicogenic headache in the general population and in the group experiencing frequent headaches . Summary of Background Data Only with the publication of the 1990 headache classification criteria did a generally accepted clinical definition of cervicogenic headache emerge . The prevaience of this form of headache has been estimated only in two highly selected in-clinic patient population s. No data exist regading the prevalence in representative unselected population s. Methods . A short question naire on headaches  was mailed to 826 r and omly selected residents of a midsized Danish town . A group of 57 individuale in the age range 20–59 years who reported having headache episodes on 5 or more days in the previous month were identified . Forty-five of the 57 were eventually interviewed and examined with respect to the IHS criteria for cervicogenic headache ( the radiological criteria were omitted on ethical grounds ) . Results Of the 45 persons examined , eight fulfilled the diagnostic criteria for cervicogenic headache , equivalent to a prevalence in the headache group of 17.8 % ( 95 % confidence interval = 8%-32 % ) . Conclusions Cervicogenic headache appears to be a relatively common form of headache , similar to migraine in prevaience OBJECTIVE This article evaluates reliability and diagnostic validity of the cervical flexion-rotation test ( FRT ) to discriminate subjects with headache because of C1/2 dysfunction . In addition , this study evaluates agreement between experienced and inexperienced examiners . METHODS These were 2 single blind comparative measurement study design s. In study 1 , 2 experienced blinded examiners evaluated the FRT in 10 asymptomatic controls , 20 subjects with cervicogenic headache ( CeH ) where C1/2 was the primary dysfunctional level , and 10 subjects with CeH but without C1/2 as the primary dysfunctional level . In study 2 , 2 inexperienced and 1 experienced blinded examiners  evaluated the  FRT  in 12 subjects with CeH and 12 asymptomatic controls . Examiners were required to state whether the FRT was positive and also to determine range of rotation using a goniometer . An analysis of variance with planned orthogonal comparison , single measure intraclass correlation coefficient ( 2,1 ) , and Bl and -Altman plot were used to analyze FRT range of rotation between the examiners . Sensitivity , specificity , and examiner agreement for test interpretation were analyzed using cross tabulation and kappa . RESULTS In study 1 , sensitivity and specificity of the FRT was 90 % and 88 % with 92 % agreement for experienced examiners ( P < .001 ) . Overall diagnostic accuracy was 89 % ( P < .001 ) and kappa = 0.85 . In study 2 , for inexperienced examiners , FRT mobility was significantly greater than for experienced examiners , but sensitivity , specificity , agreement , and kappa values were all within clinical ly acceptable levels . CONCLUSIONS The FRT can be used accurately and reliably by inexperienced examiners and may be a useful aid in CeH evaluation A single blind , age and gender matched , comparative measurement study was design ed to assess  active range of cervical motion  and  passive range of rotation in cervical flexion  in asymptomatic and cervicogenic headache subjects . Both procedures are commonly used in clinical practice to evaluate patients with cervicogenic headache .  We studied 20 women and eight men with side dominant cervicogenic headache ( mean age 43.3 years ) matched with 28 asymptomatic subjects . Two experienced manipulative therapists , who were blind to each other 's measurement , noted active ranges of cervical motion  and passive cervical rotation  performed in the flexion-rotation test using the Cervical Range of Motion Device .  Headache severity was assessed by a question naire . Additionally , one therapist prior to neck motion assessment determined the dominant symptomatic cervical motion segment . Active cervical motion in each direction was identical between the cervicogenic and control groups . In contrast , average rotation in flexion was 44 degrees to each side in the asymptomatic group and 28 degrees towards the headache side in the symptomatic group . C1 - 2 was deemed to be the dominant segmental level of headache origin in 24 of 28 subjects . In those 24 subjects range of rotation during the flexion-rotation test was inversely correlated to headache severity Persistent intermittent headache is a common disorder and is often accompanied by neck aching or stiffness , which could infer a cervical contribution to headache . However , the incidence of cervicogenic headache is estimated to be 14 - 18 % of all chronic headaches , highlighting the need for clear criterion of cervical musculoskeletal impairment to identify cervicogenic headache sufferers who may benefit from treatments such as manual therapy . This study examined the presence of cervical musculoskeletal impairment in 77 subjects , 27 with cervicogenic headache , 25 with migraine with aura and 25 control subjects . Assessment s included a  photographic measure of posture , range of movement , cervical manual examination , pressure pain thresholds , muscle length , performance in the cranio-cervical flexion test and cervical kinaesthetic sense .  The results indicated that when compared to the migraine with aura and control groups who scored similarly in the tests , the cervicogenic headache group had less range of cervical flexion/extension ( P=0.048 ) and significantly higher incidences of painful upper cervical joint dysfunction assessed by manual examination ( all P<0.05 ) and muscle tightness ( P<0.05 ) . Sternocleidomastoid normalized EMG values were higher in the latter three stages of the cranio-cervical flexion test although they failed to reach significance . There were no between group differences for other measures . A discriminant analysis revealed that manual examination could discriminate the cervicogenic headache group from the other subjects ( migraine with aura and control subjects combined ) with an 80 % sensitivity Purpose : Dysfunction of cervical and shoulder girdle muscles as reason of cervicogenic headache ( CEH ) was reinvestigated with clinical and neurophysiological studies . Methods : Forty office workers were r and omized into two groups to verify efficiency of supervised kinesiotherapy  ( N = 20 ) aim ed with improvement of muscle ’s activity and headache symptoms releasing . Headache intensity was evaluated with visual analog scale ( VAS ) , range of cervical movement ( ROM ) with goniometer , trigger points ( TrPs ) incidence with palpation and muscle ’s strength with Lovett ’s scale . Reaction of patients for muscle ’s elongation was also evaluated .  Surface electromyographical recordings  were bilaterally analyzed at rest ( rEMG ) and during maximal contraction ( mcEMG ) . Results : Deficits of cervical flexion and muscles strength were found in all patients . TrPs occurred predominantly in painful trapezius muscle . Incidence of trigger points coexisted with intensity of CEH . Results indicated on muscles dysfunction which improved only after supervised therapy . Positive correlations between increase in rEMG amplitudes and high VAS scores , high-amplitude rEMG recordings incidence and increased number of TrPs were found . Negative correlation was detected between amplitude in mcEMG and amplitude of rEMG recordings . Conclusions : Dysfunction of trapezius muscle was most responsible for CEH etiology . Proposed algorithm of kinesiotherapy was effective as complementary method of the CEH patients treatment
target: Conclusions : Despite low levels of evidence , manual examination of the cervical spine appears to aid the diagnostic process related to CGH and can be implemented by both experienced and inexperienced examiners
background: Objective : To evaluate the diagnostic validity of manual examination techniques used to diagnose  cervicogenic headache ( CGH ) .
  Background : Cervicogenic headache is a specific type of headache that originates from the cervical spine and is typically chronic in nature .
  Diagnostic criteria for CGH have been established by the International Headache Society ( IHS ) and are cited extensively in the literature .
  Diagnosis of CGH through manual examination is a more recent practice .
  To our knowledge , no systematic review of manual diagnosis of CGH has been performed .