The overlap in signs and symptoms of CGH with other forms of headaches greatly complicates the process of an appropriate diagnosis, resulting in inaccurate diagnoses in approximately 50% of CGH cases. To identify and categorise the diagnostic criteria employed for CGH in randomised controlled trials published from 1997 to 2023 and to descriptively examine the outcome measures and physical examination methods employed, with reference to different age group applications. The literature search for this systematised review was conducted from six different electronic databases using a specific search strategy and citation tracking. In total, 498 articles were screened by two reviewers based on preset inclusion and exclusion criteria using the PICO format, and disagreements were resolved by consensus; 59 RCTs were included in the review. Data were extracted on study characteristics, diagnostic criteria, outcome measures, and assessment methods. Due to methodological and clinical heterogeneity, a narrative qualitative synthesis was performed. Fifty-nine RCTs involving 3454 participants were included. The mean age of participants ranged from 11.6±2.3years in paediatric samples to 54.5±7.9years in older adults. Cervicogenic Headache International Study Group (CHISG/Sjaastad) criteria were most commonly used (49%), followed by International Headache Society (IHS) criteria (39%) and International Classification of Headache Disorders, 2nd edition (ICHD-2) criteria (3%). The commonly employed outcome measures included pain intensity (VAS/NPRS), headache frequency and duration, cervical range of motion, and disability indices (e.g.,NDI). Subgroup analysis revealed a lack of standardised diagnostic criteria in paediatric and adolescent studies. The included studies identified inconsistency in diagnostic criteria and outcome measures, particularly in younger populations. Despite the availability of established frameworks, their variable applications in the studies limit their comparability and clinical translation. This review highlights the urgent need for standardised diagnostic criteria for specific age and outcome coresets to strengthen future CGH research and clinical practice.

Occipital nerves: A concise encyclopedic review with clinical relevance in physiotherapy

BackgroundCervicogenic headache (CH) is a secondary headache disorder originating from dysfunction of the cervical spine and surrounding musculoskeletal structures. Alterations in cervical and craniofacial muscle morphology may be related to its pathophysiology. This study aimed to compare the thickness of selected head and neck muscles between individuals with and without CH using ultrasonography and to examine potential associations with clinical symptoms.MethodsA prospective cross-sectional study was conducted with 37 patients diagnosed with CH and 37 age-and sex-matched healthy controls. The thickness of the sternocleidomastoid, upper trapezius, masseter, and temporalis muscles was bilaterally measured using portable ultrasonography. Headache intensity and functional disability were assessed with standardized clinical instruments. Group comparisons and correlation analyses were performed using appropriate statistical methods.ResultsParticipants with CH demonstrated significantly reduced thickness in the bilateral sternocleidomastoid and right upper trapezius compared with controls. No significant differences were observed in the masseter or temporalis muscles. A moderate negative correlation was found between right trapezius thickness and disability scores, whereas headache intensity was not significantly related to muscle thickness.ConclusionsSternocleidomastoid and upper trapezius thinning may be associated with cervicogenic headache. Ultrasonography provides a non-invasive tool for evaluating muscle morphology in this population; however, further studies are needed to clarify its clinical implications and potential role in guiding rehabilitation approaches.

Cervicogenic headache (CEH) can be frequently misdiagnosed as migraine. This study aimed to compare clinical, demographic, and lifestyle characteristics of patients with CEH and individuals with migraine. The retrospective cross-sectional study included 112 patients with CEH and 112 age- and sex-matched individuals with migraine consulted at a single headache center in 2022-2026. The analysis involved clinical and demographic characteristics, and lifestyle factors, among them dominant sleep posture. Compared with individuals with migraine, patients with CEH were diagnosed with headache at an older age (36.27±11.95 vs. 22.62±11.13 years, p < 0.001), had shorter duration of disease (4.08±5.40 vs. 17.74±11.60 years, p < 0.001), more often reported neck pain, also occurring independently of headache (76.92% vs. 39.56%, p < 0.001), more frequently presented with greater occipital nerve (GON) sensitivity to palpation (85.44% vs. 30.21%, p < 0.001) and vitamin B12 deficiency (56.86% vs. 9.38%, p < 0.001). The CEH group contained a larger proportion of active smokers (43.75% vs. 10.71%, p < 0.001) and belly (prone) sleepers (40.18% vs. 14.29%, p < 0.001) than the migraine group. A multivariate regression analysis identified belly sleeping (OR = 11.10, p = 0.006), smoking (OR = 22.61, p = 0.005), and vitamin B12 deficiency (OR = 8.58, p = 0.005) as independent determinants of CEH. CEH differs from migraine in terms of selected clinical, demographic, and lifestyle characteristics. Neck pain independent of headache, GON sensitivity to palpation, older age at the onset of headache, and shorter time elapsed from the first manifestation to referral might be diagnostic prompts in suspected CEH. Belly sleeping, vitamin B12 deficiency, and smoking appear as independent determinants of CEH and might be considered in the prevention and management of this condition.

