Proprioceptive Deficits in Cervicogenic Headache: An Open-Source-Verified Systematic Review

Abstract

Background: Cervicogenic headache is a secondary headache disorder attributed to cervical spine or cervical soft-tissue dysfunction. Cervical proprioceptive impairment has been proposed as one mechanism linking neck pain, impaired head-neck orientation, dizziness, postural instability, and headache burden. However, the evidence base is small and uses heterogeneous measures such as cervical joint-position error, cervical kinaesthetic sense, gaze-direction recognition, sensory discrimination, and posturography. Objective: To synthesize live-verified evidence published from 1 January 2000 to 30 March 2026 on proprioceptive and sensorimotor-control deficits in cervicogenic headache and on the effects of proprioceptive or sensorimotor rehabilitation. Methods: A PRISMA 2020-informed systematic-review structure and SWiM-aligned narrative synthesis were used. The search was completed as an open-source verification search rather than a full subscription-database export. Open records were searched and verified through PubMed/MEDLINE-accessible records, Europe PMC, PubMed Central, publisher pages, DOI landing pages, ClinicalTrials.gov, institutional repositories, and open scholarly index pages. At least two independent reviewers were used for study screening, data extraction, and quality assessment. Eligibility required cervicogenic headache plus a proprioception, kinaesthetic, sensorimotor-control, balance, gaze-direction-recognition, sensory-discrimination, or postural-control outcome or intervention. Risk of bias was assessed with RoB 2 for randomized trials and ROBINS-I/JBI-style criteria for non-randomized and comparative studies. Meta-analysis was not performed because of clinical and methodological heterogeneity, incompatible outcome metrics, small samples, incomplete extractable numerical reporting, and possible overlap among related intervention cohorts. Results: Nineteen open-source records were identified, one companion trial-register record was consolidated, 18 records were screened, 13 reports were assessed for eligibility, and 11 studies were included in narrative synthesis. The included evidence comprised five comparative or observational studies and six randomized or controlled intervention studies. Comparative evidence suggests that some people with cervicogenic headache, particularly those with dizziness or balance disturbance, demonstrate worse cervical proprioceptive or postural-control performance than asymptomatic controls and, in selected conditions, than migraine comparators. Intervention evidence suggests that gaze-direction-recognition training, cervical stabilization, cervical sensorimotor-control training, and laser-guided movement-control training may improve pain, disability, cervical range of motion, gaze-direction-recognition accuracy, pressure pain threshold, postural stability, headache frequency, or headache duration. Certainty was low to very low because samples were small, follow-up was short, intervention and measurement protocols varied, assessor blinding was inconsistent or incompletely reported, and several records lacked complete extractable datasets. Conclusions: Open-source verified evidence suggests that proprioceptive and sensorimotor-control deficits may be clinically relevant in a subset of patients with cervicogenic headache and that targeted sensorimotor rehabilitation may improve selected symptoms and functional outcomes. The evidence is not strong enough to support proprioception testing as a stand-alone diagnostic discriminator or to claim universal treatment efficacy. Larger preregistered multicentre studies using ICHD-3 diagnosis, standardized proprioception protocols, blinded assessment, longer follow-up, adverse-event reporting, and open datasets are required.