Objectives: Cervical movement impairment has been identified as a core component of cervicogenic headache evaluation. However, normal range of motion values in children has been investigated rarely and no study has reported such values for the flexion-rotation test (FRT). The purpose of this study was to identify normal values and side-to-side variation for cervical spine range of motion (ROM) and the FRT, in asymptomatic children aged 6-12 years. Another important purpose was to identify the presence of pain during the FRT. Methods: Thirty-four asymptomatic children without history of neck pain or headache (26 females and 8 males, mean age 125.38 months [SD 13.14]) were evaluated. Cervical spine cardinal plane ROM and the FRT were evaluated by a single examiner using a cervical ROM device. Results: Values for cardinal plane ROM measures are presented. No significant gender difference was found for any ROM measure. Mean difference in ROM for rotation, side flexion, and the FRT were less than one degree. However, intra-individual variation was greater, with lower bound scores of 9.32u for rotation, 5.30u for side flexion, and 10.89u for the FRT. Multiple linear regression analysis indicates that movement in the cardinal planes only explains 19% of the variance in the FRT. Pain scores reported following the FRT were less than 2/10. Discussion: Children have consistently greater cervical spine ROM than adults. In children, side-to-side variation in rotation and side flexion ROM and range recorded during the FRT indicates that the clinician should be cautious when using range in one direction to determine impairment in another. Range recorded during the FRT is independent of cardinal movement variables, which further adds to the importance of the FRT, as a test that mainly evaluates range of movement of the upper cervical spine.

Pediatric headache is an increasingly reported phenomenon. Cervicogenic headache (CGH) is a subgroup of headache, but there is limited information about cervical spine physical examination signs in children with CGH. Therefore, a cross-sectional study was designed to investigate cervical spine physical examination signs including active range of motion (ROM), posture determined by the craniovertebral angle (CVA), and upper cervical ROM determined by the flexion-rotation test (FRT) in children aged between 6 and 12 years. An additional purpose was to determine the degree of pain provoked by the FRT. Thirty children (mean age 120.70 months [SD 15.14]) with features of CGH and 34 (mean age 125.38 months [13.14]) age-matched asymptomatic controls participated in the study. When compared to asymptomatic controls, symptomatic children had a significantly smaller CVA (p < 0.001), significantly less active ROM in all cardinal planes (p < 0.001), and significantly less ROM during the FRT (p < 0.001), especially towards the dominant headache side (p < 0.001). In addition, symptomatic subjects reported more pain during the FRT (p < 0.001) and there was a significant negative correlation (r = -0.758, p < 0.001) between the range recorded during the FRT towards the dominant headache side and FRT pain intensity score. This study found evidence of impaired function of the upper cervical spine in children with CGH and provides evidence of the clinical utility of the FRT when examining children with CGH.

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Schulalter und bis zu 80 Prozent bei Jugendlichen zu [32]. Kinder mit stark ausgeprägten Kopfschmerzen weisen eine allgemein geringere Lebensqualität auf [4]. Des Weiteren scheinen Kinder, die sehr früh in ihrem Leben unter Kopfschmerzen zu leiden hatten, auchimjungenErwachsenenalterprädisponiertdafürzusein[15]. DiesunterstreichtdieNotwendigkeiteinerkorrektenundfrühzeitigen Diagnose. Allerdings ist die Diagnosestellung meist schwierig, dadieUrsachefürkindlicheKopfschmerzenhäufi gnichtohneWeiteresrichtigerkanntwird.Hinzukommt,dassKinderoftProbleme haben, die Schmerzen genau zu beschreiben [31]. Daher ist eine Analyse auf verschiedenen Ebenen und unter Einbezug anderer Disziplinennotwendig,umdasProblembessererfassenzukönnen. Kindliche Schmerzverarbeitung → Die International Association of PainhatSchmerz1994wiefolgtdefi niert:"eineunangenehmesen-sorischeundemotionelleEmpfi ndung,verbundenmittatsächlicher oder potenzieller Gewebeschädigung oder beschrieben im Sinne einersolchenBeschädigung".DieseSchmerzdefi nitionverdeutlicht, dass die Schmerzwahrnehmung mit der persönlichen Erfahrung Kopfschmerzen bei Kindern Warum ein Kind Kopfschmerzen bekommt oder dauerhaft darunter leidet, kann viele Faktoren haben. Manche sind beeinfl ussbar. So kann es zum Beispiel hilfreich sein, wenn ein Kind vor dem Schlafen nicht mehr fernsieht oder wenn belastende Schulsituationen in die Therapie einbezogen werden. Harry von Piekartz und Kim Budelmann geben einen Überblick, was kindliche Kopfschmerzen beeinfl ussen kann.