Cervical neck rotation for headache diagnosis

Patients: The authors performed a cross sectional study of 60 patients who came from three groups of 20 patients: migraine headache, cervicogenic headache, and mixed headache.  The examiners were not aware of the patients’ diagnoses.

Examination: The cervical flexion–rotation test (FRT) maneuver “consisted of pre-positioning the cervical spine in maximal end range flexion followed by passive rotation of the head to the left and the right, with the subject relaxed in supine. End of range was determined either by firm resistance encountered by the therapist or the subject reporting the onset of pain, whichever came first.” The examination was done on a symptom-free day.

Results: The best cutoff with 30 degrees of rotation; patients with less than 30 degrees were more likely to have cervicogenic headache. The authors found that the area under the receiver operating characteristic curve was 0.85; however, the authors did not provide the sensitivity and specificity for that cutoff value.

Comment: The results of the study may be inflated. It is not clear whether the authors studied consecutive patients with headache or if the study was subject to spectrum bias. In addition, the patients with cervicogenic headache 10 years older which may influence cervical mobility.


Hall TM, Briffa K, Hopper D, & Robinson K (2010). Comparative analysis and diagnostic accuracy of the cervical flexion-rotation test. The Journal of Headache and Pain, 11 (5), 391-7 PMID: 20508964


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