Cervical facet arthropathy, a degenerative condition of the facet joints, is a leading cause of cervicogenic headaches. First-line therapies such as physical therapy and pharmacology often fail to provide lasting relief. Cooled radiofrequency ablation (RFA) offers a minimally invasive alternative with potential for significant pain reduction. This retrospective study evaluates the efficacy and safety of cooled RFA for patients with cervicogenic headaches. This retrospective analysis consisted of 232 procedures from 137 patients who received cooled RFA of the third occipital nerve (TON) and C3 with/out C4, with/out C5 medial branches, between 2015 and 2025 at UW Health. Data collected include pre- and post-operative pain scores assessed through the Visual Analogue Scale (VAS), duration of pain relief, and adverse events. Paired t-tests were used to analyze the data, with p-values ≤ 0.05 considered statistically significant. A significant reduction in VAS pain scores was observed (p < 0.001). Pain improvement occurred in 62.2% of procedures, with 18.4% achieving complete remission and 19.4% showing no change in pain. Among effective procedures, the average pain reduction was 58.5 ± 32.2%, with a mean duration of 10.1 ± 8.3 months. Twelve procedures were reported to have self-limiting adverse events that resolved within five months. Cooled RFA of cervical medial branches provides effective, durable, and safe pain relief for chronic neck pain and cervicogenic headaches refractory to conservative care. Broader clinical use may benefit from standardized treatment protocols and further study of long-term outcomes.

Cervicogenic headache (CGH) is a secondary headache disorder arising from dysfunction of the C2-3 facet joint. First-line management options include conservative and multidisciplinary therapies including physical therapy, pharmacologic analgesic agents, and other noninvasive modalities. However, some patients experience persistent, refractory pain despite first-line management options. More invasive, interventional approaches including nerve blocks and steroid injections targeting the C2-3 joint have demonstrated relief, but their limited duration poses a challenge for managing chronic pain. Radiofrequency ablation (RFA) has emerged as a promising, minimally invasive, treatment for chronic pain relief in CGH. In this technical report, we describe the use of cooled RFA targeting the third occipital nerve (TON) and, when applicable, the C2 medial branch, for the treatment of chronic refractory CGH. We review relevant anatomy of the C2-3 facet joint implicated in CGH, as well as the anatomic variability of it is innervation, the TON and C2 medial branch, which can influence procedural efficacy. Compared with other RFA methods such as thermal or pulsed, cooled RFA allows for the creation of more precise treatment areas with the goal of improving efficacy and pain relief. A thorough understanding of anatomy, visualization, and procedural technique are important in optimizing outcomes and minimizing adverse effects. By generating more precise and effective lesion fields, cooled RFA may enhance treatment success. This report highlights cooled RFA as a promising treatment option for patients with CGH refractory to more conservative therapies and aims to provide a framework that promotes safe implementation and future research into its effectiveness.

Efficacy of nonsurgical interventions for the management of adults with cervicogenic headache: a systematic review and meta-analyses.

Occipital pain is a debilitating condition often resistant to conventional therapies. Peripheral nerve stimulation (PNS) that targets the occipital nerve at the C2 level has emerged as a novel neuromodulation strategy offering targeted relief. This retrospective case series included 4 patients with refractory occipital pain, cervicogenic headaches, and occipital neuralgia treated with temporary percutaneous implantation of the SPRINT® PNS System (SPR Therapeutics) at C2. Patients underwent 8-week trials followed by longitudinal follow-up periods up to 24 months later. Improvements were noted in pain reduction, physical function, and sleep quality, with decreased or discontinued opioid use and high satisfaction scores. No procedural complications occurred. Temporary occipital nerve PNS at C2 may serve as an effective and safe short-term therapeutic option for refractory occipital pain, though the topic warrants further prospective studies.

