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Yedikardachian D, Quasthoff S, Lechner AT, Giuliani A, Fazekas F. [Migraine prophylaxis with trigger point therapy and lymphatic drainage : A pilot study]. Wien Med Wochenschr 2017; 167:359-367. [PMID: 28770409 DOI: 10.1007/s10354-017-0588-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 07/13/2017] [Indexed: 01/03/2023]
Abstract
Migraine is a complex, multifactorial, neurovascular disorder of the brain. Patients frequently have pericranial trigger points, but trigger point (TP) therapy for migraine has not yet been adequately studied. In contrast, lymphatic drainage (LD) has been studied in patients with migraine. The multifactorial origin of migraine suggests using a combination of approaches such as TP therapy and lymphatic drainage. The present study evaluated the effectiveness of TP therapy alone and in combination with LD in preventing migraine during treatment period and over an 8‑week period after completion of treatment. A wait list control group served as a control group. Patients completed a headache calendar. The results of this pilot study suggest a beneficial effect for TP alone and TP combined with LD for migraine prophylaxis for 8 weeks after completion of treatment.
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Affiliation(s)
- Delphine Yedikardachian
- Universitätsklinik für Neurologie, LKH-Universitätsklinikum Graz, Auenbruggerplatz 22, 8036, Graz, Österreich.
| | - Stefan Quasthoff
- Universitätsklinik für Neurologie, LKH-Universitätsklinikum Graz, Auenbruggerplatz 22, 8036, Graz, Österreich
| | - Anita T Lechner
- Universitätsklinik für Neurologie, LKH-Universitätsklinikum Graz, Auenbruggerplatz 22, 8036, Graz, Österreich
| | - Albrecht Giuliani
- Abteilung für Gynäkologie und Geburtshilfe, Krankenhaus St. Vinzenz, Zams, Österreich
| | - Franz Fazekas
- Universitätsklinik für Neurologie, LKH-Universitätsklinikum Graz, Auenbruggerplatz 22, 8036, Graz, Österreich
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Brønfort G, Evans RL, Goldsmith CH, Haas M, Leininger B, Levin M, Schmitt J, Westrom K. Spinal rehabilitative exercise and manual treatment for the prevention of migraine attacks in adults. Hippokratia 2017. [DOI: 10.1002/14651858.cd011848.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Gert Brønfort
- University of Minnesota; Integrative Health & Wellbeing Research Program, Center for Spirituality & Healing; 420 Delaware Street SE, MMC505 Minneapolis MN USA 55455
| | - Roni L Evans
- University of Minnesota; Integrative Health & Wellbeing Research Program, Center for Spirituality & Healing; 420 Delaware Street SE, MMC505 Minneapolis MN USA 55455
| | - Charles H Goldsmith
- Simon Fraser University; Faculty of Health Sciences; Blossom Hall, Room 9510 8888 University Drive Burnaby BC Canada V5A 1S6
| | - Mitchell Haas
- University of Western States; 2900 NE 132nd Avenue Portland OR USA 97230
| | - Brent Leininger
- University of Minnesota; Integrative Health & Wellbeing Research Program, Center for Spirituality & Healing; 420 Delaware Street SE, MMC505 Minneapolis MN USA 55455
| | - Morris Levin
- UCSF School of Medicine; Neurology; 2330 Post Street San Francisco California USA 94115
| | - John Schmitt
- St Catherine University; 601 25th Avenue S. Minneapolis MN USA 55454
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Leininger B, Brønfort G, Haas M, Schmitt J, Evans RL, Levin M, Westrom K, Goldsmith CH. Spinal rehabilitative exercise or manual treatment for the prevention of tension-type headache in adults. Hippokratia 2017. [DOI: 10.1002/14651858.cd012139.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Brent Leininger
- University of Minnesota; Integrative Health & Wellbeing Research Program, Center for Spirituality & Healing; 420 Delaware Street SE Minneapolis MN USA 55455
| | - Gert Brønfort
- University of Minnesota; Integrative Health & Wellbeing Research Program, Center for Spirituality & Healing; 420 Delaware Street SE Minneapolis MN USA 55455
| | - Mitchell Haas
- University of Western States; 2900 NE 132nd Avenue Portland OR USA 97230
| | - John Schmitt
- St Catherine University; 601 25th Avenue S. Minneapolis MN USA 55454
| | - Roni L Evans
- University of Minnesota; Integrative Health & Wellbeing Research Program, Center for Spirituality & Healing; 420 Delaware Street SE Minneapolis MN USA 55455
| | - Morris Levin
- UCSF School of Medicine; Neurology; 2330 Post Street San Francisco California USA 94115
| | | | - Charles H Goldsmith
- Simon Fraser University; Faculty of Health Sciences; Blossom Hall, Room 9510 8888 University Drive Burnaby BC Canada V5A 1S6
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Abstract
Objective The aim of this project was to evaluate the prevalence and pattern of musculoskeletal dysfunctions in migraine patients using a rigorous methodological approach and validating an international consensus cluster of headache assessment tests. Methods A physiotherapist, blinded towards the diagnosis, examined 138 migraine patients (frequent episodic and chronic), recruited at a specialised headache clinic, and 73 age and gender matched healthy controls following a standardised protocol. Eleven tests, previously identified in an international consensus procedure, were used to evaluate cervical and thoracic musculoskeletal dysfunctions. Results Primary analyses indicated statistically significant differences across groups for the total number of trigger points, flexion-rotation test, thoracic screening, manual joint testing of the upper cervical spine, cranio-cervical flexion test, and reproduction and resolution. Ninety three percent of the assessed patients had at least three musculoskeletal dysfunctions. Post-hoc tests showed significant differences between episodic or chronic migraine patients and healthy controls, but not between migraine groups. Conclusions A standardised set of six physical examination tests showed a high prevalence of musculoskeletal dysfunctions in migraine patients. These dysfunctions support a reciprocal interaction between the trigeminal and the cervical systems as a trait symptom in migraine.
