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F. O`Brien1, K. Narazas1, S. Bravo1,2,3
1Universidad Peruana de Ciencias Aplicadas, Terapia Fisica, Lima, Peru, 2Universidad Continental, Junin, Huancayo, Peru, 3Universidad Nacional Federico Villarreal, Lima, Lima, Peru
Background: The comorbidity between headache and cervical disorder has been studied in order to establish whether there is a direct relationship between cervical physiology and biomechanics, either as a mediating mechanism of headaches or as an effect thereof.
Purpose: To verify if there is an association between the presence of chronic headache with cervical mobility and the alteration of the C0-C1 suboccipital space.
Methods: The study was of cases and controls; the universe of study were adults between 18 and 59 years old from the city of Lima who work in the administrative field of a company with more than 500 workers. The cases consisted of workers with chronic headache in the last 6 months, controls were workers without symptoms of headache in the last 6 months. The exposure variable was cervical mobility measured with the Cervical Range of Motion Instrument CROM3 and the measurement of space C0-C1 was obtained by lateral teleradiography. The confounding variables were age, sex, and the presence of cervical pain.
Results: 55 controls and 28 cases participated. There were no differences in relation to sex or age between the groups. The cases presented 64.3% of significant and very severe impact of disability according to HIT-6. Significant associations between cervical mobility and headache were found: mobility of the left lateralization with an OR of 0.94 (IC95 0.52-0.93, p <0.013), that is, for each degree of lateralization, the probability of having pain of the head decreases by 6%, the cervical mobility restriction of the suboccipital flexion with an OR of 1.13 (IC95: 1.02 - 1.26, p = 0.022), where each degree of restriction increases the probability of suffering headache by 13 %. Furthermore, a significant association was found between the C0-C1 suboccipital space in millimeters and the presence of headache with an OR 0.69 (IC95: 0.52 - 0.93, p = 0.013). So for every millimeter of C0-C1 space there is a 31% less chance of having a headache. When the C0-C1 distance is dichotomously classified, people with a C0-C1 distance less than 4mm had an OR of 4.76 (95 1.18-19.17, p = 0. 0.28) than subjects with a C0-C1 distance ≥ 4mm. The ORs were adjusted for age, sex, and cervical pain.
Conclusion(s): Decreased cervical mobility (left lateralization), restriction of cervical mobility, as well as space C0 - C1, were found to be associated with a greater probability of presenting with chronic headache.
Implications: Patients with chronic headache may have impaired cervical mobility and C0-C1 space restriction. The physiotherapist can approach this comorbidity to establish a treatment in which clinical reasoning integrates this relationship.
Funding, acknowledgements: The project was self-financed
Keywords: Cervical mobility, Headache, C0-C1
Topic: Pain & pain management
Did this work require ethics approval? Yes
Institution: Universidad Peruana de Ciencias Aplicadas , Lima-Perú
Committee: Comité de Ética de la Facultad de Ciencias de la Salud
Ethics number: CEI/031-05-19 : PI012-19
All authors, affiliations and abstracts have been published as submitted.
