Craniovertebral AngleNCT06957873
Craniovertebral Angle and Fibromyalgia Severity
An observational study of Craniovertebral Angle and Fibromyalgia Syndrome, run by Ankara Training and Research Hospital at 3 sites in Turkey (Türkiye).
Trial summary
Forward Head Posture Frequency in Fibromyalgia Patients Assessed by Craniovertebral Angle: Association with Symptom Severity. Forward head posture is more common in patients with fibromyalgia and is a factor that increases symptom severity. Read more about this study
- Who is it for?
- Ages 18 to 55 yearsHealthy volunteers can take part
- Conditions the study is for
- Craniovertebral Angle, Fibromyalgia Syndrome
- How many people
- 134 participants
- Where
- 3 sitesTurkey (Türkiye)
- Study dates
- 1 Apr 2025to 1 Nov 2026
- Phase
- Observational
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 55 years
- All sexes
- Healthy volunteers accepted
- Adult
Study population: Our research will be conducted as a prospective study. The case group will consist of male and female patients aged 18-55 years who present to the Physical Medicine and Rehabilitation clinic with widespread pain complaints and are diagnosed with Fibromyalgia (FM) according to ACR 2010 diagnostic criteria. The control group, matched for age and gender distribution, will be selected from patients presenting with mechanical knee pain complaints and no cervical symptoms. Considering the increased likelihood of degenerative changes in the cervical region with advancing age, the investigators limited the upper age limit to 55 years. Demographic data will be collected through face-to-face interviews during examination. During this time, patients will complete the Fibromyalgia Impact Questionnaire (FIQ). The FIQ is a 10-item questionnaire that evaluates the severity of fibromyalgia symptoms.
Who may be able to join
- Aged 18-55 years
- Diagnosed with Fibromyalgia (FM) according to The American College of Rheumatology (ACR) 2010 Diagnostic Criteria for Fibromyalgia
Who cannot join
- History of past or current pathology in the cervical spine, thoracic spine, or upper extremities
- History of paraspinal or thoracic surgery involving the head, spine, or shoulders within the last six months
- Structural spinal malformation
- History of surgical or neurological disorders
- Cervical trauma or pain treatment within the last 6 months
- Temporomandibular surgery
- Psychiatric disorders (e.g., dementia, amnesia, or delirium)
- Systemic inflammatory rheumatic diseases
Trial locations and contacts
3 sites in 1 country. Contact the study team or a site near you to ask about taking part.
Turkey (Türkiye)3 sites, 2 recruiting
- Recruiting
Ankara Training and Research Hospital Ankara, Altindag, Turkey, 06230
Ankara, Altindag, 06230
Nadide Koca, 05376843434, nadide.koca@gmail.com
- Completed
Department of Physical Therapy and Rehabilitation, University of Health Sciences, Ankara Training and Research Hospital
Ankara, Altindag, 06230
- Enrolling by invitation
University of Health Sciences, Ankara Training and Research Hospital
Ankara, Altindag, 06230
About this study
Official title: Evaluation of the Relationship Between Craniovertebral Angle and Fibromyalgia Symptom Severity
Forward Head Posture Frequency in Fibromyalgia Patients Assessed by Craniovertebral Angle: Association with Symptom Severity. Forward head posture is more common in patients with fibromyalgia and is a factor that increases symptom severity.
Read the detailed description
Fibromyalgia (FM) is a chronic pain syndrome characterized by widespread musculoskeletal pain, muscle stiffness, joint rigidity, insomnia, fatigue, mood disorders, cognitive dysfunction, anxiety, depression, and general hypersensitivity.
Fibromyalgia is considered a central sensitivity syndrome. Central sensitization refers to a neuronal signal amplification mechanism within the central nervous system that leads to enhanced pain perception. Consequently, patients with FM exhibit an increased receptive field of pain, allodynia, and hyperalgesia.
Headache and temporomandibular disorders (TMD) are among the most common comorbidities in FM, displaying overlapping clinical and pathophysiological features.