Side-locked headache is commonly regarded as a warning sign for secondary intracranial pathology; however, its musculoskeletal causes may be underrecognized. We report a series of seven patients with strictly unilateral headache consistently and temporally associated with the habitual clamping of a mobile phone between the neck and shoulder during hands-free multitasking. The headache was nonthrobbing, lacked migrainous or cranial autonomic features, and was reproducible with cervical palpation or sustained neck movements. Neurological examination and neuroimaging were normal in all cases. Cervical muscle tenderness, spasm, and trigger point-mediated referred pain were prominent findings. Conservative management focusing on avoidance of the implicated posture, posture correction, and physiotherapy was associated with substantial improvement or complete resolution in all patients. This series highlights neck-shoulder mobile phone clamping as a common posture-related trigger for cervicogenic or myofascial headache and underscores the importance of assessing smartphone-handling behaviors in patients with unilateral headache. These findings are hypothesis-generating and do not establish causality.

Headache is a common complaint associated with cervical spondylotic myelopathy (CSM), presenting in more than one-third of patients. Surgical treatment of CSM has been linked to improved headache symptoms. The etiology of headache associated with subaxial cervical spine disorders is not well understood, nor is the mechanism of surgery in relieving symptom intensity. The authors hypothesized that surgical treatment of CSM has a positive impact on patients with headache symptoms, and that anterior cervical discectomy and fusion (ACDF) provides simpler access to foraminal decompression without disruption of posterior myofascial planes and thus could better relieve cervicogenic headache symptoms than a posterior approach. The present study seeks to compare the effect of posterior versus anterior approaches on headache symptom relief in patients with CSM. The authors conducted a post hoc analysis of prospectively collected data from the 14-site Spine CORe™ study group using their data from the cervical module of the Quality Outcomes Database (QOD). Patients who underwent cervical surgery via ACDF or posterior cervical laminectomy and fusion (PCLF) to treat CSM were included and reviewed. The primary outcome of Neck Disability Index (NDI) headache scores (Likert scale 0-5) were collected at baseline and at 3, 12, 24, and 60 months postoperatively. Patients with a minimum preoperative headache score of 1 at baseline were included in the analysis. Of a total of 1085 patients in the QOD database, 697 with CSM and 5-year follow-up data endorsed headache preoperatively, with a median NDI headache score of 2 and a mean NDI headache score of 2.4 at baseline. The mean patient age was 58.6 (SD 11.5) years, 490 (70.3%) had concurrent neck pain and 251 (36.0%) had concurrent C2 (n = 3, 0.4%), C3 (n = 107, 15.4%), or C4 (n = 141, 20.2%) radiculopathy. Four hundred nineteen patients (60.1%) underwent ACDF, 119 (17.1%) underwent PCLF, with the remaining 159 (22.8%) undergoing anterior decompressions without fusion, laminoplasties, laminectomies, foraminotomies, or a combination of nonfusion decompression procedures. Postoperative headache intensities were lower than baseline intensities (Kruskal-Wallis test = 373, p < 0.0001) by a median of 1 point. By the end of the 5-year follow up, 365 (87.1%) of the ACDF patients and 99 (83.2%) of the PCLF patients experienced at least some headache relief (χ2 = 0.49, p = 0.48), defined by ≥ 1-point ordinal scale improvement of the headache score. Furthermore, 201 (48%) ACDF and 42 (35.3%) PCLF patients experienced full headache relief (χ2 = 6.01, p = 0.01), defined as a decrease to a score of zero postoperatively. There was no effect of age (β = 0.5221, p = 0.32), concurrent neck pain (U = 46476, p = 0.56), or C2-4 radiculopathy (U = 24682, p = 0.98) on headache relief by the end of follow-up. Surgical treatment of CSM improved symptom intensity in patients experiencing preoperative headache. ACDF and PCLF were equally effective in relieving headache at 3-60 months postoperatively. Postoperative headache relief was not affected by surgical approach, age, concurrent neck pain, or concurrent C2-4 radiculopathy.

