Execution
- 1Position the patient supine in crook lying with the neck in neutral.
- 2Place an inflated pressure biofeedback unit under the upper cervical lordosis and sets baseline pressure to 20 mmHg.
- 3Ask the patient to gently nod as if saying yes without lifting the head or pushing backward.
- 4Ask the patient to progress through 22, 24, 26, 28, and 30 mmHg targets, usually holding each target for 10 seconds.
- 5Observe pressure steadiness, sternocleidomastoid or scalene substitution, chin poke, breath holding, and symptom response.
Positive outcome
The test is positive for impairment when the patient cannot perform a controlled cranio-cervical nod, cannot hold target pressures, or substitutes with superficial neck flexors. It is not a headache diagnosis by itself. In the cervicogenic-headache cluster, impaired CCFT performance supports deep cervical flexor dysfunction.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Jull et al. (2008) | clinical assessment review | NA | NA | NA | NA |
| James et al. (2010) | excellent intra-tester reliability in asymptomatic subjects | NA | NA | NA | NA |
| Jull et al. (2007) | cluster component | NA | NA | NA | NA |
CommentCCFT is an impairment and motor-control test, not a stand-alone diagnostic test for cervicogenic headache. It becomes more clinically meaningful when combined with upper cervical motion restriction and painful joint dysfunction. Pain, anxiety, and poor cueing can alter performance.
Low Clinical Value