Nociplastic pain is defined by the International Association for the Study of Pain as pain arising from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain. The mechanism of nociplastic pain is proposed to involve increased central nervous system sensitization and impaired sensory processing, accompanied by altered pain modulation. Definitive criteria for nociplastic pain have not yet been established. Eight specific disorders associated with central sensitization have been proposed: restless leg syndrome, chronic fatigue syndrome, FM, TMD, migraine or tension-type headache (TTH), irritable bowel syndrome, multiple chemical sensitivities, and whiplash injury.
Central sensitization is classically defined as a consequence of ongoing nociceptive inputs in chronic pain conditions. Its development is reported to be influenced by genetic factors, pain processing disorders in the brain, neuroendocrine and autonomic abnormalities, abnormal cytokines, and immune dysfunction.
As evident, conditions frequently accompanying FM, such as migraine, tension-type headache, chronic fatigue, irritable bowel syndrome, and TMD, share overlapping pathophysiology related to central sensitization.
A bidirectional relationship has been reported between primary headaches and craniocervical postural disorder, defined as Forward Head Posture (FHP). Postural disorders generate nociceptive peripheral stimuli that may lead to sensitization in the trigeminocervical complex.
The trigeminocervical complex (TCC), located in the brainstem, is a common convergence pathway where both trigeminal (dural) and cervical (primarily via the greater occipital nerve) afferent inputs are projected to higher centers in the thalamus and cortex. The TCC serves as the first sensory relay for meningeal and cephalic cutaneous information and forms the pathways for referred pain in primary headaches.
Brainstem interneurons have been shown to play a key role in pain modulation in migraine, TTH, and cluster headaches. Primary headache has been determined to result from trigeminocervical complex dysfunction. Neurophysiological studies on trigeminal reflexes support the concept of primary brainstem dysfunction and central hyperexcitability of trigeminal sensory pathways in chronic pain syndromes such as FM and TTH.
Similarly, animal studies in FM have identified a hyperalgesic state in the trigeminal region.
Sensitization in the trigeminocervical complex can lead to central sensitization by increasing thalamic and cortical stimulation. Peripheral and central sensitization are characterized by widespread hyperalgesia and allodynia. Consequently, patients with chronic primary headache exhibit a larger pain distribution area not only in the craniocervical region but throughout the entire spine.
The relationship between TCC sensitization and pain disorders has been well-documented in human and animal studies. Significant abnormalities in TCC responses have been observed in patients with trigeminal neuralgia, migraine, cluster headache, chronic tension-type headache, and fibromyalgia, attributed to hyperexcitability of trigeminal pathways.
Similarly, TMD, another comorbidity accompanying FM, frequently co-occurs with primary headaches, and the trigeminal system is reported to be the common pathophysiological mechanism.
Forward Head Posture (FHP) refers to the anterior displacement of the head relative to the trunk through upper cervical extension and lower cervical flexion. A craniovertebral angle (CVA) of 49° or less is defined as FHP.
FHP, characterized by forward head projection and rounded shoulders, is a common consequence of modern lifestyles involving prolonged use of laptops, mobile devices, or driving. It leads to persistent headache and is associated with migraine, TTH, and cervicogenic headaches.
The relationship between TMD and FHP is well-established. Forward head posture leads to TMD.
In the pathophysiology of primary headaches and TMD, which frequently accompany FM, the trigeminocervical complex emerges as a factor increasing central sensitization. FHP is reported to be a postural factor contributing to this. Central sensitization also plays a primary role in FM pathophysiology.
Postural studies in FM have reported increased thoracic kyphosis, lower CVA, and impaired cervical joint position sense.
To our knowledge, there are no studies examining the relationship between craniovertebral angle and disease severity in FM. We hypothesize that FHP may play a significant role in central sensitization in FM patients through the trigeminocervical complex, similar to its role in headaches and TMD. Therefore, we aim to investigate the frequency of FHP in FM patients and its relationship with FM disease severity.
