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Objective. This study compared adults with peripheral vestibular hypofunction (VH) to healthy controls and assessed the sensitivity and specificity of the Cervical Torsion Test (CTT) and the Head-Neck Differentiation Test (HNDT). This study aimed to determine whether neck problems affected primary outcomes. Methods. This cross-sectional study included adults from a specialist consultation for dizziness. VH had been diagnosed with the video Head Impulse Test. Exclusion criteria were conditions following head or neck trauma and diseases of the central nervous system. The sensitivity and specificity of the index tests were calculated, and regression analyses were performed to test for contributing factors. Results. A total of 19 patients with VH and a historical cohort of 19 matched healthy controls were included. Most patients with VH (84.2%) experienced symptoms in at least 1 test component, compared to 5.2% of the control group. Of patients with VH, 78.9% had symptoms during the HNDT 'en bloc' (en bloc = head and trunk rotated together), whereas only 26.3% reported symptoms during the CTT en bloc. The best discriminatory validity was found for the HNDT en bloc, with a sensitivity of 0.79 (95% CI = 0.54-0.94), a specificity of 0.86 (95% CI = 0.65-0.97), and a positive likelihood ratio of 5.79 (95% CI = 1.97 -17.00). The number of symptoms of CTT 'in torsion' (in torsion = trunk rotated actively with fixed head) was increased by a factor of 1.13 (95% CI = 1.01 -1.27) for every additional point on the Neck Disability Index. Conclusion. The CTT and HNDT can serve as non-laboratory tests for patients with dizziness. The HNDT en bloc has the best discriminatory validity, finding those with and those without VH. Symptom reproduction during torsion may help to identify when neck problems may contribute to dizziness. Impact. The HNDT en bloc may be useful for ruling VH in or out in patients with dizziness. Positive CTT and HNDT in torsion components may verify the likelihood of additional neck involvement. Keywords: Dizziness, Neck Pain, Sensitivity and Specificity, Vertigo, Vestibular Diseases, Introduction Dizziness and vertigo symptoms are commonly reported worldwide, with an assumed lifetime prevalence of 17% to 30%. (1) Many people with dizziness complain of symptom provocation with rapid head [...]

Objective. The Neck Disability Index (NDI) is a self-rated disability tool originally developed for whiplash-associated disorders and validated in cervical musculoskeletal conditions. It is now commonly used to assess neck disability in migraine, but it is unknown whether NDI scores relate to migraine and hypersensitivity, cervical musculoskeletal dysfunction, or both. This single-blinded observational study aimed to determine whether the presence of cervical musculoskeletal dysfunction, migraine features, and hypersensitivity predict NDI scores and whether alternate versions of the NDI (NDI-physical, NDI-8, NDI-5) relate more to cervical musculoskeletal dysfunction. Methods. Migraine and neck pain features, the Headache Impact Test (HIT-6), NDI, Allodynia Symptom Checklist (ASC12), and pressure pain thresholds were assessed in 104 participants with migraine and neck pain, 45 previously identified with cervical musculoskeletal dysfunction and 59 without. The NDI score was regressed on the presence or absence of cervical dysfunction, migraine features, HIT-6, total pressure pain threshold, and ASC12 while accounting for neck pain features. The presence of cervical dysfunction was regressed on the scores of NDI versions. Results. The ASC12 (standardized U = 0.20)and HIT-6 (standardized [beta] = 0.18) were significantly predictive of total NDI score, as were neck pain intensity (standardized U = 0.32) and frequency (standardized ([beta] = 0.44). No scores from alternate NDI versions related to cervical dysfunction. Conclusion. The NDI score is a complex measure of neck disability influenced by migraine disability and hypersensitivity beyond the presence of cervical musculoskeletal dysfunction. This has implications for the clinical interpretation of NDI scores in patients with migraine. Impact. Many patients with migraine and neck pain report neck disability; therefore, it is important to understand if migraine impacts neck disability. The results of this study indicate that clinicians need to consider migraine-related disability and hypersensitivity when managing neck disability in this population. Keywords: Disability, Migraine, Musculoskeletal, Neck Pain, Sensitization, Introduction Approximately 80% of individuals with migraine also experience neck pain, (1) which compounds their physical burden. (2) It is therefore important to assess disability related to neck pain in [...]

Background. The clinical diagnosis of cervicogenic dizziness (CGD) is challenging because of a lack of sensitive and specific diagnostic tests. It is vital for clinicians to know normative responses to suggested clinical tests to help them develop the method and interpretation of these tests and maximize their diagnostic value for CGD. Objective. The purpose of the study was to determine normative responses to the clinical application of the cervical torsion test and the head-neck differentiation test, with consideration of different age groups and sex. Design. This was an observational study. Methods. One hundred forty-seven people who were healthy and asymptomatic served as controls and performed both tests, which involved 3 components: cervical torsion, cervical rotation, and en bloc rotation (head and trunk rotation together). Results. Thirty-five (23.81%) of the 147 participants reported some symptoms (mild dizziness, visual disturbances, unusual eye movements on opening eyes after the test, motion sickness, or nausea) on 1 or more of the 3 test components in either test. The specificity when using a positive response to torsion alone (ie, a negative response to the rotation or en bloc component) was high (for the cervical torsion test, 98.64%; for the head-neck differentiation test, 89.8%), as participants with likely global sensorimotor sensitivity were eliminated. The combined specificity was 100%, as no participants presented with exclusive positive torsion results in both tests. Age and sex did not influence the results. Limitations. There were several examiners who were not blinded. Conclusions. Confirmation of the high specificity of these clinical tests with the method used in this study to conduct and interpret the results will allow future research to determine the sensitivity of these clinical measures in a population with CGD and specificity in those with dizziness of other origins., Dizziness is a common symptom associated with several different head and neck conditions. (1,2) Differential diagnosis is especially important after trauma to the head and neck, such as in whiplash [...]