Flexion-rotation test
For: Cervicogenic headache (C1–2)
Headache coming from the upper neck, here the joint between the top two vertebrae (C1 and C2). Usually one-sided, starting in the neck and spreading forwards, and brought on by neck movement or posture.
Treat with caution (see below)Its positive likelihood ratio reaches the usual rule-in threshold, but the book does not count it as a reliable rule-in test.
Its negative likelihood ratio reaches the usual rule-out threshold, but the book does not count it as a reliable rule-out test.
Caution: Both ratios sit right on the useful lines (LR+ 5, LR− 0.2), with wide confidence intervals: LR+ 2.6 to 9.5, LR− 0.1 to 0.4.
What the numbers mean
- Positive result: see the caution above before relying on this result.
- Negative result: see the caution above before relying on this result.
Source
Demont A, Lafrance S, Benaissa L, Mawet J. Cervicogenic headache, an easy diagnosis? A systematic review and meta-analysis of diagnostic studies. Musculoskelet Sci Pract. 2022;62:102640. Journal article · meta-analysis
Figures as they will appear in Rule It In, Rule It Out (Trokos, forthcoming). If a newer or better study changes them, this page changes with the book. Figures last updated from the book on 2 October 2026.
Get the book for the neck questions that matter: nerve root or referred pain, which myelopathy signs count, and when a neck after trauma needs imaging
This page gives the published figures. Rule It In, Rule It Out adds how to do this test, what counts as positive, how to read the result, and, where studied, whether combining it with other tests helps.
Coming in late 2026 as a PDF and a paperback. Join the list to hear when it's out
One study, one test, once a month
Rule It In is a free evidence letter for musculoskeletal clinicians: one recent study explained, one examination test with its real numbers. From Trokos, publisher of Rule It In, Rule It Out.