- Conditions
- Craniovertebral Angle, Fibromyalgia Syndrome
- Keywords
- Fibromyalgia Syndrome, craniovertebral angle
- Medical subject headings
- Fibromyalgia
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
| Study group | Role | What they receive |
|---|---|---|
| Fibromyalgia Group | Fibromyalgia (FM) is a chronic pain syndrome characterized by widespread musculoskeletal pain, muscle stiffness, joint stiffness, insomnia, fatigue, mood disorders, cognitive dysfunction, anxiety, depression, and general sensitivity. Female and male patients between the ages of 18-55 who are diagnosed with FM according to the ACR 2010 diagnostic criteria will constitute the case group. | |
| Control Group | The control group, matching similar age and gender distribution, will be selected from patients presenting with mechanical knee pain complaints and without neck complaints. Considering the increased likelihood of degenerative changes in the cervical region with advancing age, the investigators limited the upper age limit to 55. |
What is being measured
The primary outcome is the main question the study is designed to answer.
The craniovertebral angle
During the same visit, permission will be obtained from patients for photography, and it will be explained that the photograph will be used solely for scientific research. One lateral photograph will be taken from consenting patients. For this purpose, the patient will be instructed to assume a standing posture and then relax. After the photographs taken with the camera placed at shoulder level are printed, the craniovertebral angle representing the forward head posture will be measured. The craniovertebral angle is the angle between the horizontal line passing through the 7th cervical vertebra and the line connecting the tragus of the ear to the C7 spinous process. The craniovertebral angle value will be calculated as the average value measured 5 times.
Measured: up to 12 weeks
Secondary outcomes (1)
Fibromyalgia Impact Questionnaire
The Fibromyalgia Impact Questionnaire (FIQ) consists of 10 items. The first item contains 11 questions related to physical function - each question is rated on a 4-point Likert-type scale. Items 2 and 3 ask the patient to mark the number of days they felt well and the number of days they could not work (including housework) due to fibromyalgia symptoms. Items 4 through 10 are horizontal linear scales marked in increments of 10 on which the patient rates work difficulty, pain, fatigue, morning tiredness, stiffness, anxiety, and depression. The highest possible score for each of the 10 items is 10, thus the highest possible score is 100. The average FM patient scores approximately 50 points; severely affected patients typically score ≥70 points.
Measured: up to 12 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted5 May 2025
- Study start1 Apr 2025
- Primary completion1 Nov 2026 (estimated)
- Study completion1 Nov 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (14)Papers the sponsor has linked to this study.
- Other trials for Craniovertebral AngleStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Case-control
- Time perspective
- Prospective
- Enrolment
- 134 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Ankara Training and Research Hospital
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Nadide Koca, Ankara Training and Research Hospital
- Investigators
- Nadide Koca, M.D., Principal investigator, Ankara Training and Research Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06957873
- Sponsor's protocol ID
- AnkaraTRH-FTR-NK-06
- Status last verified
- Sep 2026
- First submitted
- 27 Apr 2025
- Last updated
- 9 Sep 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Publications
Graff-Radford SB, Abbott JJ. Temporomandibular Disorders and Headache. Oral Maxillofac Surg Clin North Am. 2016 Aug;28(3):335-49. doi: 10.1016/j.coms.2016.03.004.
PubMed 27475510Abanoz Y, Gulen Abanoz Y, Gunduz A, Karadeniz D, Erdemir Kiziltan M. Long latency trigemino-cervical reflex in restless legs syndrome. Int J Neurosci. 2024 Aug;134(8):924-930. doi: 10.1080/00207454.2022.2158826. Epub 2022 Dec 28.
PubMed 36533413Deodato M, Granato A, Del Frate J, Martini M, Manganotti P. Differences in musculoskeletal dysfunctions and in postural alterations between chronic migraine and chronic tension type headache: A cross-sectional study. J Bodyw Mov Ther. 2024 Jan;37:404-411. doi: 10.1016/j.jbmt.2023.11.011. Epub 2023 Nov 17.
PubMed 38432837Nazeri M, Zarei MR, Pourzare AR, Ghahreh-Chahi HR, Abareghi F, Shabani M. Evidence of Altered Trigeminal Nociception in an Animal Model of Fibromyalgia. Pain Med. 2018 Feb 1;19(2):328-335. doi: 10.1093/pm/pnx114.
