Cervicogenic headache in forward head posture: frequency and associated factors in a cross-sectional study

Background: This study aimed to determine the frequency and associated factors of cervicogenic headache (CGH) in individuals with forward head posture (FHP). Additionally, craniovertebral angle (CVA)-related factors were examined in patients diagnosed with CGH. Methods: This cross-sectional study included 117 patients aged 18–45 years who presented with neck pain and were identified with FHP. CGH diagnosis was based on the International Classification of Headache Disorders (ICHD-3) criteria. CVA was measured using posture analysis software, and assessments included the Neck Disability Index (NDI), Henry Ford Headache Disability Inventory (HDI-T), Headache Impact Scale (HIT-6), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and Visual Analog Scale (VAS) for pain. Statistical analyses included independent t-tests, chi-square tests and logistic regression models. Results: The frequency of CGH in patients with FHP was 53.8%. Compared to the non-CGH group, those with CGH had significantly lower CVA (p = 0.030) and higher PSQI (p = 0.001) and BDI scores (p < 0.001). Logistic regression analysis identified low CVA (Odds Ratio (OR): 0.878, p = 0.014) and poor sleep quality (OR: 1.140, p = 0.025) as independent predictors of CGH. Additionally, Body Mass Index and VAS scores were negatively correlated with CVA (p < 0.05). Conclusions: FHP may be associated with CGH, possibly through increased biomechanical load and neuromechanical sensitivity. Interventions such as corrective exercises, weight management, and improving sleep quality may be considered as supportive strategies in CGH management; however, causal relationships cannot be inferred from this study. Further studies are needed to explore the long-term effects of postural interventions on CGH.

Cervicogenic headache; Head; Posture; Cervical vertebrae

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