Interaction between Pain, Disability, Mechanosensitivity and Cranio-Cervical Angle in Subjects with Cervicogenic Headache: A Cross-Sectional Study

Thoracic spinal postures and mobility in patients with cervicogenic headache versus asymptomatic healthy controls: A longitudinal study

INTRODUCTION

Studies analyzing postures and mobility of the thoracic spine in the context of cervicogenic headache are missing. Insight in these parameters is needed since the cervical and thoracic spine are biomechanically related.

OBJECTIVE

To compare self-perceived optimal and habitual postures, active-assisted maximal range of motion, and repositioning error of the upper-thoracic and lower-thoracic spine between a cervicogenic headache-group and matched healthy control-group before and after a 30 min-laptop-task.

METHODS

A non-randomized longitudinal design was used to compare thoracic postures and mobility between 18 participants with cervicogenic headache (29-51 years) and 18 matched healthy controls (26-52 years). Outcomes were: self-perceived optimal and habitual postures, active-assisted maximal range of motion, and repositioning error of the upper-thoracic and lower-thoracic spine evaluated in sitting with a 3D-Vicon motion analysis system.

RESULTS

Habitual upper-thoracic postures in the cervicogenic headache-group were significantly (p = .04) less located toward the maximal range of motion for flexion compared to the control-group, self-perceived optimal upper-thoracic posture was significantly (p = .004) more extended in the cervicogenic headache-group compared to the control-group, and self-perceived optimal lower-thoracic posture could not be reestablished in the cervicogenic headache-group after the laptop-task (p = .009).

CONCLUSION

Thoracic postures differ between a cervicogenic headache-group and control-group. These differences were detected by expressing the habitual thoracic posture relative to its maximal range of motion, and by analyzing the possibility of repositioning the thoracic spine after a headache provoking activity. Longitudinal studies are needed to determine the contribution of these musculoskeletal dysfunctions to the pathophysiology of cervicogenic headache.

Effectiveness of spinal mobilization and postural correction exercises in the management of cervicogenic headache: A randomized controlled trial

OBJECTIVE

The study aims to assess the effect of spinal mobilization and postural correction exercises in patients suffering from cervicogenic headache.

METHODS

A randomized controlled trial was conducted with 72 patients. Patients were randomly allocated into three groups: spinal mobilization (n = 24), postural correction exercises (n = 24), and control group (n = 24). The primary outcome measure was headache impact test-6, and secondary outcomes were headache intensity, neck pain intensity, and neck pain-related disability measured at baseline, postintervention, and follow-up period.

RESULT

Comparison of baseline data (at 0 weeks) among groups showed a statistically nonsignificant difference. There was statistically significant improvement at postintervention (immediately after fourth week) in postural correction exercises group [headache disability: 14.95 ± 7.91 (p < .001); headache intensity: 2.58 ± 1.24 (p < .001); neck disability: 27.66 ± 18.71 (p < .001); neck pain: 1.91 ± 1.44 (p < .001)] and spinal mobilization group [headache disability: 13.83 ± 6.21 (p < .001); headache intensity: 2.29 ± 1.23 (p < .001); neck disability: 23.39 ± 19.51 (p < .001); neck pain: 1.72 ± 0.84 (p < .001)] as compared to the control group. The result of within-group analysis suggests that there was a statistically significant improvement in postintervention (immediately after fourth week) and follow-up (immediately after eighth week) scores as compared to baseline (at 0 weeks) scores for all outcomes in postural correction exercises [headache disability (p < .001), headache intensity (p < .001), neck disability (p < .001), neck pain (p < 0 .001)] as well as in spinal mobilization group [headache disability (p < .001), headache intensity (p < .001), neck disability (p < .001), neck pain (p < .001 for pre versus post; p = .001 for pre versus follow-up)]. There was a statistically nonsignificant difference between postintervention and follow-up scores of all the outcomes in the postural correction exercise and spinal mobilization group, which indicates that improvement in these groups was maintained during the follow-up period.

CONCLUSION

Spinal mobilization and postural correction exercises are effective in the management of cervicogenic headache.