Abstract text (incl. figure legends and references)

Objective: To update and evaluate available evidence of the prevalence and the diagnostic accuracy of the detailed history and clinical findings for cervicogenic headache in adults with headache.

Methods: CINAHL, Cochrane Central, Embase, PEDro and PubMed were searched for studies before March 2022 that reported detailed history and/or clinical findings related to the diagnosis of cervicogenic headache. Study selection, risk of bias assessment (QUADAS-2 and PROBAST), and data extraction were performed. Meta-analyses for the cervical flexion-rotation test was performed. Certainty of the evidence was assessed with the GRADE approach.

Results: Eleven studies were included. Moderate certainty evidence indicated that the cervical flexion-rotation test differentiated cervicogenic headache from lower cervical facet-induced headache, migraine, concomitant headaches or asymptomatic subjects (Se 83.0% [95%CI:70.0%-92.0%]; Sp 83.0% [95%CI:71.0%-91.0%]; positive LR 5.0 [95%CI:2.6-9.5]; negative LR 0.2 [95%CI:0.1-0.4]; n=4 studies; n=182 participants). Several diagnostic classifications and test clusters based on headache history and clinical findings can be useful, despite uncertain accuracy, in formulating the diagnosis of cervicogenic headache.

Conclusion: Evidence support to undertake a subjective evaluation of headache history and signs and symptoms and a physical examination of the patient neck to diagnose cervicogenic headache. During the physical examination, a positive or negative cervical flexion-rotation test has small to moderate effect on the probability of a patient having a cervicogenic headache. The diagnostic value of the other findings remains unclear.