The "skin roll" test: a diagnostic test for cervicogenic headache?

Skin roll tests were performed on 15 patients with cervicogenic headache, 15 with tension headache ("tension-type headache"; 6 with the acute ("episodic") and 9 with the chronic form), and 43 migraine without aura patients (15 without and 28 with sideshift). Three positions (trapezius, mandibular, supraorbital) were used. The results were compared with those obtained in a control series (no. = 95). Fourteen cervicogenic (93.3%), 8 tension headache (53.3%), and 8 migraine (18.6%) patients reported tenderness in the trapezius position during the procedure. Tenderness asymmetry of > or = 10 mm on the visual analogue scale (with the highest value on the symptomatic side; trapezius position) was found in 10 (67%) cervicogenic headache patients, vs 3 (20%) tension headache patients and no migraine patients. A clear tenderness asymmetry in this area may suggest a cervicogenic headache rather than a migraine without aura diagnosis. Thickness values were less helpful in distinguishing cervicogenic headache from other headaches. In the cervicogenic headache group, both tenderness and skinfold thickness showed significantly higher values on the symptomatic than on the non symptomatic side in the trapezius position, but not in the other positions. The differences between cervicogenic headache on the one hand and tension headache/migraine on the other were generally rather small, indeed, there was a considerable overlap between the groups. In single cases, therefore, the skin roll test will contribute little to the differential diagnosis of cervicogenic headache.