{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T22:49:31Z","timestamp":1779922171651,"version":"3.53.1"},"reference-count":58,"publisher":"Oxford University Press (OUP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,2,1]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Cervicogenic headache (CGH) is defined as headache symptoms originating from the cervical spine. Cervical dysfunction from abnormal posture has been proposed to aggravate or cause CGH, but there are conflicting reports as to whether there is an association between posture and CGH.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>The purpose of this study was to evaluate differences in cervical spinal posture, measured on radiographs, between patients with probable CGH and asymptomatic control participants.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>A single-blinded comparative measurement design was used.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Differences in postural variables from radiographs between participants with CGH (n=30) and age- and sex-matched asymptomatic control participants (n=30) were determined using paired t tests or the nonparametric equivalent. Postural variables were general cervical lordosis (GCL, Cobb angle C2\u2013C7), upper cervical lordosis (UCL, sagittal alignment C2 compared with C3\u2013C4), and C2 spinous process horizontal deviation. Logistic regression determined postural variables, increasing the likelihood of CGH.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There were no significant differences in posture between the CGH and control groups. The mean GCL was 10.97 degrees (SD=7.50) for the CGH group and 7.17 degrees (SD=5.69) for the control group. The mean UCL was 11.86 degrees (SD=6.46) for the CGH group and 9.44 degrees (SD=4.28) for the control group. The mean C2 spinous process horizontal deviation was 3.00 mm (SD=1.66) for the CGH group and 2.86 mm (SD=2.04) for the control group. However, there was a significant association between greater GCL and an increased likelihood of having CGH (odds ratio=1.08; 95% confidence interval=1.001, 1.191).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Limitations<\/jats:title>\n                  <jats:p>The findings are limited to an association between GCL and posture, as cause and effect cannot be determined.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The association between greater GCL and increased likelihood of having CGH suggests that GCL might be considered in the treatment of patients with CGH. However, as the data do not support posture as a cause of CGH, it is unknown whether addressing posture would reduce CGH.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2522\/ptj.20140073","type":"journal-article","created":{"date-parts":[[2014,10,10]],"date-time":"2014-10-10T00:00:17Z","timestamp":1412899217000},"page":"212-222","source":"Crossref","is-referenced-by-count":22,"title":["An Investigation of Cervical Spinal Posture in Cervicogenic Headache"],"prefix":"10.1093","volume":"95","author":[{"given":"Peter K.","family":"Farmer","sequence":"first","affiliation":[{"name":"P.K. Farmer, BAppSc(Physio), MPhil(Physio), Thrive Physio Health Clinic, Erina, New South Wales, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne J.","family":"Snodgrass","sequence":"additional","affiliation":[{"name":"S.J. Snodgrass, PT, PhD, MMedSc(Physio), Discipline of Physiotherapy, School of Health Sciences, Faculty of Health and Medicine, Hunter Building, The University of Newcastle, University Drive, Callaghan, New South Wales, Australia 2308."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony J.","family":"Buxton","sequence":"additional","affiliation":[{"name":"A.J. Buxton, DipAppSc(Med Rad), MHEd, Discipline of Medical Radiation Science (Diagnostic Radiography), School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren A.","family":"Rivett","sequence":"additional","affiliation":[{"name":"D.A. Rivett, PhD, MAppSc(ManipPhty), BAppSc(Phty), Discipline of Physiotherapy, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","reference":[{"key":"2019123005374485000_B1","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1016\/j.jmpt.2008.10.004","article-title":"Spinal curves and health: a systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health","volume":"31","author":"Christensen","year":"2008","journal-title":"J Manipulative Physiol Ther"},{"key":"2019123005374485000_B2","volume-title":"Musculoskeletal Physiotherapy: Clinical Science and Evidence-Based Practice","author":"Refshauge","year":"2004","edition":"2nd ed"},{"key":"2019123005374485000_B3","first-page":"37","article-title":"Structural rehabilitation of the spine and posture: rationale for treatment beyond the resolution of symptoms","volume":"21","author":"Troyanovich","year":"1998","journal-title":"J Manipulative Physiol Ther"},{"key":"2019123005374485000_B4","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/s11910-010-0164-9","article-title":"Cervicogenic headache: a real headache","volume":"11","author":"Antonaci","year":"2011","journal-title":"Curr Neurol Neurosci Rep"},{"key":"2019123005374485000_B5","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1016\/S1474-4422(09)70209-1","article-title":"Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment","volume":"8","author":"Bogduk","year":"2009","journal-title":"Lancet Neurol"},{"key":"2019123005374485000_B6","first-page":"33","article-title":"Treatment of cervicogenic headaches using Mulligan \u201cSNAGS\u201d and postural re-education: a case report","volume":"21","author":"Richardson","year":"2009","journal-title":"Orthopaedic Physical Therapy Practice"},{"key":"2019123005374485000_B7","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1054\/math.1997.0298","article-title":"Management of cervical headache","volume":"2","author":"Jull","year":"1997","journal-title":"Man Ther"},{"key":"2019123005374485000_B8","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1111\/j.1468-2982.2005.01042.x","article-title":"Forward head posture and neck mobility in chronic tension-type headache: a blinded, controlled study","volume":"26","author":"Fern\u00e1ndez-de-las-Pe\u00f1as","year":"2005","journal-title":"Cephalalgia"},{"key":"2019123005374485000_B9","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1111\/j.1468-2982.2006.01162.x","article-title":"Myofascial trigger points, neck mobility and forward head posture in unilateral migraine","volume":"26","author":"Fern\u00e1ndez-de-las-Pe\u00f1as","year":"2006","journal-title":"Cephalalgia"},{"key":"2019123005374485000_B10","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1111\/j.1526-4610.2006.00632.x","article-title":"Myofascial trigger points, neck mobility, and forward head posture in episodic tension-type headache","volume":"47","author":"Fern\u00e1ndez-de-las-Pe\u00f1as","year":"2007","journal-title":"Headache"},{"key":"2019123005374485000_B11","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1046\/j.1468-2982.2001.00264.x","article-title":"Physical impairments in cervicogenic headache: traumatic vs. nontraumatic onset","volume":"21","author":"Dumas","year":"2001","journal-title":"Cephalalgia"},{"key":"2019123005374485000_B12","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1046\/j.1468-2982.1993.1304272.x","article-title":"Cervical headache: an investigation of natural head posture and upper cervical flexor muscle performance","volume":"13","author":"Watson","year":"1993","journal-title":"Cephalalgia"},{"key":"2019123005374485000_B13","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.math.2005.04.007","article-title":"Clinical tests of musculoskeletal dysfunction in the diagnosis of cervicogenic headache","volume":"11","author":"Zito","year":"2006","journal-title":"Man Ther"},{"key":"2019123005374485000_B14","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1007\/s00431-013-2046-z","article-title":"Is there a difference in head posture and cervical spine movement in children with and without pediatric headache?","volume":"172","author":"Budelmann","year":"2013","journal-title":"Eur J Pediatr"},{"key":"2019123005374485000_B15","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1097\/00007632-199804150-00015","article-title":"The correlation between surface measurement of head and neck posture and the anatomic position of the upper cervical vertebrae","volume":"23","author":"Johnson","year":"1998","journal-title":"Spine (Phila Pa 1976)"},{"key":"2019123005374485000_B16","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1111\/j.1526-4610.1993.hed3302090.x","article-title":"Roentgenographic