The fascial-biomechanical relationship in headache: cross-sectional investigation with clinical correlations

Mechanical and fascial connections may be associated with a series of problems that could be related to headaches, including plantar alignment disorders, lower-extremity - related dysfunctions, and spinal misalignment; connections to cranial structures such as the dura mater have also been proposed conceptually, though these remain theoretical rather than clinically established.

To investigate the possible associations between dysfunction in the posterior biomechanical chain, including fascial structures, and headache, particularly regarding mechanical stress in the craniocervical region and its potential relationship with the presence and persistence of headaches.

The cross-sectional study was completed with 24 individuals diagnosed with headache and 24 healthy controls. In addition to participants' clinical headache assessments, foot posture was evaluated using the Foot Posture Index (FPI) and the Navicular Drop Test (NDT). Lower extremity flexibility was measured using standard goniometric assessment. Spinal angles were assessed in the lumbar, thoracic, and cervical regions using a digital inclinometer. Forward head posture was assessed by measuring the distance between the tragus and malleolus from the lateral side. Both groups were compared in terms of these variables.

The groups were similar in terms of age, gender, and dominant side (p > .05), but body mass index was significantly higher in the headache group (p = .044). In the fascial-biomechanical assessment, left hamstring flexibility (p = .033) and lumbar spinal angle (p = .049) were significantly lower in the headache group, while cervical spinal angle was significantly higher (p = .033). No significant differences were found between groups regarding other lower extremity, foot posture, and spinal parameters (p > .05).

Differences in regions distant from the craniocervical area, particularly the hamstrings and lumbar spine, were associated with selected postural and flexibility characteristics in individuals with headache. These findings suggest that elements of the posterior chain beyond the cervical region may warrant consideration in the musculoskeletal assessment of individuals with headache, pending confirmation from future studies.