An investigation of cervical spinal posture in cervicogenic headache

Background: Cervicogenic headache (CGH) is defined as headache symptoms originating from the cervical spine. Cervical dysfunction from abnormal posture has been proposed to aggravate or cause CGH, but there are conflicting reports as to whether there is an association between posture and CGH. Objective: To evaluate differences in cervical spinal posture, measured on radiographs, between patients with probable CGH and asymptomatic control participants. Design: Single blinded comparative measurement design. Methods: Differences in postural variables from radiographs between CGH (n=30) and aged and gender matched asymptomatic control participants (n=30) were determined using paired t-tests or the non-parametric equivalent. Postural variables were general cervical lordosis (GCL, Cobb angle C2-C7), upper cervical lordosis (UCL, sagittal alignment C2 compared with C3-C4) and C2 spinous process horizontal deviation. Logistic regression determined postural variables increasing the likelihood of CGH. Results: There were no significant differences in posture between CGH and controls (mean GCL, CGH group 10.97°, SD 7.50, controls 7.17, SD 5.69, P = 0.06; UCL CGH 11.86°, SD 6.46, controls 9.44, SD 4.28, P = 0.10; C2 spinous process horizontal deviation CGH 3.00mm, SD 1.66, controls 2.86, SD 2.04, P = 0.77). However, there was a significant association between greater GCL and an increased likelihood of having CGH (OR=1.08, 95% CI 1.001, 1.191, P=0.042). Limitation: The findings are limited to an association between GCL and posture, as cause and effect cannot be determined. Conclusions: The association between greater GCL and increased likelihood of having CGH suggests that GCL might be considered in the management of patients with CGH. However, as the data do not support posture as a cause of CGH, it is unknown whether addressing posture would reduce CGH