findings of the cervical spine in tension-type headache","volume":"33","author":"Nagasawa","year":"1993","journal-title":"Headache"},{"key":"2019123005374485000_B17","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1111\/j.1526-4637.2006.00201.x","article-title":"Cervical zygapophysial joint pain maps","volume":"8","author":"Cooper","year":"2007","journal-title":"Pain Med"},{"key":"2019123005374485000_B18","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1177\/03331024850050S3118","article-title":"Manual diagnosis of C2\/3 headache","volume":"5","author":"Jull","year":"1985","journal-title":"Cephalalgia"},{"key":"2019123005374485000_B19","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1136\/jnnp.57.10.1187","article-title":"Third occipital nerve headache: a prevalence study","volume":"57","author":"Lord","year":"1994","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"2019123005374485000_B20","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1016\/j.math.2010.06.002","article-title":"Reliability of manual examination and frequency of symptomatic cervical motion segment dysfunction in cervicogenic headache","volume":"15","author":"Hall","year":"2010","journal-title":"Man Ther"},{"key":"2019123005374485000_B21","first-page":"45","article-title":"Use of CT scans in the study of the upper cervical vertebrae in strictly lateralised migrainous headache (and other intermittent headache?)","volume-title":"New Advances in Headache Research","author":"Boquet","year":"1989"},{"key":"2019123005374485000_B22","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1046\/j.1468-2982.1989.901015.x","article-title":"Lateralization of headache: possible role of upper cervical trigger point","volume":"9","author":"Boquet","year":"1989","journal-title":"Cephalalgia"},{"key":"2019123005374485000_B23","volume-title":"Back Pain & Spinal Manipulation","author":"Murtagh","year":"2001","edition":"2nd ed"},{"key":"2019123005374485000_B24","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1046\/j.1526-4610.1998.3806442.x","article-title":"Cervicogenic headache: diagnostic criteria","volume":"38","author":"Sjaastad","year":"1998","journal-title":"Headache"},{"key":"2019123005374485000_B25","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1046\/j.1526-4610.2003.03187.x","article-title":"Cervicogenic headache: locus of control and success of treatment","volume":"43","author":"Stanton","year":"2003","journal-title":"Headache"},{"key":"2019123005374485000_B26","doi-asserted-by":"crossref","first-page":"793","DOI":"10.2165\/00023210-200418120-00004","article-title":"Cervicogenic headache: practical approaches to therapy","volume":"18","author":"Martelletti","year":"2004","journal-title":"CNS Drugs"},{"key":"2019123005374485000_B27","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1007\/s00330-004-2498-7","article-title":"Quantification of C2 cervical spine rotatory fixation by X-ray, MRI and CT","volume":"15","author":"Gradl","year":"2005","journal-title":"Eur Radiol"},{"key":"2019123005374485000_B28","volume-title":"Textbook of Radiographic Positioning and Related Anatomy","author":"Bontrager","year":"2010","edition":"7th ed"},{"key":"2019123005374485000_B29","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1097\/00007632-199704150-00007","article-title":"Apophysial joint degeneration, disc degeneration, and sagittal curve of the cervical spine: can they be measured reliably on radiographs?","volume":"22","author":"Cote","year":"1997","journal-title":"Spine (Phila Pa 1976)"},{"key":"2019123005374485000_B30","doi-asserted-by":"crossref","first-page":"2072","DOI":"10.1097\/00007632-200008150-00011","article-title":"Cobb method or Harrison posterior tangent method: which to choose for lateral cervical radiographic analysis","volume":"25","author":"Harrison","year":"2000","journal-title":"Spine (Phila Pa 1976)"},{"key":"2019123005374485000_B31","first-page":"23","article-title":"Inter and intra-examiner reliability of the upper cervical X-ray marking system: a third and expanded look","volume":"3","author":"Rochester","year":"1994","journal-title":"CRJ: Chiropractic Research Journal"},{"key":"2019123005374485000_B32","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/S0003-6870(01)00043-6","article-title":"A