Determining associations between physical signs on clinical examination of the cervical spine and the presence of headache of cervicogenic origin

Background: Numerous clinical tests may be used in the assessment of patients with cervicogenic headache (CGH). However, the relative value of these tests in their contribution to the identification of CGH remains under investigated. Whilst certain physical examination findings have been proposed to be associated with CGH, consensus on which findings provide the strongest association with the condition remains elusive. Objectives: To determine which cervical physical assessment techniques commonly used in CGH are positively associated with CGH. Design: Single blind observational study. Methods: Five physical assessment tests of the cervical spine were applied to 20 headache and 20 asymptomatic participants. Inclusion criteria for the headache group met International Headache Society criteria for CGH except positive diagnostic blocks. Selected tests included cervical proprioception using relocation tests, the Cranio-Cervical Flexion Test, the Cervical Flexion Rotation Test, cervical retraction range of motion and reproduction and resolution of familiar head pain with upper cervical spine sustained joint mobilisation. Results: Upper cervical spine sustained joint mobilisation testing with reproduction and resolution of familiar head pain was strongly associated with CGH with a statistically significant difference between the two groups (OR=36, p<0.01). This assessment was 78% sensitive and 90% specific in identifying CGH. Other physical tests were not statistically associated with CGH. Conclusions: Reproduction and resolution of familiar head pain with upper cervical spine sustained joint mobilisation is effective in identifying those with CGH from asymptomatic individuals. Other cervical measures of range of motion, proprioception and deep muscular endurance did not clearly identify CGH.