ArticleBMJ open2020
Validation of a clinical examination to differentiate a cervicogenic source of headache: a diagnostic prediction model using controlled diagnostic blocks.
Article in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it, 45 citations in OpenAlex.
- A clinical guide for physiotherapists to assess and manage cervical musculoskeletal impairment and pain sensitivity in migraine patients.The Journal of manual & manipulative therapy · 2025Guideline
- The effect of targeted upper cervical musculoskeletal management on the frequency and burden of migraine headache in adults - a single cohort pilot study.The Journal of manual & manipulative therapy · 2026Article
- Benchmark evaluation of large language models for clinical decision support in headache management.Journal of oral & facial pain and headache · 2026Article
- Current and future advances in practice: cervical spondylosis and mechanical neck pain.Rheumatology advances in practice · 2025Review
- Differences in physical examination findings between those who present with or without headache soon after a whiplash injury: a cross-sectional study.The Journal of manual & manipulative therapy · 2024Article
- Application of biomechanical principles to upper cervical spine anatomy to alleviate symptoms of intermittent cranial nerve IX irritation. Directions for successful self-management of headache post-concussion? A case series.The Journal of manual & manipulative therapy · 2023Article
- Perception and knowledge of learners about the use of 3D technologies in manual therapy education - a qualitative study.BMC medical education · 2023Article
- Headache and orofacial pain: A traffic-light prognosis-based management approach for the musculoskeletal practice.Frontiers in neurology · 2023Article
- The Neck Disability Index Reflects Allodynia and Headache Disability but Not Cervical Musculoskeletal Dysfunction in Migraine.Physical therapy · 2022Observational
- Cervical musculoskeletal impairments in migraine.Archives of physiotherapy · 2021Article
- A new test protocol and device for measuring the cranio-cervical flexion test in participants with bruxism.Archives of physiotherapyArticle
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Corrections and comments
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Authors and funding
5 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesNeck pain commonly accompanies recurrent headaches such as migraine, tension-type and cervicogenic headache. Neck pain may be part of the headache symptom complex or a local source. Patients commonly seek neck treatment to alleviate headache, but this is only indicated when cervical musculoskeletal dysfunction is the source of pain. Clinical presentation of reduced cervical extension, painful cervical joint dysfunction and impaired muscle function collectively has been shown to identify cervicogenic headache among patients with recurrent headaches. The pattern's validity has not been tested against the 'gold standard' of controlled diagnostic blocks. This study assessed the validity of this pattern of cervical musculoskeletal signs to identify a cervical source of headache and neck pain, against controlled diagnostic blocks, in patients with headache and neck pain.
designProspective concurrent validity study that employed a diagnostic model building approach to analysis.
settingHospital-based multidisciplinary outpatient clinic in Joliet, Illinois.
participantsA convenience sample of participants who presented to a headache clinic with recurrent headaches associated with neck pain. Sixty participants were enrolled and thirty were included in the analysis. OUTCOME MEASURES: Participants underwent a clinical examination consisting of relevant tests of cervical musculoskeletal dysfunction. Controlled diagnostic blocks of C2/C3-C3/C4 established a cervical source of neck pain. Penalised logistic regression identified clinical signs to be included in a diagnostic model that best predicted participants' responses to diagnostic blocks.
resultsTen of thirty participants responded to diagnostic blocks. The full pattern of cervical musculoskeletal signs best predicted participants' responses (expected prediction error = 0.57) and accounted for 65% of the variance in responses.
conclusionsThis study confirmed the validity of the musculoskeletal pattern to identify a cervical source of headache and neck pain. Adopting this criterion pattern may strengthen cervicogenic headache diagnosis and inform differential diagnosis of neck pain accompanying migraine and tension-type headache.
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