Demont Anthony, Lafrance Simon, Benaissa Leila, Mawet Jérôme
INSERM 1123 ECEVE, Faculty of Médecine, Université Paris-Diderot, Paris, France.
School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada.
Musculoskelet Sci Pract. 2022 Dec;62:102640. doi: 10.1016/j.msksp.2022.102640. Epub 2022 Aug 31.
The diagnosis of cervicogenic headache (CGH) remains a challenge for clinicians as the diagnostic value of detailed history and clinical findings remains unclear.
To update and evaluate available evidence of the prevalence and the diagnostic accuracy of the detailed history and clinical findings for CGH in adults with headache.
Systematic review with meta-analysis.
CINAHL, Cochrane Central, Embase, PEDro and PubMed were searched for studies before March 2022 that reported detailed history and/or clinical findings related to the diagnosis of cervicogenic headache. Study selection, risk of bias assessment (QUADAS-2 and PROBAST), and data extraction were performed. Meta-analyses for the cervical flexion-rotation test (CFRT) was performed. Certainty of the evidence was assessed with the GRADE approach.
Eleven studies were included. Moderate certainty evidence indicated that the CFRT differentiated CGH from lower cervical facet-induced headache, migraine, concomitant headaches or asymptomatic subjects (Se 83.0% [95%CI:70.0%-92.0%]; Sp 83.0% [95%CI:71.0%-91.0%]; positive LR 5.0 [95%CI:2.6-9.5]; negative LR 0.2 [95%CI:0.1-0.4]; n = 4 studies; n = 182 participants). Several diagnostic classifications and test clusters based on headache history and clinical findings can be useful, despite uncertain accuracy, in formulating the diagnosis of CGH.
Evidence support to undertake an evaluation of headache history and signs and symptoms and a physical examination of the patient neck to diagnose CGH. During the physical examination, a positive or negative CFRT probably has a small to moderate effect on the probability of a patient having a CGH. The diagnostic value of the other findings remains unclear.
#CRD42020201772.
由于详细病史和临床检查结果的诊断价值尚不清楚，颈源性头痛（CGH）的诊断对临床医生来说仍然是一项挑战。
更新并评估关于成人头痛患者中颈源性头痛的患病率以及详细病史和临床检查结果的诊断准确性的现有证据。
系统评价与荟萃分析。
检索CINAHL、Cochrane Central、Embase、PEDro和PubMed数据库，查找2022年3月之前报告的与颈源性头痛诊断相关的详细病史和/或临床检查结果的研究。进行研究选择、偏倚风险评估（QUADAS - 2和PROBAST）以及数据提取。对颈椎屈伸旋转试验（CFRT）进行荟萃分析。采用GRADE方法评估证据的确定性。
纳入11项研究。中等确定性证据表明，CFRT可将颈源性头痛与下颈椎小关节引起的头痛、偏头痛、伴随性头痛或无症状受试者区分开来（敏感性83.0% [95%置信区间：70.0% - 92.0%]；特异性83.0% [95%置信区间：71.0% - 91.0%]；阳性似然比5.0 [95%置信区间：2.6 - 9.5]；阴性似然比0.2 [95%置信区间：; n = 4项研究；n = 182名参与者）。尽管准确性不确定，但基于头痛病史和临床检查结果的几种诊断分类和测试组合在制定颈源性头痛的诊断时可能有用。
有证据支持通过评估头痛病史、体征和症状以及对患者颈部进行体格检查来诊断颈源性头痛。在体格检查期间，CFRT的阳性或阴性结果可能对患者患有颈源性头痛的概率有小到中等程度的影响。其他检查结果的诊断价值仍不明确。
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