field comparison of neck and shoulder postures in symptomatic and asymptomatic office workers","volume":"33","author":"Szeto","year":"2002","journal-title":"Appl Ergon"},{"key":"2019123005374485000_B33","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1111\/j.1468-2982.2007.01345.x","article-title":"Cervical musculoskeletal impairment in frequent intermittent headache, part 1: subjects with single headaches","volume":"27","author":"Jull","year":"2007","journal-title":"Cephalalgia"},{"key":"2019123005374485000_B34","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1111\/j.1468-2982.2008.01617.x","article-title":"Physical therapy and exercise in headache","volume":"28","author":"Antonaci","year":"2008","journal-title":"Cephalalgia"},{"key":"2019123005374485000_B35","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1046\/j.1468-2982.2003.00605.x","article-title":"Magnetic resonance imaging of patients with cervicogenic headache","volume":"23","author":"Coskun","year":"2003","journal-title":"Cephalalgia"},{"key":"2019123005374485000_B36","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1111\/j.1600-0404.2007.00962.x","article-title":"Prevalence of cervicogenic headache: V\u00e5g\u00e5 study of headache epidemiology","volume":"117","author":"Sjaastad","year":"2008","journal-title":"Acta Neurol Scand"},{"key":"2019123005374485000_B37","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/j.jmpt.2008.08.003","article-title":"Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test","volume":"31","author":"Jull","year":"2008","journal-title":"J Manipulative Physiol Ther"},{"key":"2019123005374485000_B38","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1016\/j.jmpt.2004.05.007","article-title":"Upper crossed syndrome and its relationship to cervicogenic headache","volume":"27","author":"Moore","year":"2004","journal-title":"J Manipulative Physiol Ther"},{"key":"2019123005374485000_B39","doi-asserted-by":"crossref","first-page":"2485","DOI":"10.1097\/01.brs.0000144449.90741.7c","article-title":"Modeling of the sagittal cervical spine as a method to discriminate hypolordosis: results of elliptical and circular modeling in 72 asymptomatic subjects, 52 acute neck pain subjects, and 70 chronic neck pain subjects","volume":"29","author":"Harrison","year":"2004","journal-title":"Spine (Phila Pa 1976)"},{"key":"2019123005374485000_B40","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.jmpt.2005.02.015","article-title":"Determining the relationship between cervical lordosis and neck complaints","volume":"28","author":"McAviney","year":"2005","journal-title":"J Manipulative Physiol Ther"},{"key":"2019123005374485000_B41","doi-asserted-by":"crossref","first-page":"1835","DOI":"10.1097\/00007632-200209010-00004","article-title":"A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache","volume":"27","author":"Jull","year":"2002","journal-title":"Spine (Phila Pa 1976)"},{"key":"2019123005374485000_B42","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1007\/BF01627655","article-title":"Longus colli has a postural function on cervical curvature","volume":"16","author":"Mayoux-Benhamou","year":"1994","journal-title":"Surg Radiol Anat"},{"key":"2019123005374485000_B43","volume-title":"Whiplash, Headache and Neck Pain","author":"Jull","year":"2008"},{"key":"2019123005374485000_B44","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1007\/s10194-012-0436-7","article-title":"Manual therapies for cervicogenic headache: a systematic review","volume":"13","author":"Chaibi","year":"2012","journal-title":"J Headache Pain"},{"key":"2019123005374485000_B45","doi-asserted-by":"crossref","first-page":"344","DOI":"10.2340\/16501977-0527","article-title":"Effect of neck exercises on cervicogenic headache: a randomized controlled trial","volume":"42","author":"Ylinen","year":"2010","journal-title":"J Rehabil Med"},{"key":"2019123005374485000_B46","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.math.2011.12.005","article-title":"Can a functional postural exercise improve performance in the cranio-cervical flexion test? a preliminary study","volume":"17","author":"Beer","year":"2012","journal-title":"Man Ther"},{"key":"2019123005374485000_B47","doi-asserted-by":"crossref","first-page":"408","DOI":"10.2522\/ptj.20060009","article-title":"Effect