Upper Neck Problemes In Women With Chronic Migraine Headaches

In this study, they used a test that I perform in my office on headache patients.  Its called the Flexion Rotation Test.  What I do, is to have you lay on your back, and I gently flex your chin to your chest.  Then I turn the head both ways to see if there is any difference.  For migraine patients, their headaches are usually on the side of the joint restriction in the upper neck.  When I provide the treatment designed to help with this mechanical problem, the headaches usually get better.

European Journal of Physical and Rehabilitation Medicine

Ferracini GN, et al.

This study was set up with the aim to examine differences in musculoskeletal impairments of the neck including active global and upper cervical spine mobility, the presence of symptomatic upper cervical spine joints, cervicocephalic kinesthesia and head/neck posture between women with episodic migraine, chronic migraine, and controls. The authors concluded that women with migraine demonstrated musculoskeletal impairments of the upper cervical spine expressed as restricted cervical rotation, decreased upper cervical rotation, and the presence of symptomatic upper cervical joints. They found no differences between episodic or chronic migraine.


  • In this cross-sectional study, the authors enrolled 55 women with episodic migraine, 16 with chronic migraine, and 22 matched healthy women.
  • By an assessor blinded to the subject’s condition, active cervical range of motion, upper cervical spine mobility (i.e., flexion-rotation test), referred pain from upper cervical joints, cervicocephalic kinesthesia (joint position sense error test, JPSE), and head/neck posture (i.e. the cranio-vertebral and cervical lordosis angles) were evaluated.


  • Compared to healthy women, women with migraine demonstrated reduced cervical rotation (P=0.012).
  • The authors found no differences between episodic and chronic migraine in cervical mobility.
  • For flexion-rotation test, significant differences were also reported, suggesting that upper cervical spine mobility was restricted in both migraine groups (P<0.001).
  • As per the outcomes, referred pain obtained on manual examination of the upper cervical spine mimicking pain symptoms was present in 50% of migraineurs.
  • Between episodic and chronic migraine, no differences were observed in the frequency of symptomatic upper cervical joint.
  • They found no differences in JPSE or posture among groups (P>0.121).

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