Cervicogenic headache (CeH) is a common secondary headache type arising from a disorder or lesion of the cervical spine and its soft tissues. This study aimed to evaluate the effect of osteopathic manipulative treatment (OMT) in patients with CeH. A total of 413 patients with CeH were treated by 30 osteopaths and allocated by block randomization to an OMT group (n=226) or a placebo group (n=187). The primary outcome was the Neck Disability Index (NDI) score; the secondary outcome was upper cervical rotation measured with the Flexion-Rotation Test (FRT) utilizing a cervical range of motion (CROM) device. Patients received two treatments over 4weeks (standardized sham vs. findings-based OMT). Two-factor analyses of variance (ANOVAs) were utilized for the NDI score and CROM_FRT_sum, and Cohen's d was calculated for all clinical outcomes. A severity-based subgroup analysis of the NDI was performed. The NDI improved by 5.9 points (11.8 %) in the OMT group and by 2.5 points (5.1 %) in the placebo group from baseline to final follow-up. Only the OMT group reached the established minimal clinically important difference (MCID) of 5.5 points. Effect sizes in the OMT group were large (Cohen's d=0.74 short-term and 0.87 at follow-up). OMT reduces pain and improves functional disability in patients with CeH in a clinically meaningful way. Patients with higher initial NDI scores benefit more from OMT than others.

Cervicogenic Headache (CGH) is classified as a secondary type of headache with both muscular and neurological impairments. There are many physiotherapeutic interventions for its management like spinal manipulation, mobilisation, Myofascial Release (MFR), postural correction exercises, and electrotherapy but evidence for sustained long-term effects remains limited. Slump mobilisation is an emerging technique that can alleviate pain by targeting dural tension in the spine, restoring mobility, reducing pain, and addressing underlying musculoskeletal and neural dysfunctions. This case report aims to evaluate the effects of Slump mobilisation combined with suboccipital MFR on pain, cervical ROM, and overall Quality Of Life (QOL) in an individual with CGH. A 36-year-old female having CGH as diagnosed by (CGH International Study Group, CHISG) criteria since one year came with neck stiffness and pain in neck radiating to the head and forehead. Stress, watching television, and using mobile phone aggravated her symptoms, while analgesics relieve them. Slump mobilisation was performed in three sets, each consisting of 30–40 repetitions over two minutes, with one-minute breaks between sets, suboccipital MFR was given for four minutes for three days/week for four weeks. Pain was assessed using Headache Impact test- 6 (HIT-6) and the Pain Pressure Threshold (PPT) was assessed by algometer to assess tenderness of splenius capitis, rectus capitis and upper trapezius muscle and Cervical Range of Motion (CROM) by using universal goniometer. The QOL was assessed using 36-Short-form questionnaire at baseline and post-intervention. Significant improvements were observed on HIT-6 (66 to 50), PPT of trapezius (right) from 1.59 to 3.46, trapezius (left) from 1.57 to 2.49, splenius capitis (right) from 1.65 to 2.89, splenius capitis (left) from 1.46 to 2.72, rectus capitis (right) from 1.53 to 2.52, and rectus capitis (left) from 1.42 to 2.57. Cervical ROM also showed improvement in all the movements. Additionally, the SF-36 scores improved from 40.37% to 84.87%. The present case highlights that slump mobilisation combined with suboccipital MFR can be used as an effective intervention in the management of CGH.