PubMed 28505350Wodehouse T, Bahra A, Mehta V. Changes in peripheral and central sensitization in patients undergoing occipital nerve stimulation. Br J Pain. 2020 Nov;14(4):250-255. doi: 10.1177/2049463719860548. Epub 2019 Jul 29.
PubMed 33194189Caponnetto V, Deodato M, Robotti M, Koutsokera M, Pozzilli V, Galati C, Nocera G, De Matteis E, De Vanna G, Fellini E, Halili G, Martinelli D, Nalli G, Serratore S, Tramacere I, Martelletti P, Raggi A; European Headache Federation School of Advanced Studies (EHF-SAS). Comorbidities of primary headache disorders: a literature review with meta-analysis. J Headache Pain. 2021 Jul 14;22(1):71. doi: 10.1186/s10194-021-01281-z.
PubMed 34261435Liang Z, Galea O, Thomas L, Jull G, Treleaven J. Cervical musculoskeletal impairments in migraine and tension type headache: A systematic review and meta-analysis. Musculoskelet Sci Pract. 2019 Jul;42:67-83. doi: 10.1016/j.msksp.2019.04.007. Epub 2019 Apr 25.
PubMed 31054485Ji RR, Nackley A, Huh Y, Terrando N, Maixner W. Neuroinflammation and Central Sensitization in Chronic and Widespread Pain. Anesthesiology. 2018 Aug;129(2):343-366. doi: 10.1097/ALN.0000000000002130.
PubMed 29462012Yoo YM, Kim KH. Current understanding of nociplastic pain. Korean J Pain. 2024 Apr 1;37(2):107-118. doi: 10.3344/kjp.23326. Epub 2024 Mar 20.
PubMed 38504389Yakkaphan P, Smith JG, Chana P, Tan HL, Ravindranath PT, Lambru G, Renton T. Temporomandibular Disorders and Fibromyalgia Prevalence: A Systematic Review and Meta-Analysis. J Oral Facial Pain Headache. 2023 Nov 17;37(3):177-193. doi: 10.11607/ofph.3260.
PubMed 37975782Lee W, Shin HJ, Min IK, Kim CS, Kim KM, Heo K, Chu MK. Shared comorbidity of depression, migraine, insomnia, and fibromyalgia in a population-based sample. J Affect Disord. 2024 Jun 1;354:619-626. doi: 10.1016/j.jad.2024.03.077. Epub 2024 Mar 15.
PubMed 38494140Siracusa R, Paola RD, Cuzzocrea S, Impellizzeri D. Fibromyalgia: Pathogenesis, Mechanisms, Diagnosis and Treatment Options Update. Int J Mol Sci. 2021 Apr 9;22(8):3891. doi: 10.3390/ijms22083891.
PubMed 33918736de Tommaso M, Vecchio E, Nolano M. The puzzle of fibromyalgia between central sensitization syndrome and small fiber neuropathy: a narrative review on neurophysiological and morphological evidence. Neurol Sci. 2022 Mar;43(3):1667-1684. doi: 10.1007/s10072-021-05806-x. Epub 2022 Jan 14.
PubMed 35028777Oton T, Carmona L, Rivera J. Patient-journey of fibromyalgia patients: A scoping review. Reumatol Clin (Engl Ed). 2024 Feb;20(2):96-103. doi: 10.1016/j.reumae.2023.07.005.
PubMed 38395498
Study at a glance
From the registry record, last updated by the sponsor on 9 Sep 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Evaluation of the Relationship Between Craniovertebral Angle and Fibromyalgia Symptom Severity
- ClinicalTrials.gov ID
- NCT06957873
- Acronym / sponsor ID
- AnkaraTRH-FTR-NK-06
- Conditions
- Craniovertebral Angle, Fibromyalgia Syndrome
- Keywords
- Fibromyalgia Syndrome, craniovertebral angle
- Study type
- Observational
- Recruitment status
- Recruiting
- Enrolment
- 134 participants (estimated)
- Lead sponsor
- Ankara Training and Research HospitalUniversity, hospital or other
- Study start
- 1 Apr 2025 (actual)
- Primary completion
- 1 Nov 2026 (estimated)
- Study completion
- 1 Nov 2026 (estimated)
- First posted
- 5 May 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Forward Head Posture Frequency in Fibromyalgia Patients Assessed by Craniovertebral Angle: Association with Symptom Severity. Forward head posture is more common in patients with fibromyalgia and is a factor that increases symptom severity.
