The cervical spine in tension type headache

Key points

1. 0197.5% of headache subjects had at least one hypomobile cervical segment (C1-C3) vs 60% of non-headache subjects (p=0.000015)
2. 0265% of the headache group had abnormal active inter-segmental motion on X-ray vs 30% of controls (p=0.000236)
3. 0362.5% of the headache group had reduced cervical lordosis vs 35% of controls (mean lordotic angle 18.25 degrees vs 24.025 degrees, p=0.020573)
4. 04After 6 chiropractic treatments over 3 weeks, the treatment group showed significant improvements in inter-segmental motion, cervical lordosis, and tender point counts
5. 05Cervical range of motion differences between groups were mostly non-significant; only extension (p=0.047) and left lateral flexion (p=0.007) differed significantly

How it was conducted

Design

Controlled cross-sectional comparison with an uncontrolled pre-post treatment arm; master's dissertation

Participants

80 subjects total: 40 tension-type headache (Group A) and 40 asymptomatic non-headache controls (Group B); ages 18-44, majority European students

Groups

Group A1 (n=20) received chiropractic treatment; Group A2 (n=20) received no treatment; Group B (n=40) served as control

Intervention

Light soft tissue therapy followed by chiropractic spinal adjustment(s), 6 treatments over 3 weeks

Primary outcomes

Motion palpation, inter-segmental flexion/extension X-rays, cervical sagittal curve (lordotic angle), algometer tender point counts, CROM goniometry

Statistical tests

Two-sample unpaired t-test (inter-group); Wilcoxon signed rank test (intra-group); 95% confidence level

What they found

• Motion palpation: 97.5% of headache subjects had at least one C1-C3 fixation vs 60% of controls; mean fixations per subject 1.425 vs 0.7 (p=0.000015)
• Active inter-segmental X-ray: 65% of headache group had at least one abnormal segment (C1-C6) vs 30% of controls; mean abnormal segments 1.175 vs 0.375 (p=0.000236)
• Passive inter-segmental X-ray: 50% of headache group vs 25% of controls had at least one abnormal segment; difference not statistically significant (p=0.052642)
• Lordotic angle: headache group mean 18.25 degrees vs control group 24.025 degrees (p=0.020573)
• Tender points: 97.5% of headache group vs 82% of controls had at least one; mean tender points 2.25 vs 1.15 per subject (p=0.000001)
• Extension range of motion: headache group mean 65.5 degrees vs control 70.25 degrees (p=0.047); left lateral flexion 63.375 vs 68.675 degrees (p=0.007); all other ranges non-significant
• Post-treatment (Group A1): active inter-segmental motion improved from mean 1.3 to 0.45 abnormal segments (p=0.000394); passive from 0.85 to 0.5 (p=0.005547)
• Post-treatment (Group A1): lordotic angle improved from mean 19.1 degrees to 23.95 degrees (p=0.000354)
• Post-treatment (Group A1): tender points reduced from mean 2.25 to 1.15 per subject (p=0.000017)
• Post-treatment (Group A1): lateral flexion right improved from 45 to 48 degrees (p=0.016); rotation right from 65 to 69 degrees (p=0.008); flexion and extension changes were non-significant

Limitations

• No placebo or sham treatment control for the intervention arm; treatment group results cannot be separated from natural history or regression to the mean
• Treatment group sample size of 20 was acknowledged as pilot-scale, limiting statistical power and generalisability
• Homogeneity of groups was not achieved through matched pairing; subjects were consecutively allocated, introducing potential selection bias
• Motion palpation is inherently subjective despite blinded confirmation; goniometry and algometry carry measurement error acknowledged by the author

Why it matters

For patients

People with tension-type headaches often have stiff, tender cervical joints, and a short course of chiropractic care may reduce those physical signs, though larger placebo-controlled trials are needed before strong treatment recommendations can be made.

For clinicians

Routine cervical assessment in tension-type headache patients is warranted; hypomobility at C1-C2 and C2-C3, loss of lordosis, and pericervical tender points are the most discriminating findings, but treatment efficacy conclusions remain preliminary without a controlled trial.

For readers

This is a small dissertation-level study with no sham control, so findings point toward a cervical spine contribution to tension-type headache rather than proving chiropractic as an effective treatment.