Execution
- 1Perform the cervical flexion-rotation test and record restriction or asymmetry.
- 2Manually examine C0-C3 and record whether familiar headache is reproduced with painful upper cervical joint dysfunction.
- 3Perform the craniocervical flexion test or deep neck flexor endurance assessment.
- 4Check whether the three findings form a coherent cervical musculoskeletal pattern.
- 5Screen for migraine, tension-type headache, vascular red flags, neurological signs, and non-cervical causes before classifying the headache.
Positive outcome
The cluster is positive when restricted upper cervical motion, painful upper cervical joint dysfunction, and impaired deep neck flexor function are all present in a patient whose headache behavior fits cervicogenic headache. The cluster supports a cervical musculoskeletal source more strongly than any single test. It does not replace medical headache red-flag screening.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Jull et al. (2007) | discriminant clinical examination pattern | 100 | 94 | 16.7 | 0.0 |
| Getsoian et al. (2020) | validation study | NA | NA | NA | NA |
CommentThis is the highest-value cervicogenic-headache construct because it uses a pattern rather than a single sign. The Jull 2007 values are strong but came from a controlled headache-classification sample, not a general emergency dizziness population. Use the cluster only after excluding serious secondary headache features and non-cervical vestibular or vascular causes.
High Clinical Value