Cervicogenic headache is a type of headache caused by a neck disorder and is characterized pain on one side of the head. According to published studies, up to 4.1% of the general population experiences this type pe headache. The Quebec Professional Order of Physiotherapy provides more details on their blog from a health professional perspective. It is mentioned in the article that people who are stressed or anxious often experience this type of headache, due to muscle tension in the neck.
Goal
To determine whether or not the headache originates from the cervical spine, there is a physical test that can determine specific movement disorder in the upper neck. The cervical flexion-rotation test (CFRT) can be used to verify whether neck movements are altered, but it does not necessarily provide information about the cause of the headache. Professors Jean-Philippe Paquin and Yanick Tousignant-Laflamme therefore explored the real value of the CFRT results for cervicogenic headaches diagnosis.
Methodology
In order to do so, the researchers wrote this opinion article based on their clinical experience and expertise as physiotherapists, and evidence from a literature review, which consists of presenting and evaluating the scientific articles published regarding this topic.
Main findings
Although the value and the validity of this test is very well documented in the literature, there are two important issues that may raise questions about the validity of the cervical flexion-rotation test.
1- The criterion’s accuracy in determining whether the test is positive or negative is imprecise. The movement amplitude is often not measured with a reliable and clinically valid tool and pain replication is not considered as a criterion to determine whether the test is positive. Furthermore, there are biases associated with this test: four factors can increase the risks of misinterpretation of results, including the presence of pain during the test, the patient’s age, the measurement tool as well as diagnostic errors.
2- The reference gold-standard used to validate the CFRT is a biomechanical examination performed by the clinician. It consists of passive movement tests. This reference standard has certain weaknesses related to its validity, but there a few safe and non-invasive alternatives.
Take home message
CFRT remains a very useful clinical test, but it provides perhaps more information about cervical biomechanics than about the exact cause of the symptoms. It may be interesting to use CFRT’s results to better orient patients who may potentially respond to manual therapy approach, rather than solely for diagnostic purposes.
