Cervicospinal Posture and Pain in Cervicogenic Headache

Study Overview
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Brief Summary
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Cervicogenic headache (CEH) is a type of symptomatic headache that is characterized by chronic unilateral headache secondary to cervical spine dysfunction. Generally, it gets worse by neck movements, continuous placement of the head in an awkward position and exposure to external pressure on the upper cervical or occipital region. The pain was demonstrated to originate from lower cervical disc prolapse and spinal nerve roots in some studies, while it is suggested in some others to occur due to the upper cervical region as well. Although disturbed cervical alignment has been determined in tension headache and migraine, there are few studies with controversial results in the literature investigating the effects of the change in cervical lordosis on CEH. These contradictory results strongly influence the decision of whether exercise should be added to the treatment protocol in CEH and also the creation of an appropriate treatment program by the clinicians. In light of this background, the aim of this study was to compare the cervical radiographs of patients with CEH and patients with neck pain without a headache.

Detailed Description
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The general demographics, pain status and cervical radiological evaluations of the patients was performed in this prospective, cross-sectional, single-blind study evaluating two different disease groups compatible in age and gender and the two groups were compared. For inclusion in the Cervicogenic Headache group, inclusion criteria determined by the Cervicogenic Headache International Study Group (CHISG) were used. Symptoms of all patients were questioned in detail and physical examinations were performed. After obtaining demographic information such as age, height and weight, severity and duration of pain were asked to the patients and Neck Disability Index (NDI) and Visual Analogue Scale (VAS) were used for pain assessment Cervical radiographic analysis was evaluated measuring general cervical lordosis and upper cervical lordosis on lateral standing X-rays using Surgimap®. General cervical lordosis and Upper cervical lordosis measurements were performed on the lateral cervical graph.

Official Title
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Is it Possible to Distinguish Cervicogenic Headache From Neck Pain With Cervicospinal Posture?: A Single-blind, Prospective Cross-sectional Trial

Conditions
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Cervicogenic Headache, Neck Pain

Intervention / Treatment
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* Diagnostic Test: Lateral radiography


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: For Cervicogenic headache group Unilateral headache, starting from the upper neck/occipital region and spreading to the oculofrontotemporal area on the symptomatic side Pain triggered by neck movements and/or continuous awkward positions Decreased joint range of motion in the cervical vertebra Exclusion Criteria: For Cervicogenic headache group Previously diagnosed to have any other syndromes of headache (Migraine, Tension headache, etc.) Presence of bilateral headache; For the neck pain group, Presence of 2 or more neurological symptoms (decreased upper extremity muscle strength, decreased reflexes and hypoesthesia compatible with the dermatome regions) Suggesting nerve root compression (radiculopathy, plexopathy); for both groups, Presence of any signs suspicious of central nervous system involvement (hyperreflexia, nystagmus, decreased vision, etc) Reluctance to participate in the study.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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Female

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Cervicogenic headache<br>The group with cervicogenic headaches | Diagnostic Test: Lateral radiography<br>* The lordosis angles were measured on the lateral cervical graphs of all patients.<br>|
| Neck pain<br>The group with isolated neck pain | Diagnostic Test: Lateral radiography<br>* The lordosis angles were measured on the lateral cervical graphs of all patients.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| General cervical lordosis | General cervical lordosis is basically measured by the Cobb method. In the lateral graph, the angle between the two lines drawn perpendicular to the lines passing on the inferior end plate of the C2 and C7 vertebrae is considered as the General cervical lordosis angle. | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Upper cervical lordosis | For the measurement of upper cervical lordosis, a line is drawn from the uppermost posterior point of the odontoid process to the lowermost posterior point of C2. The second line is drawn to pass between the lowermost-posterior portions of the C3 and C4 cervical vertebrae. The angle between these two lines is considered the upper cervical lordosis angle | 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cervicogenic headache, Disability, Pain