Cervical neuro-musculoskeletal impairments in people with cervicogenic headache: a systematic review and meta-analysis

Abstract

Background: People with cervicogenic headache (CGH) typically present with headache symptoms similar to other headache forms but with distinguishing features of neuro-musculoskeletal impairments. With current diagnostic criteria it is unclear which impairments are important for CGH diagnosis.

Objective: To comprehensively review the evidence for cervical neuromusculoskeletal impairments in people with a diagnosis of CGH when compared to asymptomatic controls.

Methods: Eight databases were searched for relevant studies evaluating neuro-musculoskeletal impairments in people with CGH. Risk-of-bias and overall quality of the evidence were assessed and meta-analyses performed.

Results: Sixteen studies were included, the majority with low risk of bias. In comparison with asymptomatic controls the subjects with CGH presented with reduced combined cervical flexion-extension ROM (MD −9.26˚, 95% CI: −12.24˚, −6.27˚, I² = 6%), side flexion ROM (MD: −2.97˚, 95% CI: 5.48˚, −0.46˚, I² = 51%), and rotation ROM (MD: −13.57, 95% CI: −16.10, −11.03, I² = 99%). Upper cervical rotation ROM was markedly reduced towards the headache side (MD: −15.07˚, 95% CI: −16.61˚, −13.53˚, I² = 68%). Similarly, cervical flexor (MD: −33.70˚, 95% CI: −47.23˚, −20.16˚, I² = 0%) and extensor strength (MD: −55.78, 95% CI: −77.56, −34.00, I² = 0%) was reduced in subjects with CGH along with reduced craniovertebral angle. Kinaesthetic sense was not significantly impaired in subjects with CGH. The overall rating score for certainty of evidence was high to very low for all assessed outcomes.

Conclusion: People with CGH have significantly decreased cervical ROM and muscle function with level of evidence ranging from high to very low.

Keywords:

• Cervicogenic headache
• musculoskeletal
• upper cervical
• articular impairments

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Kiran Satpute

Kiran Satpute holds postgraduate qualification in Musculoskeletal Physiotherapy. He is Associate Professor and Head of the Musculoskeletal Department at Smt. Kashibai Navale College of Physiotherapy, India. He is currently a PhD Scholar at Sancheti College of Physiotherapy, India.

Nilima Bedekar

Nilima Bedekar is Professor and Head of the Musculoskeletal Department and PhD guide at Sancheti College of Physiotherapy, India. She has published many peer-reviewed articles.

Toby Hall

Toby Hall is a Specialist Musculoskeletal Physiotherapist, Adjunct Associate Professor at Curtin University, Australia, and director of Manual Concepts. He graduated as a physiotherapist in the UK in 1985, completed an MSc in 1996 and a PhD in 2010. He has published more than 20 book chapters, more than 140 peer-reviewed articles, and 3 books.