Is there a difference in head posture and cervical spine movement in children with and without pediatric headache?

Abstract

Pediatric headache is an increasingly reported phenomenon. Cervicogenic headache (CGH) is a subgroup of headache, but there is limited information about cervical spine physical examination signs in children with CGH. Therefore, a cross-sectional study was designed to investigate cervical spine physical examination signs including active range of motion (ROM), posture determined by the craniovertebral angle (CVA), and upper cervical ROM determined by the flexion-rotation test (FRT) in children aged between 6 and 12 years. An additional purpose was to determine the degree of pain provoked by the FRT. Thirty children (mean age 120.70 months [SD 15.14]) with features of CGH and 34 (mean age 125.38 months [13.14]) age-matched asymptomatic controls participated in the study. When compared to asymptomatic controls, symptomatic children had a significantly smaller CVA (p < 0.001), significantly less active ROM in all cardinal planes (p < 0.001), and significantly less ROM during the FRT (p < 0.001), especially towards the dominant headache side (p < 0.001). In addition, symptomatic subjects reported more pain during the FRT (p < 0.001) and there was a significant negative correlation (r = -0.758, p < 0.001) between the range recorded during the FRT towards the dominant headache side and FRT pain intensity score. This study found evidence of impaired function of the upper cervical spine in children with CGH and provides evidence of the clinical utility of the FRT when examining children with CGH.

Concurrent Validity and Reliability of an Inertial Measurement Unit for the Assessment of Craniocervical Range of Motion in Subjects with Cerebral Palsy

“…On the contrary, the reduction of craniocervical ROM has been described as a characteristic of several musculoskeletal and neurological diseases. Thus, cervicogenic headache in children determines reduced flexion, extension, and lateroflexion, although not rotational movements [64], plagiocephaly limits cervical ROM, especially in the rotational plane [65], and congenital muscular torticollis reduces ROM in frontal and transversal planes [66]. In conclusion, specific craniocervical ROM is not a characteristic of CP in children, at least when muscle tone is slightly increased.…”

Measurement of range-of-motion in infants with indications of upper cervical dysfunction using the Flexion-Rotation-Test and Lateral-Flexion-Test: a blinded inter-rater reliability study in a clinical practice setting

“…When at least one of these tests indicates reduced passive ROM, UCD is clinically diagnosed and, dependent on the direction of reduced mobility, treated with specific techniques [5]. To date, research has acknowledged good reliability of the FRT in adults [10][11][12][13] and children [14] while in infants only one study examined the intrarater reliability; one rater examined infants with torticollis and found high intra-rater reliability (ICC: ≥0.77) [15]. Even though the validity and reliability of the FRT and LFT in infants are still largely unknown, manual therapists currently use these tests in their diagnostic clinical decision-making [5].…”

Physiotherapie von Kopfschmerz bei Kindern und Jugendlichen

“…Bei der Inspektion und Observation von HWS und Kopf ist v. a. auf eine nach vorne geschobene Kopfposition zu achten. Der aus einer Anteroposition resultierende verkleinerte CVA kann im Zusammenhang mit Kopfschmerzen stehen [26]. Der CVA wird mittels Goniometer oder digitaler Klinimetrie bestimmt (▶ Abb.…”

“…Bei den Kindern mit Kopfschmerzen zeigte sich ein craniovertebraler Winkel (CVA) von 47,27 ° (Standardabweichung; SD 2,36); in der Kontrollgruppe lag der CVA bei 51,26 ° (SD 4,78) ( Abb. 2 ) 26 . Überdies imponierten eine reduzierte Beweglichkeit bei aktiven Nackenbewegungen, eine auf der dominanten Kopfschmerzseite deutlich verringerte Beweglichkeit beim Flexions-Rotations-Test (FRT; 33 ° vs. 43 °) sowie mehr Schmerzen während des FRT ( Abb.…”

“…Zervikale Funktion Auch die zervikale Region wird auf ihre aktive und passive Beweglichkeit getestet 26 , 46 , 47 , 48 . Der FRT untersucht die hochzervikale Wirbelsäule: Bei Kindern mit zervikogenen Kopfschmerzen kann der Test auf der Kopfschmerzseite signifikant eingeschränkt sein 26 ( Abb. 4 ).…”