The "skin roll" test: a diagnostic test for cervicogenic headache?

Area of Science:

• Neurology
• Diagnostic Medicine

Background:

• Cervicogenic headache (CeH) diagnosis can be challenging.
• Differentiating CeH from other headache types like tension-type headache (TTH) and migraine without aura (MwoA) is crucial for effective treatment.

Purpose of the Study:

• To evaluate the diagnostic utility of the skin roll test in distinguishing cervicogenic headache from tension-type headache and migraine without aura.
• To assess tenderness and skinfold thickness variations in specific anatomical positions.

Main Methods:

• Skin roll tests were conducted on patients with CeH, TTH, and MwoA, as well as a control group.
• Three positions were tested: trapezius, mandibular, and supraorbital.
• Tenderness and skinfold thickness were measured using a visual analogue scale and compared between symptomatic and non-symptomatic sides.

Main Results:

• Tenderness in the trapezius position was reported by 93.3% of CeH patients, 53.3% of TTH patients, and 18.6% of MwoA patients.
• Tenderness asymmetry (> or = 10 mm) in the trapezius position was observed in 67% of CeH patients versus 20% of TTH patients and 0% of MwoA patients.
• Skinfold thickness differences were less discriminatory, though both tenderness and thickness were higher on the symptomatic side in the trapezius position for CeH patients.

Conclusions:

• Tenderness asymmetry in the trapezius position during a skin roll test may suggest cervicogenic headache over migraine without aura.
• The skin roll test has limited value in the differential diagnosis of individual cases due to considerable overlap between headache groups.
• Thickness measurements were not significantly helpful in differentiating CeH from other headache types.