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An investigation of the contribution of cervical factors to headache


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Grimmer, KA (1996) An investigation of the contribution of cervical factors to headache. PhD thesis, University of Tasmania.

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This thesis reports on the contribution of cervical factors to headache, which
occurred in the absence of a history of trauma to the neck. Individuals who
had never sustained an injury to the neck were randomly selected from the
electoral rolls of two southern Tasmanian municipalities for this crosssectional
observational study. Five hundred and twenty-three individuals
were invited to participate, and following exclusions and refusals, 490
subjects were examined. Twenty subjects participated in a pilot study of the
device designed to measure cervical posture, 427 subjects participated in the
main study, which examined the association between headache and habitual
cervical resting posture in sitting, and 43 subjects supplied data on which the
predictive model was tested. New measures needed to be developed because no appropriate measures
were available in a clinical setting. A diagnostic tool for headache was
constructed from colloquial descriptions of three of the seven pain patterns
attributed by Jull (1981) to headache of cervical origin. Non-diseased status
was conferred upon those subjects who failed to identify all elements of the
diagnostic tool. Headache frequency was measured retrospectively using a
seven level nominal scale. Headache frequency in the study sample ranged
from one headache every couple of months to daily. Cervical resting posture
in sitting was measured by the Linear Excursion Measurement Device
(LEMD), as the excursion of the superior-most tip of the helix of the ear (an
anatomical point chosen to represent the distal aspect of the cervical spine)
and the spinous process of C7 (a point chosen to represent the proximal
aspect of the cervical spine), when subjects moved from a standard corrected
posture to their habitual resting posture.
All 427 subjects participating in the main study were asked to recall the
frequency of their headaches in the preceding month. A subset of these
subjects (93 subjects) also supplied prospective headache data by
completing a headache diary for a month. A comparison of retrospective
and prospective data indicated that, over a two month period, the headache
characteristic was stable and consistent. Compared with the prospective
headache diary, men tended to over-report headache retrospectively while
women tended to under-report it.
Headache was expressed in frequencies of occasional and frequent:
occasional headache occurred less frequently than twice per month, and
frequent headache occurred at least twice a month. The prevalence in the
sample data, of headache specifically associated with cervical factors, was
63.7 per cent. Occasional headache was suffered by 55.5 per cent of
headache sufferers and frequent headaches were suffered by the remaining
44.5 per cent of headache sufferers. Significantly more women reported
headache than men. The excursion of the two chosen anatomical points was reproducible over
days, and over a month. Angles of excursion of 11.5 degrees or more,
traced by the spinous process of C7, were associated with frequent
headache. The crude odds ratios (C.O.R.) were similar for men and women
(2.29 (95%CL 1.03-5.01) and 2.43 (95%CL 1.00-5.81) respectively). Angles
of excursion of 6 degrees or more, traced by the superior-most tip of the helix
of the ear, were associated with frequent headache for men but not for
women (C.O.R. of 1.73 (95%CL 0.86-3.49) and 1.06 (95%CL 0.52-2.14)
respectively). There was no convincing association between occasional
headache and large angles of excursion at the spinous process of C7 and the
superior-most tip of the helix of the ear, for either men or women. The cervical resting posture described by large angles of excursion of the
superior-most tip of the helix of the ear, and of the spinous process of C7 was
characterised by a forward leading chin with the occiput of the skull caudally
rotated within, or slightly anterior to, the vertical axis. The cervical lordosis
was habitually extended in this resting head position.
In order to inform future studies on headache, and to control for confounding
effects on the association between frequent headache and cervical excursion
angles, a number of other causes of headache were proposed and measured.
There was little biological theory to guide these investigations. Two
scenarios were proposed to more clearly define the nature of the relationship
of headache with its causes. One scenario was proposed where causes of
headache were associated in an antecedent fashion with cervical resting
posture during postural development, and during moment-by-moment
postural manoeuvres. The second scenario described the independent
action of selected variables with headache, acting on established posture. There were gender differences in estimates of the strength of association,
between headache, cervical resting posture and the other proposed causes
of headache. The cross-sectional nature of the data precluded more specific
examination of these relationships. Under the scenario of independence of
action with headache, wearing dentures confounded the association between
C7 excursion angles and frequent headache for men but not for women. A
predictive model for frequent headache was developed. It included only the
dummy predictor for C7 excursion angles, as no other variable was identified
as an important inclusion. This model predicted frequent headache with
moderate sensitivity and fair specificity, but predicted less well in an
independent data set.

Item Type: Thesis (PhD)
Keywords: Headache, Posture
Copyright Holders: The Author
Copyright Information:

Copyright 1996 the Author - The University is continuing to endeavour to trace the copyright
owner(s) and in the meantime this item has been reproduced here in good faith. We
would be pleased to hear from the copyright owner(s).

Additional Information:

Thesis (Ph.D.)--University of Tasmania, 1996

Date Deposited: 09 Dec 2014 00:01
Last Modified: 14 Mar 2017 05:27
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