Chronic spinal musculoskeletal pain (CSP) is a prevalent and disabling condition affecting hundreds of millions worldwide. Ultrasound-guided acupotomy (UGA) has emerged as a minimally invasive intervention for CSP. This study aimed to systematically evaluate the efficacy and safety of UGA for CSP through a meta-analysis of randomised controlled trials (RCTs). The study protocol was prospectively registered with PROSPERO (CRD420251156718). A systematic search was conducted in PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Database, and VIP Database from inception to August 2025 for RCTs. Primary outcomes included pain intensity assessed by the Visual Analogue Scale (VAS), functional disability assessed by the Neck Disability Index/Oswestry Disability Index (NDI/ODI) and the Japanese Orthopaedic Association (JOA) score, and overall clinical response rate. Secondary outcomes included recurrence rate and incidence of adverse events. Methodological quality was assessed using the modified Jadad scale, Cochrane risk of bias tool, and GRADE system. Meta-analysis, subgroup analysis, sensitivity analysis, and publication bias assessment were performed. A total of 32 RCTs involving 2669 participants were included, all conducted in China and published between 2014 and 2025, covering spinal conditions including cervical spondylosis, lumbar disc herniation, cervicogenic headache, ankylosing spondylitis, and related disorders. UGA showed significant advantages over control groups in reducing pain intensity (VAS: SMD = -0.80, 95% CI: -0.97 to -0.64) and improving functional outcomes (NDI/ODI: SMD = -0.99, 95% CI: -1.36 to -0.63; JOA score: SMD = 0.77, 95% CI: 0.43 to 1.12), along with a higher overall response rate (RR = 1.15, 95% CI: 1.12-1.19). A trend toward reduced recurrence was observed (RR = 0.63, 95% CI: 0.27-1.43), though this did not reach statistical significance. Adverse events in the UGA group were mild and less frequent (0%-13.8%) than controls (0%-51.7%). Subgroup analysis revealed that add-on UGA therapy yielded optimal outcomes with low heterogeneity. Evidence quality was moderate for pain and response rate, and low for other outcomes. It should be noted that all 32 included RCTs were conducted in China, which may limit the generalisability of these findings to other geographic and clinical contexts. UGA appears to be an effective and safe intervention for CSP, with particular benefit observed when used as an add-on therapy. However, given the moderate to low certainty evidence, high heterogeneity, and predominant risk of bias due to lack of blinding, these results should be interpreted with caution. Further high-quality multicentre RCTs with standardised protocols are warranted to confirm these findings.

Cervicogenic headache (CGH) is frequently associated with altered cervical sensorimotor control, reduced range of motion and impaired postural stability. Prior work has shown that proprioceptive retraining with gaze direction recognition (GDR) can reduce pain and improve postural stability in CGH and chronic neck pain. To examine whether adding a GDR-based proprioceptive training to standard physiotherapy reduces headache frequency and duration and improves postural balance (COPpath length) in CGH patients. Thirty-eight participants with CGH (aged 35-49 years) were randomly assigned to receive either standard physiotherapy (Control, n = 19) or physiotherapy plus GDRproprioceptive training (Treatment, n = 19) for 8 weeks (3 sessions/week). Outcomes measured pre- and post-intervention included headache frequency (attacks/month), headache duration (hours/attack), and center-of-pressure (COP) path length during quiet standing. Multivariate analyses revealed significant effects of time and group × time interaction (Wilks' Λ = 0.142, F (3,30) = 60.55, P < 0.001; Wilks' Λ = 0.193, F (3,30) = 41.77, P < 0.001), indicating greater improvements in the treatment group. Follow-up ANOVAs showed significant time and interaction effects for COP path length (F (1,32) = 186.0, P < 0.001; F (1,32) = 130.0, P < 0.001), headache duration (F (1,32) = 16.0, P = 0.00035; F (1,32) = 7.43, P= 0.010), and headache frequency (F (1,32) = 11.7, P = 0.002; F (1,32) = 7.61, P = 0.010). Groups did not differ at baseline. Adding GDR-based proprioceptive training to standard physiotherapy produced greater improvements in headache burden and markedly improved postural balance compared with standard physiotherapy alone.

Purpose: To present an unusual case of intermittent angle closure glaucoma masquerading as migraine and cervicogenic headaches. Methods: A patient with a 10-year history of chronic headaches presented with a 5-day history of pain and blurred vision in the right eye. She was found to have acute angle closure glaucoma. She was treated with intraocular pressure-lowering agents, followed by laser iridotomy. The patient provided copies of her medical visits between 2010 and 2016. These records were carefully reviewed and summarized. Results: Treatment with laser iridotomy resolved symptoms of ocular pain and headaches that the patient had been suffering from for over a decade. During that period, she was treated with a variety of medications, including anti-migraine drugs, non-steroidal anti-inflammatory medications, muscle relaxants, and narcotic analgesics. She was also treated with chiropractic manipulations, physical therapy, cervical epidural steroid injections, and botulinum toxin injections. Conclusion: This is a rare case where symptoms presumably caused by intermittent angle closure persisted for over 10 years before progressing to acute angle closure crisis (complete angle closure). The presence of documented cervical spine disease complicated making a definitive diagnosis. The presence of unilateral blurred vision with headaches should prompt investigating possible intermittent angle closure as the cause, even in a patient whose symptoms have been present for as long as ten years.

