Cervicogenic headache, an easy diagnosis? A systematic review and meta-analysis of diagnostic studies

The occurrence of cervicogenic headache: A mapping review

BACKGROUND

Occurrence of cervicogenic headache (CeH), mostly expressed by estimates of the prevalence, ranges between 0.4% and 42%. However, transparency on such estimates is lacking, which hinders generalizing results.

OBJECTIVE

Mapping the occurrence (expressed by incidence/prevalence) of CeH.

DESIGN

Mapping review.

METHOD

A systematic literature search of PubMed, EMBASE, Web of Science, Scopus databases (last search update January 28th, 2025). The search query comprised terminology relating to "CeH", "prevalence", "incidence".

RESULTS

Thirty-four publications were included (prevalence n = 32, incidence n = 2). The prevalence of CeH varied depending on the geographical location (Norway: 0.17% - USA: 69%), population (age: 0.17%-56.7%, chronic headache: 0.17% - computer users: 64.5%), setting (inpatient: 13.8%-69%, outpatient: 0.38%-10%), diagnostic criteria (International Headache Society: 0.38%-40%, Cervicogenic Headache International Study Group: 0.17%-64.5%), and diagnostic process (questionnaires: 5.3%-64.5%, clinical examination: 0.17%-56.7%, diagnostic block: 0.17%-16.1%).

CONCLUSION

Most publications were retrieved from Europe, Asia, and the United States. One multicentre study provided results for the African continent. No conclusion could be drawn on the incidence of CeH. The populations studied (e.g., general, age-stratified, specific), settings (e.g., hospital, private practice, clinics, emergency services), diagnostic criteria (e.g., International Headache Society or Cervicogenic Headache International Study Group) and processes (e.g., questionnaires, clinical examination) were heterogeneous. Four publications required a diagnostic block in the diagnostic process. A standardized methodology, especially regarding the diagnostic criteria and process, is needed to compare studies, guarantee quality, and provide estimates to inform policy makers.

The Treatment of Cervicogenic Headache with Transcranial Direct Current Stimulation and Exercise Therapy: A Randomized Control Trial Evaluating Functional Outcomes

ObjectiveThe objectives of this study were to evaluate functional outcomes of cervical motor control, strength and endurance following active transcranial direct current stimulation (tDCS) with exercise therapy (ET) compared to sham tDCS/+ET in patient with cervicogenic headache (CGH),DesignThis was a pilot sham-controlled, participant and assessor blinded, randomized controlled trial.MethodsThirty-two participants with CGH were randomized to active tDCS/+ET or sham tDCS/+ET. Participants completed 6-weeks of daily ET concurrently combined with 3 sessions per week of tDCS. Assessments included: craniocervical flexion test (mmHg), cervical isometric strength (N), cervical flexor and extensor endurance (seconds), and range of motion (degrees) pre-treatment, post-treatment, 6-weeks and 12-weeks post treatment. Linear mixed effect models evaluated group-time interactions at each follow-up while accounting for exercise program adherence and sex.ResultsThere were significant group-time interactions for activation scores on the craniocervical flexion test from pre-treatment to post-treatment (β = 1.571; 95%CI[0.155, 2.988]; p = 0.030), 6-weeks (β = 1.571; 95%CI[0.155, 2.988]; p = 0.030), and 12-weeks (β = 1.954; 95%CI[0.465, 3.443]; p = 0.011) favoring the active tDCS/+ET group.ConclusionsActive tDCS/+ET demonstrated significant benefits in deep cervical flexor motor control compared to sham tDCS/+ET that remained improved up to 12 weeks post-treatment. This suggests tDCS/+ET may improve of functional outcomes for patients with CGH.

Effects of neck-exercise and health promotion on headache outcomes in office workers: secondary analysis of the NEXpro stepped wedge cluster randomised controlled trial

BACKGROUND

Headache conditions have a high prevalence worldwide. Office workers with high and demanding workload, but low physical activity levels are considered vulnerable for suffering from headache. This analysis examines whether exercise combined with health promotion at the workplace is effective for headache relief in office workers.

METHODS

This study reports the results of secondary outcomes of a stepped wedge cluster randomized controlled trial. Office workers (n = 120) were randomly assigned to a twelve-week supervised intervention period, consisting of neck and shoulder girdle exercises with health promotion interventions performed at the workplace. Secondary outcomes were analysed and modelled for headache occurrence, frequency, and the Headache Impact Test-6 (HIT-6), accounting for possible effects for the intervention, the period it had been introduced, and interactional and nested effects.

RESULTS

At baseline, 88 of the 120 participants reported ≥ one headache episode in the past four weeks, with a mean headache frequency of 3.58 days for that period. The mean HIT-6 score for the entire cohort amounted to 53.6 points. For headache occurrence and HIT-6, the simplest model with the intervention only, showed the best statistical fit with an odds ratio for headache occurrence of 0.46 (95% confidence interval: 0.25 to 0.84), and - 2.23 (95% confidence interval: -3.35 to -1.12) points on the HIT-6 questionnaire. For headache frequency, the model accounting for interaction effects (intervention x period) had the best statistical fit and showed an incidence rate ratio of 0.57 (95% confidence interval: 0.44 to 0.74) for the first period, but not for later ones.

