Pediatric Cervical Headaches
This study by Budelmann et al examined the following three objective criteria in children classified with cervical headaches:
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Active range of motion of the cervical spine
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Upper cervical rotation as determined by the Flexion Rotation Test (FRT)
- Forward head posture measured by the Craniovertebral Angle (CVA)
The authors found when compared to an age matched group of asymptomatic handball players those with cervical headaches had:
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Significantly less cervical active range of motion in flexion, extension and rotation
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Greater forward head posture as measured by a significantly smaller CVA
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Significantly less upper cervical rotation as measured by the FRT, especially towards the headache side
- Significantly more pain reported during and immediately after the FRT.
Active cervical range of motion and the Flexion Rotation Test are simple objective exams that can help identify children with cervical headaches.
Flexion Rotation Test: With the patient lying supine, fully flex the cervical spine by taking the chin to the manubrium. While maintaining full flexion, rotate the head to each the left and the right, noting any asymmetry. Normal is approx. 45 degrees of rotation. A FRT less than 30 degrees is considered positive.
Reference: Budelmann K et al Is there a difference in head posture and cervical spine movement in children with and without pediatric headache? Eur J Pediatr. 2013 Oct;172(10):1349-56