Physical Therapy and Rehabilitation

Physical Therapy and Rehabilitation

ISSN 2055-2386
Original Research

Clinical Relationship Between Cervicogenic Headache and Leg Length Discrepancy

Marc Robertson* and Robert Gregory

*Correspondence: Marc Robertson

† This author contributed equally to this work.

Southern Connecticut State University, New Haven, Connecticut, USA.


Background: Cervicogenic headache (CGH) is a secondary classification of headache theorized to originate from degenerative pathology and/or nociceptive irritation of the cervical spine. The purpose of this study was to assess if a relationship existed between CGH and clinically relevant leg length discrepancy.

Methods: Participant demographic data were collected [age (years), gender, height (cm), body mass (kg), and body mass index (BMI) (kg•m- ²)] on 37 individuals between the ages of 18 and 65 years. Participants completed a CGH diagnostic questionnaire, were assessed for blood pressure, leg length discrepancy, cervical range of motion, cervical posture, cervical facet pathological degeneration through palpation, and underwent the cervical flexion-rotation test.

Results: Twenty-three of thirty-seven participants met the CGH diagnostic criteria. Significant differences were demonstrated between participants who met and those who did not meet CGH diagnostic criteria regarding LLD (x̄=32.82, SD ±6.19 mm and x̄=7.49, SD±5.70 mm, respectively) (p<0.0001), flexionrotation test side-to-side difference mean (x̄=27.74, SD±9.09 degrees and x̄=3.43, SD±1.90 degrees, respectively) (p<0.0001), and headache frequency mean (x̄=3.34, SD±2.45 days per week and x̄=0.42, SD ±0.72 days per week, respectively) (p=0.004). Relationships were investigated between LLD >20mm and; diagnostic flexion-rotation test (r=1.00 p=2.22E-16), CGH questionnaire (r=0.91 p=1.52E-12), additional diagnostic criteria (r=0.79 p=1.68E-07), flexion-rotation test side-to-side difference (r=0.72 p=7.69E-06), and headache frequency (r=0.56 p=0.001).

Conclusion: A significant association was found between participants who positively met diagnostic criteria for cervicogenic headache and leg length discrepancy >20 mm, significantly different from participants with frequent headache who did not meet the diagnostic criteria for cervicogenic headache. Cervicogenic headache is a secondary classification of headache whose etiology is derived from cervical spine pathology. Treatment for cervicogenic headache has focused on mediation of cervical spine pathology with inattention for the etiology of unilateral symptom presentation. Cervicogenic headache treatment outcomes have been effective regarding symptom mediation, yet fleeting. Leg length discrepancy >20mm should be considered in the examination and treatment regarding cervical spine pathological degeneration as found to be responsible for the presentation of cervicogenic headache.

Keywords: Cervical spine, cervicogenic headache, cervicogenic migraine, flexion-rotation test, leg length discrepancy, cervicogenic headache diagnosis

ISSN 2055-2386
Volume 8
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