Cervicogenic headache (CGH) is frequently associated with cervical radiculopathy (CR), but its prevalence and contributing factors in patients undergoing conservative treatment are not well established. To assess the prevalence of CGH and identify the factors associated with it among patients with CR undergoing conservative treatment. A cross-sectional analytical study was conducted from May 2023 to December 2023 in the Physical Medicine and Rehabilitation (PMR) of Monastir, Tunisia. Patients with CR consulting in PMR and Rheumatology departments were included. The prevalence of CGH was evaluated using the IHS diagnostic criteria, and associated factors were analyzed. CGH was diagnosed in 53 out of 86 patients (61.6%) with CR. Univariate analysis revealed that limitations in right cervical rotation, impaired cervical spine proprioception, reduced neck flexor and extensor strength, functional impairment, high anxiety levels, and lower scores in the physical and mental health domains of quality of life were associated with CGH. Multivariate analysis identified high anxiety score (OR=1.44; 95% CI 1.04-1.98; p=0.024), limitation of right cervical rotation (OR=0.80; 95% CI 0.70-0.90; p < 0.001), and impaired proprioception during flexion (OR=1.38; 95% CI 1.08-1.76; p=0.009) as independent factors associated with CGH. CGH seems to be highly prevalent in CR patients undergoing conservative treatment. This study suggests that key factors associated with CGH are proprioception deficit, anxiety, and reduced quality of life. Further large-scale studies are needed to confirm these findings.

Background/Objectives: Cervical pain is defined as pain in the neck that may or may not radiate to one or both upper extremities and lasts at least one day. Headaches are within the spectrum of neck pain, defined as any painful sensation perceived in the head that can extend to the neck. They are classified as primary (migraines and tension headaches) or secondary (cervicogenic headaches) depending on their clinical presentation and associated symptoms. The objective of this review is to compare the effects of dry needling with and without spinal manipulative techniques versus the application of other physical therapy modalities. Methods: A systematic review was conducted searching articles compatible with the objectives of this study in PubMed, ScienceDirect, and Scopus databases using the search terms spinal manipulation, cervical manipulation, dry needling, headache, headaches, and migraine over the last five years and combined with the Boolean operators AND and OR. After screening, all studies underwent methodological quality assessments using the PEDro scale and qualitative synthesis for study design, patients' characteristics, interventions, comparators, outcomes assessed and main results data. Results: Thirteen randomized clinical trials were selected. The quality of the studies is varied, with PEDro scale values ranging from six to eight. Dry needling and cervical manipulations have proven to be effective tools, compared to other interventions, in reducing pain and improving functionality in patients with headaches. Conclusions: Dry needling techniques and manipulations have shown significant effects on parameters related to pain, sensitivity, functionality, and general health in patients with headaches. However, future studies are necessary to more deeply analyze the long-term effects of both techniques.

ObjectiveTo examine whether problematic smartphone use is associated with pain intensity, functional disability, emotional distress, sleep quality, and health-related quality of life in individuals with cervicogenic headache compared with healthy adults.DesignCase-control study.SettingOutpatient clinics of Physical Medicine and Rehabilitation and Neurology at a university hospital.ParticipantsA total of 158 adults, including 78 individuals diagnosed with cervicogenic headache and 80 age- and sex-matched healthy controls.Main measuresSmartphone Addiction Scale-Short Form, Headache Impact Test-6, Neck Disability Index, Hospital Anxiety and Depression Scale, Jenkins Sleep Scale, and Short Form-12 Health Survey.ResultsIndividuals with cervicogenic headache reported significantly higher levels of smartphone-related behavioural problems, headache impact, neck-related disability, anxiety, depressive symptoms, and sleep disturbance than healthy controls (all p < 0.05). Physical and mental health-related quality of life scores were significantly lower in the cervicogenic headache group. Problematic smartphone use was positively associated with depressive symptoms (r = 0.224) and poor sleep quality (r = 0.369), and negatively associated with mental health-related quality of life (r = -0.277). Neck-related disability (β = 0.327) and mental health-related quality of life (β = 0.551) were independent predictors of problematic smartphone use, explaining 31% of the variance.ConclusionsProblematic smartphone use is associated with greater symptom burden, emotional distress, sleep problems, and reduced quality of life in individuals with cervicogenic headache. Smartphone-related behavioural patterns may represent a modifiable factor to be considered within comprehensive rehabilitation and lifestyle-based management strategies.

