Chronic Primary Headache Subjects Have Greater Forward Head Posture than Asymptomatic and Episodic Primary Headache Sufferers: Systematic Review and Meta-analysis

Abstract

Objective To summarize the cervical physical examination characteristics in subjects with chronic primary headache and compare those with a healthy population and a population with episodic primary headache. Design Systematic review and meta-analysis. Subjects Humans ≥18 years old. At least one of the study groups should be constituted by subjects diagnosed with one of the chronic primary headache subtypes according to the International Classification of Headache Disorders, 3rd Edition. Comparison Neck physical examination outcomes of subjects with chronic primary headache compared with a healthy population or subjects with episodic primary headache. Outcomes Forward head posture (FHP), cervical range of movement, motor control, neck muscle activity, and reproduction and resolution of symptoms. Methods Two reviewers assessed independently the MEDLINE, EMBASE, WOS, MEDES, PEDro, and CINAHL databases to select observational studies. First, both implemented an agreement for a search strategy. Then, they screened independently for duplicates, titles, abstracts, and full-text information. A meta-analysis was conducted to compare measures between groups. Results Twelve studies (N = 1,083) with moderate quality (mean ± SD = 7.75 ± 1.48 on the Newcastle Ottawa Scale) were selected for the qualitative analysis. The meta-analysis showed that patients with chronic primary headache presented greater forward head posture than asymptomatic participants (N = 275, Hg = 0.68, 95% CI = 0.25–1.1, Z = 3.14, P < 0.01) and patients with episodic primary headache (N = 268, Hg = 0.39, 95% CI = 0.13–0.65, Z = 2.98, P < 0.01). Conclusions There is moderate to strong evidence that patients with chronic primary headache present greater FHP than asymptomatic individuals and moderate evidence that patients with chronic primary headache present greater forward head posture than those with episodic primary headache.

Inter, intra-examiner reliability and validity of inertial sensors to measure the active cervical range of motion in patients with primary headache

“…Even though those differences were all lower than the MDC 90 , authors recommend to interpret those results with caution. Finally, recent systematic reviews with meta-analyses indicate that patients with chronic primary headache present higher forward head posture than those with episodic primary headache and asymptomatic individuals (Elizagaray-Garcia et al, 2020[ 11 ]); thus, we consider it a limitation that the sensor does not measure this type of movement and we propose it as a future line of research.…”

“…The research was performed in 2 visits to prevent possible bias in the results of the second measurement after numerous cervical movements in patients with high cervical disability (Liang et al, 2019[ 22 ]; Szikszay et al, 2019[ 30 ]; Elizagaray-Garcia et al, 2020[ 11 ]). During the first visit, each participant was provided with all the information related to the study and was given an additional information document to consult if required.…”

Radiophobic Fear-Mongering, Misappropriation of Medical References and Dismissing Relevant Data Forms the False Stance for Advocating Against the Use of Routine and Repeat Radiography in Chiropractic and Manual Therapy

“…58,59 All of these spinal parameters are diagnosed by radiography and, again, these relationships are current scientific consensus based on SRs. 54 -59…”

“…anterior head translation), for example, is associated with headache, altered muscle activity, altered proprioception, altered breathing, pain and disability. [54][55][56] Loss of lumbar lordosis, particularly loss of distal lordosis is associated with and causative for low back pain (LBP). 57,58 Osteoarthritis and spondylolisthesis are linked to LBP.…”

“…58,59 All of these spinal parameters are diagnosed by radiography and, again, these relationships are current scientific consensus based on SRs. [54][55][56][57][58][59] As mentioned, despite factions within chiropractic claiming the opposite, the routine assessment of a patient's spinopelvic biomechanical parameters is the standard for evaluating adult spinal deformity (ASD) and subluxation/misalignment patterns. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][60][61][62] The International Spine Study Group (ISSG) in fact states: "accurate assessment of ASD requires a thorough radiographic evaluation of both the spine and pelvis, including concomitant assessment of the cervical, thoracic, and lumbar spine, as well as the femoral heads and pelvis."…”