Cummins Damien C, Thomas Lucy C, Osmotherly Peter G
School of Health Sciences, The University of Newcastle, Callaghan - Australia.
School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia - Australia.
Arch Physiother. 2025 Jun 20;15:158-164. doi: 10.33393/aop.2025.3340. eCollection 2025 Jan-Dec.
Reproduction and resolution of head pain with sustained upper cervical mobilization has been proposed as a diagnostic indicator of Cervicogenic Headache (CGH). However, there has been little focus on describing head pain response during the application of these maneuvers. The purpose of this study was to describe the head pain response during the performance of sustained upper cervical spine mobilization in people with probable CGH.
In this case series of 20 individuals with probable CGH as defined under the International Headache Society criteria, were assessed by one experienced physiotherapist who administered five sustained upper cervical spine mobilization techniques to each participant. Reproduction of head pain during mobilization was noted. At the start, during, and end of each mobilization technique, change in head pain intensity and time taken to achieve head pain resolution was recorded.
Sixteen of the 20 participants experienced reproduction and resolution of head pain within 90 seconds of sustained upper cervical mobilization. This phenomenon occurred no more frequently with the mobilization of C2 than with C1. Eight patients reported this on the dominant head pain side only, 6 patients experienced this bilaterally. Neck pain was present in 13 of the 20 participants.
From this case series, it seems that neither the duration (measured in seconds) nor the magnitude of reduction in head pain intensity was markedly different across dominant compared to non-dominant head pain sides or across cervical levels, indicating reproduction and resolution behavior is irregular. The presence of CGH without neck pain is possible.
持续的上颈椎松动术引发和缓解头痛已被提议作为颈源性头痛（CGH）的一项诊断指标。然而，对于这些手法应用过程中头痛反应的描述却很少受到关注。本研究的目的是描述疑似CGH患者在进行持续上颈椎松动术时的头痛反应。
在这个病例系列中，2十条符合国际头痛协会标准定义的疑似CGH患者，由一名经验丰富的物理治疗师进行评估，该治疗师对每位参与者实施了五种持续上颈椎松动术。记录了松动术过程中头痛的再现情况。在每种松动术开始、进行中和结束时，记录头痛强度的变化以及头痛缓解所需的时间。
20名参与者中有16名在持续上颈椎松动术90秒内出现头痛再现和缓解。C2松动时这种现象的发生频率并不比C1松动时更高。8名患者仅在头痛占主导的一侧出现这种情况，6名患者双侧出现。20名参与者中有13名存在颈部疼痛。
从这个病例系列来看，与非主导头痛侧相比，主导头痛侧或不同颈椎节段之间，头痛强度降低的持续时间（以秒为单位）和幅度似乎没有明显差异，这表明头痛再现和缓解行为是不规则的。无颈部疼痛的CGH是可能存在的。
