Manual diagnostics of the segmental dysfunction of C1-C2 and C2-C3 segments in cervicogenic headache and migraine

One of the main etiological factors of cervicogenic headache (CGH) is a violation of the biomechanics of the cervical spine (CS), mainly in the joints of the three upper cervical vertebrae (C1, C2, C3). To identify motion restriction in patients with CGH, a so-called flexion–rotation test has been proposed, which makes it possible to assess the limitation of the mobility of the atlantoaxial joint (C1-C2), which occurs on the side of the headache. Also, this test has been proposed for the differential diagnosis of CGH and migraine. Since the sources of CGH can be both the C1-C2 and C2-C3 joints, we proposed an alternative test – the test for lateral side bending and rotation in the C1-C2 and C2-C3 joints. During this test, the occlusion of movements in the joints below the C1-C2 spinal motion segment is achieved not by bending the neck, but by side bending in the C2-C3 joint. We used this test for both CGH and migraine.