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
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 .
Intertester reliability and diagnostic validity of the cervical flexion-rotation test.
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
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
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 .