of neck exercise on sitting posture in patients with chronic neck pain","volume":"87","author":"Falla","year":"2007","journal-title":"Phys Ther"},{"key":"2019123005374485000_B48","doi-asserted-by":"crossref","first-page":"E458","DOI":"10.1097\/BRS.0b013e31828802c2","article-title":"The effect of age on cervical sagittal alignment: normative data on 100 asymptomatic subjects","volume":"38","author":"Park","year":"2013","journal-title":"Spine (Phila Pa 1976)"},{"key":"2019123005374485000_B49","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1016\/S0020-1383(98)00184-3","article-title":"Cervical curvature in acute whiplash injuries: prospective comparative study with asymptomatic subjects","volume":"29","author":"Matsumoto","year":"1998","journal-title":"Injury"},{"key":"2019123005374485000_B50","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1302\/0301-620X.76B1.8300650","article-title":"The straight cervical spine: does it indicate muscle spasm?","volume":"76","author":"Helliwell","year":"1994","journal-title":"J Bone Joint Surg Br"},{"key":"2019123005374485000_B51","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1007\/s11916-001-0029-7","article-title":"Cervicogenic headache: anatomic basis and pathophysiologic mechanisms","volume":"5","author":"Bogduk","year":"2001","journal-title":"Curr Pain Headache Rep"},{"key":"2019123005374485000_B52","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1046\/j.1526-4610.2000.040008689.x","article-title":"Case reports: headache caused by a spinal cord stimulator in the upper cervical spine","volume":"40","author":"Ward","year":"2000","journal-title":"Headache"},{"key":"2019123005374485000_B53","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1111\/j.1526-4637.2006.00247.x","article-title":"The longitudinal effectiveness of lateral atlantoaxial intra-articular steroid injection in the treatment of cervicogenic headache","volume":"8","author":"Narouze","year":"2007","journal-title":"Pain Med"},{"key":"2019123005374485000_B54","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1007\/BF00588037","article-title":"C2 rotation and spinous process deviation in migraine: cause or effect or coincidence?","volume":"33","author":"Macpherson","year":"1991","journal-title":"Neuroradiology"},{"key":"2019123005374485000_B55","doi-asserted-by":"crossref","first-page":"3","DOI":"10.2519\/jospt.2005.35.1.3","article-title":"A specific exercise program and modification of postural alignment for treatment of cervicogenic headache: a case report","volume":"35","author":"McDonnell","year":"2005","journal-title":"J Orthop Sports Phys Ther"},{"key":"2019123005374485000_B56","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1056\/NEJMra010917","article-title":"Migraine: current understanding and treatment","volume":"346","author":"Goadsby","year":"2002","journal-title":"N Engl J Med"},{"key":"2019123005374485000_B57","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1111\/j.1526-4610.2012.02169.x","article-title":"Head pain referral during examination of the neck in migraine and tension-type headache","volume":"52","author":"Watson","year":"2012","journal-title":"Headache"},{"key":"2019123005374485000_B58","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1046\/j.0333-1024.2001.00207.x","article-title":"Cervicogenic headache: evaluation of the original diagnostic criteria","volume":"21","author":"Antonaci","year":"2001","journal-title":"Cephalalgia"}],"container-title":["Physical Therapy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ptj\/article-pdf\/95\/2\/212\/31633693\/ptj0212.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ptj\/article-pdf\/95\/2\/212\/31633693\/ptj0212.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,12,30]],"date-time":"2019-12-30T05:37:59Z","timestamp":1577684279000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ptj\/article\/95\/2\/212\/2684140"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,2,1]]},"references-count":58,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2015,2,1]]}},"URL":"https:\/\/doi.org\/10.2522\/ptj.20140073","relation":{},"ISSN":["0031-9023","1538-6724"],"issn-type":[{"value":"0031-9023","type":"print"},{"value":"1538-6724","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,2,1]]}}}