Does Cervicogenic Headache Result in the Presence of Neural Tension, and Does this Affect the Position and Mobility of Atlas?

Background: Cervicogenic headaches (CGH) can be the result of dysfunction of the upper cervical spine. Due to the soft tissue connection between muscle, cervical fascia, and dura, this region might contribute to the development of CGH. Objective: Evaluate if subjects with CGH have neural tension signs. The secondary objective was to investigate if a correlation between the position and mobility of atlas and cervicogenic headaches exists. Methods: 60 Subjects were recruited. Self-reported outcome measures, passive neck flexion rotation test, upper limb tension test (ULTT), slump test, and straight leg raise test (SLR) were assessed. Results: There was a significant difference in atlanto-axial rotation to the right with p=0.025. There was no statistical significance in left rotation. There was no significant relationship between CGH, ULTT, slump and SLR with P>0.05. Atlas position was significantly related to CGH with P<0.001, and position of the atlas was significantly related to atlanto-axial motion with p<0.001. Discussion: There is a direct relationship between the position and mobility of atlas and CGH. Fascial connections between structures could result in dural tension and should be considered when managing patients with CGH. The use of the ULTT, Slump test, and SLR test does not appear to be beneficial in identifying those with CGH.