Cervicogenic Headache and the Relationship Between the Position and Movement of the Upper Cervical Spine and Dura

Abstract

Background: It has been demonstrated that cervicogenic headaches (CGH) is caused by dysfunction of the upper cervical spine. Due the soft tissue connection between muscle, cervical fascia and dura, this region might contribute to the development of CGH’s. This study evaluated if subjects with CGH have concurrent neural tension signs. The secondary aim of this study was to investigate if there is a correlation between the position of atlas and mobility of atlantoaxial joint in those experiencing cervicogenic headaches compared to a healthy control group.Methods: A convenience sample of 60 subjects were recruited for this study. Each subjected completed self-reported outcome measures, after which the passive neck flexion rotation test, upper limb tension test (ULTT), slump test, and straight leg raise test (SLR) was performed by the physical therapist.Outcomes: There was a significant difference in the passive atlantoaxial rotation to the right between the CGH and the control group p = 0.025. There was a no statistically significance in left rotation. There was no significant relationship between CGH and the ULTT, slump ad SLR with P > 0.05. The position of atlas was significantly related with CGH with P < 0.001 and position of atlas was significantly related to AA motion with p < 0.001Discussion: The results of this study demonstrate that there is a direct relationship between the position of atlas, unilateral restriction in AA rotation, and the presence of CGH’s. The presence of fascial connections between structures of the high cervical spine and the dura motion could result in dural tension and should be considered by physical therapists when managing patients with CGH. The use of the ULTT, Slump test, and SLR test do not appear beneficial identifying those with CGH.