Measuring Headache and Examining the Upper Cervical Spine

A Delphi survey ranked headache frequency as the most important baseline measure, alongside intensity, duration, quality of life on the HIT-6, medication days and global perceived effect. The Neck Disability Index reflected migraine disability more than neck dysfunction. Toby explains the anatomy: C0-1 mainly flexes and extends, C1-2 mainly rotates, and C2-3 couples rotation with side bending. Upper cervical movements relate to headache better than whole neck range. Retraction takes C0-1 and C1-2 to end range flexion, protraction to end range extension, with the jaw kept horizontal. Rotation with C2 fixed should reach about 15 degrees each way, with more than 20 raising concern about the alar ligament, and around 20 with C3 fixed. Combined movement tests developed by Brian Edwards help guide treatment. The flexion rotation test has a normal range of about 44 degrees, a cutoff of 30 degrees separating cervicogenic headache from migraine and 85% diagnostic accuracy, losing about three degrees per decade. Manual examination above C4 is reliable, with C1-2 the most common dominant level.