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Diagnostic Criteria and Outcome Measures for Cervicogenic Headache in Randomised Controlled Trials: An Updated
Sushmitha Iyer1, Kalashree Hadya Ananda1, Muhammed Rashid2,3
1Department of Musculoskeletal Sciences, JSS College of Physiotherapy, Mysore, Karnataka, India.
Insights
Diagnosing cervicogenic headache (CGH) is challenging due to overlapping symptoms. This review found inconsistent diagnostic criteria and outcome measures in studies, especially for younger patients, highlighting a need for standardization.
Area of Science:
- Neurology
- Clinical Research
- Evidence-Based Medicine
Background:
- Cervicogenic headache (CGH) diagnosis is complicated by overlapping symptoms with other headache types, leading to misdiagnoses in up to 50% of cases.
- A lack of standardized diagnostic criteria and outcome measures hinders effective research and clinical practice for CGH.
Purpose of the Study:
- To systematically review diagnostic criteria for CGH used in randomized controlled trials (RCTs) from 1997 to 2023.
- To examine outcome measures and physical examination methods in these RCTs, considering different age groups.
- To identify inconsistencies and gaps in current CGH diagnostic and assessment practices.
Main Methods:
- A systematic literature search was conducted across six electronic databases.
- 498 articles were screened, with 59 RCTs meeting inclusion criteria based on PICO format.
- Data extraction and narrative qualitative synthesis were performed due to heterogeneity.
Main Results:
- Fifty-nine RCTs involving 3454 participants were analyzed.
- Cervicogenic Headache International Study Group (CHISG/Sjaastad) criteria (49%) and International Headache Society (IHS) criteria (39%) were most common.
- Inconsistency in diagnostic criteria was noted, particularly in pediatric and adolescent studies.
Conclusions:
- Significant inconsistency exists in diagnostic criteria and outcome measures for CGH, especially in pediatric populations.
- Variable application of established diagnostic frameworks limits study comparability and clinical translation.
- Standardized diagnostic criteria and outcome measures are urgently needed for CGH research and clinical practice across all age groups.
Background:
The overlap in signs and symptoms of CGH with other forms of headaches greatly complicates the process of an appropriate diagnosis, resulting in inaccurate diagnoses in approximately 50% of CGH cases.
Objective:
To identify and categorise the diagnostic criteria employed for CGH in randomised controlled trials published from 1997 to 2023 and to descriptively examine the outcome measures and physical examination methods employed, with reference to different age group applications.
Methodology:
The literature search for this systematised review was conducted from six different electronic databases using a specific search strategy and citation tracking. In total, 498 articles were screened by two reviewers based on preset inclusion and exclusion criteria using the PICO format, and disagreements were resolved by consensus; 59 RCTs were included in the review. Data were extracted on study characteristics, diagnostic criteria, outcome measures, and assessment methods. Due to methodological and clinical heterogeneity, a narrative qualitative synthesis was performed.
Results:
Fifty-nine RCTs involving 3454 participants were included. The mean age of participants ranged from 11.6 ± 2.3 years in paediatric samples to 54.5 ± 7.9 years in older adults. Cervicogenic Headache International Study Group (CHISG/Sjaastad) criteria were most commonly used (49%), followed by International Headache Society (IHS) criteria (39%) and International Classification of Headache Disorders, 2nd edition (ICHD-2) criteria (3%). The commonly employed outcome measures included pain intensity (VAS/NPRS), headache frequency and duration, cervical range of motion, and disability indices (e.g., NDI). Subgroup analysis revealed a lack of standardised diagnostic criteria in paediatric and adolescent studies.
Conclusion:
The included studies identified inconsistency in diagnostic criteria and outcome measures, particularly in younger populations. Despite the availability of established frameworks, their variable applications in the studies limit their comparability and clinical translation. This review highlights the urgent need for standardised diagnostic criteria for specific age and outcome coresets to strengthen future CGH research and clinical practice.
