ClinicalTrials.gg
RecruitingNCT04722913Updated Jan 20, 2025

Relation Between Cervicogenic Headache and Forward Head Posture

An observational study in Cervicogenic Headache, sponsored by Cairo University. Recruiting at 1 site in Egypt. Open to participants aged 18 Years to 25 Years. Per ClinicalTrials.gov, last updated 2025-01-20.

Sponsored by Cairo University · Observational

From the registry’s dates

  • Primary completion was expected by Jan 2025, 1 year 9 months ago, but the record still lists the study as recruiting.
  • Started Dec 2024; still recruiting 1 year 11 months later.
Study type
Observational
Model
Cohort
Time perspective
Prospective
Enrollment
400
Ages
18 Years to 25 Years
Sex
All
01

Study summary

This study will be designed to determining whether there is a relationship between CGH and cervical posture which may potentially provide physical therapists with evidence supporting the assessment and treatment of abnormal posture in this patient group.

Read the detailed description

Headaches have been posed to be a common occurring complaint being as frequent as 66% in general population. One the common types of headaches is Cervicogenic Headache which is considered as a secondary headache whereas the symptoms occur due to cervical spine and its bony components, disc or soft tissue structures. Cervicogenic headache is a syndrome described as pain felt on one side of the head, relating same side neck, shoulder and arm pain that is aggravated by neck movements or sustained head posture The prevalence of CGH has been reported 4.1% in general population 17.5% in patients and 41.4% in medical students.

The most general cause of cervicogenic headache (CGH) is the alteration of structure in the neck due to bad posture.

Proper posture is defined as a musculoskeletal balance which involves a minimal amount of stress and strain on the body , Forward head posture (FHP) is one of the commonly recognized types of poor head postures in the sagittal plane.FHP was defined as 'any alignment in which the external auditory meatus is positioned anterior to the plumbline through the shoulder joint.

Sustaining the head in this forward posture for prolonged period of time has been associated with the development of other musculoskeletal disorders such as 'upper crossed syndrome', which leads to reduction of lordosis in lower cervical and kyphosis of upper thoracic vertebra. In the long run, this may cause shortening of muscular fibers muscles involving the atlanto-occipital articulation, overstretching of muscles around joint and leads to chronic neck pain , There are many factors that could contribute to the development of forward head posture such as age, gender frequency of physical activity, occupation, usage of computer and smartphones and others.

It is noted that CGHs can often be related to forward neck and head posture, which is accompanied by a high muscular tone of the supporting extensors to keep the head from gravity. Such unstable state causes overstrain of the cervical muscles, and induces headache and neck pain.

FHP is a common postural defect among university students. This high prevalence may be related to the prolonged computer use and faulty posture during lectures.

Office workers of being sedentary for prolonged periods are liable to adopt forward head posture and thus generating neck strain, sprain and pain. Moreover, forward head posture is commonly found in people spending long periods on computers, mobile phones and game consoles.

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.

Statement of the problem:

There is lack of literature concerning the presence of cervicogenic headache among subjects with forward head posture.

This study will answer the following question Does forward head Posture is associated with cervicogenic headache?

Purpose of the study:

This study will be designed to determining whether there is a relationship between CGH and cervical posture which may potentially provide physical therapists with evidence supporting the assessment and treatment of abnormal posture in this patient group.

Significance of the study:

Ideal posture describes a state of maintaining balance in the body using minimal musculoskeletal activity without causing pain or discomfort. The tendency to stay seated for long periods of time can cause changes in the alignment of the spine, leading to improper posture, such as a rounded shoulder or forward head posture (FHP) .This change in posture can lead to a spatial change between the spine and the line of gravity, causing an overload on muscles and connective tissues . Neck pain or neck dysfunction is a musculoskeletal disorder caused by improper posture with physical impairment or functional limitation. The FHP is known as an internal factor that causes dysfunction with shoulder and neck pain. FHP results in a posture in which the extended head and upper cervical, and the lower cervical vertebrae flex. This increases the length of the external moment (the arm) by moving the gravitational center (the head) ahead of the load bearing axis. The exposure to this constant load on the craniovertebral extension muscles and the noncontractile structures causes a change in the biomechanical movement, and this increased stress can cause musculoskeletal damage or pain. In addition, FHP can also limit the functional movement in the head and neck area. These limitations are caused by irregular rotation and gliding movement inside the articular capsule whilst moving the joint. Moreover, it was reported that extended periods of FHP can result in a decreased number of sarcomere, as well as shortening of the muscle fibers, which can affect muscular contraction. As mentioned above, there are frequent occurrences of functional movement limitations or non-specific pain in the head and neck region in patients with FHP. Therefore, many studies have described the aspects of FHP that lead to functional movement limitations, and the pain in the head and neck area.

It is known that the quality of life in people suffering from headache is worse than in healthy subjects, in addition, this high prevalence disorder has negative health consequences in terms of occupational, economic and social factors.