Cervicogenic headache (CGH) is a secondary headache linked to cervical spine disorders and musculoskeletal dysfunction. Recent research suggests that the posterior myofascial chain, extending from the cervical region to the lower limbs, may contribute to CGH. Muscle tightness and trigger points (TrPs) in this chain can exacerbate headache symptoms. However, limited research on the prevalence of tightness and TrPs in the posterior kinetic chain highlights the need for further investigation to inform targeted treatments. The main aim of this study is to determine the prevalence of tightness and the presence of TrPs in the muscles of the posterior myofascial chain in subjects with CGH. A total of 1,283 participants were screened using the Cervicogenic Headache International Study Group criteria, identifying 188 with CGH. This cross-sectional study assessed muscle tightness and TrPs in the posterior kinetic chain at one point in time. Seventeen TrPs across the upper back, lower back, and lower limbs were examined by examiner 1. Muscle tightness in the trapezius, thoracolumbar fascia, piriformis, hamstrings, and gastrosoleus was evaluated by examiner 2 using a goniometer or measuring tape. Data show that participants with left or right CGH have higher tightness percentages in the trapezius (left: 96.93%, right: 98.88%), thoracolumbar fascia (89.89%), and hamstrings (left: 97.95%, right: 95.55%). TrPs were more in the occipital ridge (left: 84.69%, right: 86.66%), splenius capitis and cervicis (left: 65.30%, right: 61.11%), lower cervical spine (left: 90.81%, right: 96.66%), and rhomboid (left: 55.10%, right: 53.33%). A one-sample t-test, which compared the scores to normal values, revealed a significant difference (p = 0.0001) in tightness and TrPs in the posterior kinetic chain. The findings indicate that individuals with CGH exhibit a high occurrence of muscle tightness and TrPs on the posterior myofascial chain on the affected side.

Background. Cerebral venous circulation disorders occupy a significant place in the structure of vascular disorders in cervicogenic headache (CH). Available publications lack data on a comparative study of the state of venous cerebral hemodynamics in patients with CH during pathogenetic treatment of venous cerebral circulation disorders. Ruprose – dynamic study of cerebral venous blood flow and venous hemodynamic reactivity in patients with CH on the background of diosmin treatment. Materials and methods. A clinical and Doppler examination of 37 patients with CH aged 18 to 45 years was performed, in particular, cervicocranialgia (CCA) – 21 patients, posterior cervical sympathetic Barré–Lieu syndrome (BLS) – 16 patients. The maximum blood flow velocity (Vmax) in the vertebral (VV) veins, basal veins of Rosenthal (BV), straight sinus (SS), and the coefficient of reactivity to ortho­ (OL) and antiorthostatic (AOL) loading in the VV (CrvvOL, CrvvAOL) and SS (CrssOL, CrssAOL) as background indicators and against the backround of diosmin use were studied. Results. In patients with CH, Vmax was increased with an emphasis on BV in the CCA group and with an emphasis on VV and SS in the BLS group. In OL in VV in the groups of patients with CCA and BLS, hyporeactivity was noted, more pronounced in CCA. CrssOLwere not significantly change SS, more pronounced in patients with BLS. Against the background of diosmin use there was a decrease in Vmax in VV, BV and SS, as well as a decrease in CrdsAOL. Conclusions. In CH, signs of venous dyscirculation were noted, and they were more pronounced in BV in patients with CCA, as well as in VV and SS in patients with BLS. Hyperreactivity to AOL was also found in SS, which indicates subclinical intracranial venous hypertension. Under the influence of diosmin treatment, an improvement in venous hemodynamics was observed, most pronounced in VV, as well as stabilization of CrssOL indicators. The tendency to normalize the changed indicators of venous blood flow against the background of diosmin treatment demonstrates the significance of the velocity indicators of blood flow in the cerebral veins for determining the degree of venous dyscirculation and monitoring the effectiveness of treatment in patients with CH.