SIB #470- Is Neck Posture Different in Neck Pain VS. Headache?
The Study: Is it Possible to Distinguish Cervicogenic Headache from Neck Pain with Cervicospinal Posture?
The Facts:
a. The authors defined cervicogenic headache as a headache originating in the upper cervical spine. They also noted that the definition of these headaches included: A unilateral headache starting in the neck or occipital area with pain produced by neck motion or placing the neck in awkward positions and decreased cervical vertebral motion.
b. They compared the radiographs of patients suffering from cervicogenic headaches and those suffering from nonspecific neck pain.
c. The study looked at 45 female subjects with the specified headaches and 45 women with the specified neck pain.
d. All subjects received upright A-P and lateral cervical radiographs.
e. They measured both the general cervical lordosis (GCL) and the upper cervical lordosis (UCL) on the lateral radiographs.
f. The authors found no significant difference in the neck postures of the cervicogenic headache group as compared to the neck pain group.
Take Home:
The lateral cervical lordosis was about the same in patients with cervicogenic headache and those with neck pain although the general lordosis although both groups tended to show reduced lordosis on average. .
Reviewer's Comments:
This doesn’t come as a great surprise. Cervicogenic headaches arise from the upper cervical area and the definition goes further so that the headache cases had unilateral headache starting in the neck or occipital area with pain produced by neck motion or placing the neck in awkward positions and decreased cervical vertebral motion as noted above. Other than the headache portion these are the types of things we would expect in the cases with neck pain so we might expect the lateral radiographs to be similar. It would have been nice if there was some special thing in the cervical lordosis that would differentiate one of these types of problems from the other but this study did not find one.
They end their conclusion by stating, “Pain mechanisms need to be elucidated by detailed analysis of the whole spinal alignment using different methods investigating ligament, muscle, and spinal changes in the upper cervical region in this patient group.” That seems like a good idea.
Reviewer: Roger Coleman DC
Editor’s Comments: Wouldn’t it be great if symptoms were always directly correlated with spinal structure. Unfortunately, that’s never been the case. And while this was a worthwhile study to do, I think most of us with an interest in spinal posture would have probably suspected the outcome. Oh, If only things were so clear cut and easy.
Editor: Mark R. Payne DC
Reference: Yeliz Bahar-Ozdemir, Omer Ozdemir. Is it Possible to Distinguish Cervicogenic Headache from Neck Pain with Cervicospinal Posture? A Single-Blind, Prospective Cross-Sectional Trial. Pain Physician 2020 Nov;23(6):E687-E694.
Link to Abstract: https://pubmed.ncbi.nlm.nih.gov/33185387/
Link to Article: https://www.painphysicianjournal.com/current/pdf?article=NzE2NA%3D%3D&journal=131