Detailed description
Fibromyalgia (FM) is a chronic pain syndrome characterized by widespread musculoskeletal pain, muscle stiffness, joint rigidity, insomnia, fatigue, mood disorders, cognitive dysfunction, anxiety, depression, and general hypersensitivity.
Fibromyalgia is considered a central sensitivity syndrome. Central sensitization refers to a neuronal signal amplification mechanism within the central nervous system that leads to enhanced pain perception. Consequently, patients with FM exhibit an increased receptive field of pain, allodynia, and hyperalgesia.
Headache and temporomandibular disorders (TMD) are among the most common comorbidities in FM, displaying overlapping clinical and pathophysiological features.
Nociplastic pain is defined by the International Association for the Study of Pain as pain arising from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain. The mechanism of nociplastic pain is proposed to involve increased central nervous system sensitization and impaired sensory processing, accompanied by altered pain modulation. Definitive criteria for nociplastic pain have not yet been established. Eight specific disorders associated with central sensitization have been proposed: restless leg syndrome, chronic fatigue syndrome, FM, TMD, migraine or tension-type headache (TTH), irritable bowel syndrome, multiple chemical sensitivities, and whiplash injury.
Central sensitization is classically defined as a consequence of ongoing nociceptive inputs in chronic pain conditions. Its development is reported to be influenced by genetic factors, pain processing disorders in the brain, neuroendocrine and autonomic abnormalities, abnormal cytokines, and immune dysfunction.
As evident, conditions frequently accompanying FM, such as migraine, tension-type headache, chronic fatigue, irritable bowel syndrome, and TMD, share overlapping pathophysiology related to central sensitization.
A bidirectional relationship has been reported between primary headaches and craniocervical postural disorder, defined as Forward Head Posture (FHP). Postural disorders generate nociceptive peripheral stimuli that may lead to sensitization in the trigeminocervical complex.
The trigeminocervical complex (TCC), located in the brainstem, is a common convergence pathway where both trigeminal (dural) and cervical (primarily via the greater occipital nerve) afferent inputs are projected to higher centers in the thalamus and cortex. The TCC serves as the first sensory relay for meningeal and cephalic cutaneous information and forms the pathways for referred pain in primary headaches.
Brainstem interneurons have been shown to play a key role in pain modulation in migraine, TTH, and cluster headaches. Primary headache has been determined to result from trigeminocervical complex dysfunction. Neurophysiological studies on trigeminal reflexes support the concept of primary brainstem dysfunction and central hyperexcitability of trigeminal sensory pathways in chronic pain syndromes such as FM and TTH.
Similarly, animal studies in FM have identified a hyperalgesic state in the trigeminal region.
Sensitization in the trigeminocervical complex can lead to central sensitization by increasing thalamic and cortical stimulation. Peripheral and central sensitization are characterized by widespread hyperalgesia and allodynia. Consequently, patients with chronic primary headache exhibit a larger pain distribution area not only in the craniocervical region but throughout the entire spine.
The relationship between TCC sensitization and pain disorders has been well-documented in human and animal studies. Significant abnormalities in TCC responses have been observed in patients with trigeminal neuralgia, migraine, cluster headache, chronic tension-type headache, and fibromyalgia, attributed to hyperexcitability of trigeminal pathways.
Similarly, TMD, another comorbidity accompanying FM, frequently co-occurs with primary headaches, and the trigeminal system is reported to be the common pathophysiological mechanism.
Forward Head Posture (FHP) refers to the anterior displacement of the head relative to the trunk through upper cervical extension and lower cervical flexion. A craniovertebral angle (CVA) of 49° or less is defined as FHP.
FHP, characterized by forward head projection and rounded shoulders, is a common consequence of modern lifestyles involving prolonged use of laptops, mobile devices, or driving. It leads to persistent headache and is associated with migraine, TTH, and cervicogenic headaches.
