Craniocervical Flexion Test in patients with migraine: discriminatory validity and accuracy

Abstract text (incl. figure legends and references)

Objectives: To evaluate the discriminatory validity and provide a clinical cut-off of the craniocervical flexion test (CCFT) in migraineurs stratified by the report of neck pain, headache-related disability and neck disability.

Methods: This study enrols 50 women without headache and 102 women with migraine recruited by convenience from a local tertiary care setting. The standard reference for migraine diagnosis was the International Classification of Headache Disorders. All volunteers underwent the CCFT and the patients with migraine patients answered the Migraine Disability Assessment (MIDAS) and Neck Disability Index (NDI) questionnaires. Discriminatory validity was verified by groups comparison. The clinical cut-off was obtained and classified according to the diagnostic accuracy of the CCFT.

Results: The CCFT presented discriminative validity for comparing control (median = 28, IRQ = 6) with migraine (median = 26, IRQ = 4, p = 0.01) and migraine with neck pain (median = 26, IRQ = 4, p = 0.01), but not among the migraine subtypes with disability by migraine or neck pain related disability on the MIDAS and NDI. The diagnostic accuracies were classified between poor and not discriminating with the area under the receiver operating characteristic curve ranging from 57% to 69%, and non-acceptable values of sensitivity, specificity and positive and negative likelihood ratios.

Conclusion: The CCFT is able to discriminate asymptomatic controls from migraine patients with and without neck pain. However, it cannot discriminate patients with migraine according to their pain-related disability. In addition, the CCFT does not offer a cut-off value adequate to identify the deficit of function of the deep flexor muscles in migraine patients.