CONCLUSIONS

Neck exercises and health promotion had a positive impact on headache occurrence, headache frequency and HIT-6, with the latter not reaching clinical importance. Although only statistically significant for headache frequency, larger effects were found during earlier periods or shorter interventional exposure for all outcomes, necessitating refresher sessions at later periods.

TRIAL REGISTRATION

NCT04169646.

Pain as a disease in the new International Classification of Diseases (ICD-11): Latin American expert consensus

Aims: Pain diagnoses in the 10th version of the International Classification of Diseases (ICD-10) did not adequately support the current management of pain. Therefore, we aimed to review the new 11th revision (ICD-11) in order to analyze its usefulness for the management, coding, research and education of chronic pain from a Latin American perspective. Methods: The Latin American Federation of Associations for the Study of Pain convened a meeting of pain experts in Lima, Peru. Pain specialists from 14 Latin American countries attended the consensus meeting. Results: In ICD-11, chronic pain is defined as pain that persists or recurs longer than 3 months and is subdivided into seven categories: chronic primary pain and six types of chronic secondary pain. Chronic primary pain is now considered a disease in itself, and not a mere symptom of an underlying disease. Conclusion: The novel definition and classification of chronic pain in ICD-11 is helpful for better medical care, research and health statistics. ICD-11 will improve chronic pain management in Latin American countries, for both the pain specialist and the primary care physician.

Sex as a Biological Variable in Oral Diseases: Evidence and Future Prospects

The interest of the scientific community on sex and gender differences in health and disease has increased substantially over the past 25 to 30 y as a result of a long process of events and policies in the biomedical field. This is crucial as compelling evidence from human and animal model studies has demonstrated that sex and gender influence health, molecular and cellular processes, and response and predisposition to disease. The present scoping review aims to provide a synthesis of sex differences in oral diseases, ranging from periodontal disease to orofacial pain conditions, from risk of caries development to apical periodontitis. Overall, findings from this review further support a role for sexual dimorphism influencing disease predisposition and/or progression in oral diseases. Of note, this review also highlights the lack of consideration of additional factors such as gender and other psychosocial and external factors potentially influencing oral health and disease. New conceptual frameworks capable of capturing multiple fundamental domains and measurements should be developed in clinical and preclinical studies to inform sex-based individualized preventive and treatment strategies.

The Magnitude of Physical and Sensory Impairments in Post-traumatic and Non-traumatic Cervicogenic Headaches: A Comparative Study

Background Cervicogenic headaches can significantly deteriorate the quality of life of patients and decrease their productivity. Few studies have been conducted to assess the magnitude of physical impairments among patients with non-traumatic and post-traumatic cervicogenic headaches. Therefore, this study was conducted to examine and compare the magnitude of cervical physical impairments among patients with post-traumatic cervicogenic headaches in contrast to patients with non-traumatic cervicogenic headaches, migraine, and a group of sex- and age-matched controls who did not have headaches. Methodology This was a comparative study. A total of 104 patients and 30 sex- and age-matched controls were included. The patients were stratified into three groups: post-traumatic cervicogenic headaches (n = 42), non-traumatic cervicogenic headaches (n = 30), and migraines (n = 32). The cervical active range of motion and proprioception were assessed using a goniometer, the craniovertebral angle was measured while the heads of the subjects rested in a comfortable position, the strength of the cervical flexors and extensors was assessed using a hand-held dynamometer, and endurance of the short cervical flexors was assessed while the subjects were in a supine position with no pillow. Skin roll tests were performed in the trapezius and mandibular areas, and pain was measured using the McGill Pain Questionnaire-Short Form. Results Patients in the post-traumatic cervicogenic headache group reported a significantly higher number of headache days (p < 0.001) compared to the controls, patients with migraines, and those with non-traumatic cervicogenic headaches. Patients with post-traumatic cervicogenic headaches showed a significant reduction in total rotation, flexion and extension, lateral bending, and craniovertebral angle compared to the controls, patients with migraines, and those with non-traumatic cervicogenic headaches. On the other hand, the controls endured significantly longer and had stronger neck flexors and extensors compared to the patients in the migraine, non-traumatic, and post-traumatic cervicogenic headache groups, respectively. Patients with post-traumatic cervicogenic headaches significantly reported higher affective and total pain compared to the controls and patients in the migraine group. Conclusions Patients with post-traumatic cervicogenic headaches had significant deficits in the cervical active range of motion in the different planes, endurance, and strength of cervical flexors and extensors compared to the controls and patients with migraine and non-traumatic cervicogenic headaches. Similarly, patients with post-traumatic cervicogenic headaches reported higher affective pain compared to the controls and patients with migraines. The results of this study indicated that patients with post-traumatic cervicogenic headaches have significantly higher physical impairments compared to patients with non-traumatic cervicogenic headaches. These differences warrant caution when combining data from patients with non-traumatic and post-traumatic cervicogenic headaches.