Cervicogenic headache is a classification of headache in which pain is referred from the cervical spine or the upper part of the neck.
Differential diagnosis of cervicogenic headaches from other headache types is an essential factor in guiding our physiotherapists to the development of appropriate intervention plans. The diagnostic criteria for cervicogenic headache, as established by the International Headache Society (IHS), facilitates this process. This makes make a very important component our physiotherapy approach in reference to an accurate diagnosis. Facet joints at occiput/ C1, C1/C2, and C2/C3 have been found to refer localised symptoms to the occipital and suboccipital region, which can be associated with cervicogenic headache pain.
The flexion–rotation test has been described as a method to differentiate rotational motions taking place at the upper versus lower cervical spine. The test is commonly performed passively. The passive flexion–rotation test (FRT-P) is performed with the patient supine. An examiner passively positions the patient’s neck into full flexion to pre-tension the structures of the middle and lower cervical spine, then the patient’s head is passively rotated each direction while the flexed position is maintained. Since the C1/C2 motion segment accounts for 40–60% of the total cervical ROM, this test is intended to isolate motion at that segment. Criteria for a positive test consists of ROM restriction with firm resistance, a 10-degree difference in motion between painful and non-painful sides, and pain provocation.
The FRT-P has been found to have a high degree of sensitivity (90–91%) and specificity (88–90%) when used to examine patients with cervicogenic headache.