The relationship between TMD and FHP is well-established. Forward head posture leads to TMD.
In the pathophysiology of primary headaches and TMD, which frequently accompany FM, the trigeminocervical complex emerges as a factor increasing central sensitization. FHP is reported to be a postural factor contributing to this. Central sensitization also plays a primary role in FM pathophysiology.
Postural studies in FM have reported increased thoracic kyphosis, lower CVA, and impaired cervical joint position sense.
To our knowledge, there are no studies examining the relationship between craniovertebral angle and disease severity in FM. We hypothesize that FHP may play a significant role in central sensitization in FM patients through the trigeminocervical complex, similar to its role in headaches and TMD. Therefore, we aim to investigate the frequency of FHP in FM patients and its relationship with FM disease severity.
Study design
- Observational model
- Case-control
- Time perspective
- Prospective
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Fibromyalgia Group | – | –Fibromyalgia (FM) is a chronic pain syndrome characterized by widespread musculoskeletal pain, muscle stiffness, joint stiffness, insomnia, fatigue, mood disorders, cognitive dysfunction, anxiety, depression, and general sensitivity. Female and male patients between the ages of 18-55 who are diagnosed with FM according to the ACR 2010 diagnostic criteria will constitute the case group. |
| Control Group | – | –The control group, matching similar age and gender distribution, will be selected from patients presenting with mechanical knee pain complaints and without neck complaints. Considering the increased likelihood of degenerative changes in the cervical region with advancing age, the investigators limited the upper age limit to 55. |
Who may qualify
- Ages
- 18 to 55 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult
- Study population
- Our research will be conducted as a prospective study. The case group will consist of male and female patients aged 18-55 years who present to the Physical Medicine and Rehabilitation clinic with widespread pain complaints and are diagnosed with Fibromyalgia (FM) according to ACR 2010 diagnostic criteria. The control group, matched for age and gender distribution, will be selected from patients presenting with mechanical knee pain complaints and no cervical symptoms. Considering the increased likelihood of degenerative changes in the cervical region with advancing age, the investigators limited the upper age limit to 55 years. Demographic data will be collected through face-to-face interviews during examination. During this time, patients will complete the Fibromyalgia Impact Questionnaire (FIQ). The FIQ is a 10-item questionnaire that evaluates the severity of fibromyalgia symptoms.
Key inclusion criteria (2 listed)
- Aged 18-55 years
- Diagnosed with Fibromyalgia (FM) according to The American College of Rheumatology (ACR) 2010 Diagnostic Criteria for Fibromyalgia
Key exclusion criteria (8 listed)
- History of past or current pathology in the cervical spine, thoracic spine, or upper extremities
- History of paraspinal or thoracic surgery involving the head, spine, or shoulders within the last six months
- Structural spinal malformation
- History of surgical or neurological disorders
- Cervical trauma or pain treatment within the last 6 months
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
The craniovertebral angle
Time frame: up to 12 weeks
During the same visit, permission will be obtained from patients for photography, and it will be explained that the photograph will be used solely for scientific research. One lateral photograph will be taken from consenting patients. For this purpose, the patient will be instructed to assume a standing posture and then relax. After the photographs taken with the camera placed at shoulder level are printed, the craniovertebral angle representing the forward head posture will be measured. The craniovertebral angle is the angle between the horizontal line passing through the 7th cervical vertebra and the line connecting the tragus of the ear to the C7 spinous process. The craniovertebral angle value will be calculated as the average value measured 5 times.
1 secondary outcome
Fibromyalgia Impact Questionnaire
Time frame: up to 12 weeks
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 9 Sep 2026.
- Background: PubMed 27475510Graff-Radford SB, Abbott JJ. Temporomandibular Disorders and Headache. Oral Maxillofac Surg Clin North Am. 2016 Aug;28(3):335-49. doi: 10.1016/j.coms.2016.03.004.
- Background: PubMed 36533413Abanoz Y, Gulen Abanoz Y, Gunduz A, Karadeniz D, Erdemir Kiziltan M. Long latency trigemino-cervical reflex in restless legs syndrome. Int J Neurosci. 2024 Aug;134(8):924-930. doi: 10.1080/00207454.2022.2158826. Epub 2022 Dec 28.
