Headache and impairments in cervical function

In the last decades, several publications appeared on the relationship between impairments in cervical spine function and different types of headaches. The cervical functions most studied and described are changes in head position, mobility, and the neck flexors’ muscular endurance. A Delphi study among experts in the field of physical treatment of headaches proposed a variety of physical tests for tension-type headaches, migraine, and cervicogenic headaches (Luedtke 2016).

However, recently published systematic reviews (Liang 2019, Anarte-Lazo 2021) show that evidence is low to determine a relationship between a decline in function (mobility, muscle strength, posture) in and between different types of headache such as migraine, tension-type headache (TTH) and cervicogenic headache. Liang et al. (2019) noted that a lack of association between headache features and forward head posture (FHP) or ROM in TTH, and flexion-rotation test (FRT) in migraine, support the possibility that cervical impairments can sometimes be unrelated to headache and, in some participants, be incidental features or co-existing cervical disorders. In addition, Anarte Lazo et al. (2021) concluded that impairments in cervical spine function (FRT and muscle endurance) are insufficient to provide a definitive diagnosis of cervicogenic headache versus migraine.
Although the FRT is not useful for discriminating between types of headaches, this test showed significant differences in the range of motion of the upper cervical spine in participants with TTH, migraine, and cervicogenic headaches compared to healthy participants. However, the FRT shows a similar decrease in cervical ROM in patients with neck pain. (Dunning et al. 2012 Rodriquez-Sanz 2021).  
Assessment of cervical function in patients is useful in patients with headaches, but these findings have to be interpreted carefully.   

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