Headache production during physical examination in patients with and without headache attributed to a whiplash injury: A case-control study

Provocation of headache on physical examination of the neck may reflect a role of cervical structures in the presence of acute whiplash-associated headache (WAH). To determine differences in headache provocation during physical tests in people with and without WAH after a whiplash injury. Case-contr...

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Bibliographic Details
Published in:Musculoskeletal science & practice 2023-08, Vol.66, p.102779-102779, Article 102779
Main Authors: Anarte-Lazo, E., Rodriguez-Blanco, C., Bernal-Utrera, C., Falla, D.
Format: Article
Language:English
Subjects:
Case-Control Studies
Cervical Vertebrae
Headache - diagnosis
Headache - etiology
Humans
Intra-rater test-retest reliability
Neuromusculoskeletal disorders
Pain
Physical Examination - methods
Physical testing
Reproducibility of Results
Whiplash Injuries - complications
Whiplash Injuries - diagnosis
Whiplash-associated disorders
Whiplash-associated headache
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Summary:Provocation of headache on physical examination of the neck may reflect a role of cervical structures in the presence of acute whiplash-associated headache (WAH). To determine differences in headache provocation during physical tests in people with and without WAH after a whiplash injury. Case-control study. Forty-seven people with acute whiplash-associated disorders participated, 28 with WAH. Passive accessory intervertebral movement over the tubercle of C1, the spinous processes of C2-C3 and facet joints of C0-C4, the flexion-rotation test (FRT), manual palpation of cranio-cervical muscles and the upper limb neurodynamic test + cranio-cervical flexion were assessed bilaterally twice by a blinded examiner; headache provocation was determined. Cohen's kappa and Chi-squared were determined to evaluate the intra-rater reliability of test results and differences between groups, respectively. A logistic regression model was also performed. Intra-rater reliability of headache provocation was good or excellent for most tests. Significant differences between groups were found with higher positive tests in WAH for the assessment of C2 (68%), the most painful side of C0-C1 (57%), C1-C2 (75%) and C2-C3 (53%), most (79%) and least (25%) restricted sides of the FRT, and manual palpation of the most painful side for the trapezius (53%), masseter (50%) and temporalis (46%) muscles. Provocation of headache during the assessment of C2 and C1-C2 on the most painful side demonstrated the highest association with WAH. Mechanical provocation of headache is more frequent in people with WAH than in those without headache soon after a whiplash injury. •Headache provocation on physical examination was reliable in people with acute whiplash-associated disorders.•Headache was provoked during physical examination tests of the cervical spine more commonly in those with headache.•Caution must be taken since mechanical provocation of headache may be due to heightened sensitisation.
ISSN:2468-7812
2468-7812
DOI:10.1016/j.msksp.2023.102779