- Background: PubMed 38432837Deodato M, Granato A, Del Frate J, Martini M, Manganotti P. Differences in musculoskeletal dysfunctions and in postural alterations between chronic migraine and chronic tension type headache: A cross-sectional study. J Bodyw Mov Ther. 2024 Jan;37:404-411. doi: 10.1016/j.jbmt.2023.11.011. Epub 2023 Nov 17.
- Background: PubMed 28505350Nazeri M, Zarei MR, Pourzare AR, Ghahreh-Chahi HR, Abareghi F, Shabani M. Evidence of Altered Trigeminal Nociception in an Animal Model of Fibromyalgia. Pain Med. 2018 Feb 1;19(2):328-335. doi: 10.1093/pm/pnx114.
- Background: PubMed 33194189Wodehouse T, Bahra A, Mehta V. Changes in peripheral and central sensitization in patients undergoing occipital nerve stimulation. Br J Pain. 2020 Nov;14(4):250-255. doi: 10.1177/2049463719860548. Epub 2019 Jul 29.
- Background: PubMed 34261435Caponnetto V, Deodato M, Robotti M, Koutsokera M, Pozzilli V, Galati C, Nocera G, De Matteis E, De Vanna G, Fellini E, Halili G, Martinelli D, Nalli G, Serratore S, Tramacere I, Martelletti P, Raggi A; European Headache Federation School of Advanced Studies (EHF-SAS). Comorbidities of primary headache disorders: a literature review with meta-analysis. J Headache Pain. 2021 Jul 14;22(1):71. doi: 10.1186/s10194-021-01281-z.
- Background: PubMed 31054485Liang Z, Galea O, Thomas L, Jull G, Treleaven J. Cervical musculoskeletal impairments in migraine and tension type headache: A systematic review and meta-analysis. Musculoskelet Sci Pract. 2019 Jul;42:67-83. doi: 10.1016/j.msksp.2019.04.007. Epub 2019 Apr 25.
- Background: PubMed 29462012Ji RR, Nackley A, Huh Y, Terrando N, Maixner W. Neuroinflammation and Central Sensitization in Chronic and Widespread Pain. Anesthesiology. 2018 Aug;129(2):343-366. doi: 10.1097/ALN.0000000000002130.
- Background: PubMed 38504389Yoo YM, Kim KH. Current understanding of nociplastic pain. Korean J Pain. 2024 Apr 1;37(2):107-118. doi: 10.3344/kjp.23326. Epub 2024 Mar 20.
- Background: PubMed 37975782Yakkaphan P, Smith JG, Chana P, Tan HL, Ravindranath PT, Lambru G, Renton T. Temporomandibular Disorders and Fibromyalgia Prevalence: A Systematic Review and Meta-Analysis. J Oral Facial Pain Headache. 2023 Nov 17;37(3):177-193. doi: 10.11607/ofph.3260.
- Background: PubMed 38494140Lee W, Shin HJ, Min IK, Kim CS, Kim KM, Heo K, Chu MK. Shared comorbidity of depression, migraine, insomnia, and fibromyalgia in a population-based sample. J Affect Disord. 2024 Jun 1;354:619-626. doi: 10.1016/j.jad.2024.03.077. Epub 2024 Mar 15.
- Background: PubMed 33918736Siracusa R, Paola RD, Cuzzocrea S, Impellizzeri D. Fibromyalgia: Pathogenesis, Mechanisms, Diagnosis and Treatment Options Update. Int J Mol Sci. 2021 Apr 9;22(8):3891. doi: 10.3390/ijms22083891.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Nadide Koca, M.D. principal investigator
Ankara Training and Research Hospital
3 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Craniovertebral Angle and Fibromyalgia Syndrome, run by Ankara Training and Research Hospital at 3 sites in Turkey (Türkiye).
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 2 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 9 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 3 sites in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Nadide Koca, M.D. (+905376843434, nadide.koca@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
The craniovertebral angle (time frame: up to 12 weeks). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT06957873, which also lists 14 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 9 Sep 2026.