Watson Headache Test | Headache &Dizziness Assessment

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Watson Headache Test

Watson Headache Test | Headache &Dizziness Assessment

While migraines and tension-type headaches are primary headaches, the literature claims that there may be accompanying occipital and neck symptoms. Different observations in migraine and tension-type headaches suggest that afferent cervical nociceptive inputs are involved in primary headaches.

Watson et al. (2012) investigated if, and to what extent, head pain could be reproduced in tension-type headaches and patients with migraine without aura during the manual examination of the cervical spine, specifically the atlanto-occipital to C2-3 segments. 

In their study, the symptom response and grading intervertebral mobility achieved an intra-rater reliability of kappa of 0.667 and kappa of 1 respectively, which indicates good to perfect agreement. What they found was that patients that suffer from tension-type headaches and migraineurs had significantly more head pain referrals than controls. However, no further validation has been carried out on these techniques which is why we give them a moderate clinical value.

Two Techniques have been carried out.

Technique 1

The patient is in supine lying position and the head is rotated 20° away from the side of the headache, or in case of bilateral headache away from the side the spinous process of C2 deviated toward.
Then, apply pressure over the posterior arch of C1 with one thumb and use your other hand to rotate the head ipsilaterally, which stresses the atlanto-occipital joint.
Hold this position for 5 seconds.


Technique 2

The patient’s head is rotated approximately 30°.
Then apply pressure over the contralateral articular pillar of C2 with one thumb guiding that segment, which stresses the C2-3 segment.
Hold this position for 5 seconds.

In both techniques, the patient is asked to report on the reproduction of head pain with either “yes” or “no”. 

The explanation for this phenomenon lies in the convergence of cervical afferents onto neurons in the trigeminal nuclei that can refer pain to temporofrontal regions. 


Headache exercise program


If you would like to learn how to diagnose common forms of headaches, check out the posts below:



Watson, D. H., & Drummond, P. D. (2012). Head pain referral during examination of the neck in migraine and tension‐type headache. Headache: The Journal of Head and Face Pain52(8), 1226-1235.

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