The proposed association between abnormal cervical posture and headache has been demonstrated in migraine and tension-type headaches, but there are conflicting results in CGH. Despite this lack of agreement, clinicians routinely assess and treat altered posture for CGH. therefore, it is important to examine possible associations in order to guide treatment.

Hypotheses:

There will be no significant relationship between cervicogenic headache and forward head posture.

02

Conditions studied

  • Cervicogenic Headache
03

In context

Post-Traumatic Headache

192 studies on the registry are indexed under Post-Traumatic Headache; 54 are open to participants now.

This study's planned enrollment of 400 is above the median of 90 across 21 observational studies indexed under Post-Traumatic Headache.

Browse Post-Traumatic Headache studies →

Lead sponsor

Cairo University is the lead sponsor of 4,941 studies on the registry; 1,458 are open to participants now.

Of its 37 completed or terminated interventional studies of FDA-regulated products, 5 (14%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years to 25 Years
Sexes eligible
All
Sampling method
Non-probability sample

Study population

University students who were taking consecutive lectures for 3 hours. Subjects who worked forward for 3 hours or more on laptop. Subjects usually in awkward head position.

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  1. Subjects with Craniovertebral angle (CVA) less than 50 degrees. (Gavin Morrison, 2018).
  2. University students who were taking consecutive lectures for 3 hours and who worked forward for 3 hours or more on laptop (Arfa Naz et al, 2018).

Exclusion criteria

Exclusion Criteria:

  1. History of significant medical conditions that might be potential to physical examination of the cervical spine, including known cancer, osteoporosis, nerve root symptoms, inflammatory or infectious diseases affecting the neck instability of the cervical spine, or reported potential vertebrobasilar insufficiency symptoms (Peter K. Farmer et al, 2015).
  2. History of cervical spine injures (fracture, sprain, strain, whiplash), cervical spondylosis, obvious spinal deformities, neurological and neuromuscular disorders, TMJ dysfunction, cervicothoracic and lumbar kyphoscoliosis, rheumatic disease, torticollis, and balance disorders (B. Shaghayegh fard et al, 2015).
Terms in these criteria, in plain language(1)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Contraindication

A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.

05

Study design

Observational model
Cohort
Time perspective
Prospective
Enrollment
400 participants (estimated)
Patient registry
No

Interventions

  • Diagnostic testPhotogrametry , flexion rotation (FRT) test, Diagnosis of CGH according diagnostic criteria of the Cervicogenic Headache International Study Group (CHISG)

    Photogrammetry is the science and technology of obtaining reliable information about physical objects and the environment through the process of recording, measuring and interpreting photographic images and patterns of electromagnetic radiant imagery and other phenomena. Flexion rotation (FRT) test: FRT is a manual examination technique with high sensitivity and specificity. It is performed with the patient in supine by passively taking the cervical spine into full flexion. End-range cervical flexion imparts ligamentous tension that impedes movement at vertebral segments below C2.7 Maintaining the flexion position, the patient's head is then rotated to each side until the patient reports pain or the operator determines that end of motion has been achieved. It is then determined if a restriction in ROM is present.

06

What researchers measure

Primary outcomes

  1. comparing FRT and photogrammetry findings to CHISG criteria.

    Analysis of photogrammetry, interpreting the results of the flexion rotation test to diagnose the presence of forward head posture then identify if FHP is correlated with cervicogenic headeach which will be diagnosed by diagnostic criteria of the Cervicogenic Headache International Study Group (CHISG).

    Time frame: baseline

07

Study locations

1 of 1 sites recruiting
  • Mirna Ebrahim Abdelmagid
    Giza, 12511, Egypt
    Recruiting
08

References and documents

Publications

  • Blumenfeld A, Siavoshi S. The Challenges of Cervicogenic Headache. Curr Pain Headache Rep. 2018 Jun 13;22(7):47. doi: 10.1007/s11916-018-0699-z. PubMed 29900508 ↗
09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reached

Started Dec 2024 (actual). Primary completion is estimated for Jan 2025, 1 month after the start.

How these figures are worked out, and which studies are left out of them.

Registered
Jan 21, 2021
First posted
Jan 25, 2021
StartActual
Dec 10, 2024
Primary completionEst.
Jan 30, 2025
CompletionEst.
Feb 15, 2025
Last update
Jan 20, 2025
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Jan 20, 2025, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT04722913
Lead sponsor
Cairo University
Responsible party
Merna ibrahim (Researcher, Cairo University) — Principal investigator
First posted
Jan 25, 2021
Start date
Dec 10, 2024
Primary completion
Jan 30, 2025 (estimated)
Completion
Feb 15, 2025 (estimated)
Last update
Jan 20, 2025

Study contacts

merna ibrahim, Bsc
Contact
mernaibrahim00@gmail.com
01113983641
Yasser Ramzy, Professor
study director · Cairo University
Maher El-Kabalawy, Professor
study chair · Cairo University

Oversight

FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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