Measurement properties of the Craniocervical Flexion Test in patients with migraine: intra- and inter-examiner reliability and construct validity

Abstract

Migraine is a disabling headache commonly associated with signs of cervical dysfunction. One of the manifestations of this dysfunction is the reduction in the deep neck flexor muscles activation, evaluated by the Craniocervical Flexion Test (CCFT). The CCFT is already used and recommended by international experts to assess migraine patients. However, there is a lack of data on the measurement properties of this test supporting its quality, as reliability and construct validity, to guarantee the test application to both clinicians and researchers. Therefore, the study aims to determine the intra- and inter-examiner reliability of the Craniocervical Flexion Test and the test's construct validity evaluating disability in patients with migraine. One hundred women will be selected, aged between 18 and 55 years, with a diagnosis of migraine provided by an experienced neurologist according to the criteria of the International Classification of Headache Disorders - 3rd edition. Will be excluded from the sample subjects with a diagnosis of other headaches, associated or not with migraine, history of trauma in the cervical or face region, pregnancy, diagnosis of herniated or cervical disc degeneration, uncontrolled systemic diseases, or who received anesthetic blockage in the craniocervical region in the last three months. Thar participants will answer questions about the migraine clinical features and fulfill the Migraine Disability Index (MIDAS) and Headache Impact Test (HIT-6) questionnaires to measure the migraine disability. The CCFT will be performed by two trained evaluators and repeated after seven days. The inter-examiner and intra-examiner reliability will be calculated using the weighted Kappa coefficient. Construct validity will be verified through Spearman's Correlation of CCFT data with migraine pain intensity and MIDAS and HIT-6 final scores (p<0.05). Our findings may support clinical decision-making and the use of the CCFT in research and clinical practice. (AU)