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

## TL;DR

This study found that over half of people with forward head posture had cervicogenic headaches, which were linked to poor sleep and a smaller craniovertebral angle.

## Contribution

The study identifies low craniovertebral angle and poor sleep quality as independent predictors of cervicogenic headache in individuals with forward head posture.

## Key findings

- Cervicogenic headache occurred in 53.8% of individuals with forward head posture.
- Low craniovertebral angle and poor sleep quality independently predicted cervicogenic headache.
- Body Mass Index and pain scores were negatively correlated with craniovertebral angle.

## Abstract

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.