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Affiliation(s)
- Kerstin Luedtke
- Department of Systems Neuroscience, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Wiebke Starke
- Department of Systems Neuroscience, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Arne May
- Department of Systems Neuroscience, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Stroppa-Marques AEZ, Melo-Neto JSD, Valle SPD, Pedroni CR. MUSCULAR PRESSURE PAIN THRESHOLD AND INFLUENCE OF CRANIOCERVICAL POSTURE IN INDIVIDUALS WITH EPISODIC TENSION-TYPE HEADACHE. COLUNA/COLUMNA 2017. [DOI: 10.1590/s1808-185120171602162637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: The objective of this study was to analyze the pressure pain threshold (PPT) of the sternocleidomastoid (SCM), suboccipital (SO) and upper trapezius (UT) muscles and the craniocervical posture in individuals with episodic tension-type headache (ETTH). Methods: This study was a cross-sectional, non-randomized study with 60 young adults (77% female) comprising both sexes and an age range of 18-27 years. Individuals were distributed into a control group (G1) and individuals with ETTH (G2). The frequency of headaches per month was recorded. A pressure dynamometer was used to evaluate the PPT. Photogrammetry was used to evaluate the cervical lordosis (CL) and cephalic protrusion (CP). The data were statistically analyzed. Results: There were differences in the PPT, where the UT, SO and SCM muscles presented lower sensitivity to pain, respectively. The SCM muscle presented a lower PPT in G2. The CL and CP angles were significantly lower in G2. Conclusion: Individuals with ETTH exhibited a significantly lower PPT in the SCM and SO muscles than in the UT muscle. Nevertheless, individuals with ETTH presented with the SCM muscle being more sensitive to pain as well as higher CL and CP than individuals without symptomatology.
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Di Paolo C, D'Urso A, Papi P, Di Sabato F, Rosella D, Pompa G, Polimeni A. Temporomandibular Disorders and Headache: A Retrospective Analysis of 1198 Patients. Pain Res Manag 2017; 2017:3203027. [PMID: 28420942 PMCID: PMC5379086 DOI: 10.1155/2017/3203027] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 03/14/2017] [Indexed: 12/25/2022]
Abstract
Aim. Headache is one of the most common diseases associated with Temporomandibular Disorders (TMDs). The aim of this study was to evaluate, retrospectively, if headache influences TMD's symptoms. Material and Methods. A total sample of 1198 consecutive TMD patients was selected. After a neurological examination, a diagnosis of headache, according to the latest edition of the International Classification of Headache Disorders, was performed in 625 subjects. Patients were divided into two groups based on presence/absence of headache: Group with Headache (GwH) and Group without Headache (GwoH). Descriptive statistics and Chi-square index were performed. Results. Sociodemographic (gender, marital status, and occupation) and functional factors, occlusion (occlusal and skeletal classes, dental formula, and occlusal abnormalities), and familiar pain did not show a statistically significant correlation in either group. Intensity and frequency of neck pain, arthralgia of TMJ, and myalgia showed higher correlation values in GwH. Conclusion. This study is consistent with previous literature in showing a close relationship between headache and TMD. All data underlines that headache makes pain parameters more intense and frequent. Therefore, an early and multidisciplinary treatment of TMDs should be performed in order to avoid the overlay of painful events that could result in pain chronicity.
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Affiliation(s)
- Carlo Di Paolo
- Department of Oral and Maxillofacial Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Anna D'Urso
- Department of Oral and Maxillofacial Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Piero Papi
- Department of Oral and Maxillofacial Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Francesco Di Sabato
- Department of Clinical Medicine, Headache Center, “Sapienza” University of Rome, Rome, Italy
| | - Daniele Rosella
- Department of Oral and Maxillofacial Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Giorgio Pompa
- Department of Oral and Maxillofacial Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillofacial Sciences, “Sapienza” University of Rome, Rome, Italy
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Analysis of the upper cervical spine stiffness during axial rotation: A comparative study among patients with tension-type headache or migraine and asymptomatic subjects. Clin Biomech (Bristol, Avon) 2017; 42:128-133. [PMID: 28157621 DOI: 10.1016/j.clinbiomech.2017.01.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 10/19/2016] [Accepted: 01/26/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Many studies reported the implication of the cervical musculoskeletal system in patients with tension type headache and migraine. The objective of this study is to investigate the upper cervical spine stiffness features in axial rotation among headache patients in comparison with a healthy population. METHODS 48 subjects including 30 migraine patients with/without aura and 18 patients with tension-type headache, aged between 18 and 60years (mean 36, SD 11years) have been evaluated. Stiffness measurements were carried out for passive axial rotation using a torque meter device. The flexion-rotation test was used to emphasize assessment of the upper cervical spine. FINDINGS Neither the stiffness nor the neutral zone varies between different populations studied. Passive range of motion in axial rotation is unilaterally reduced in symptomatic subjects (p=0.001). Considering the elastic zone, right and left motion magnitude was significantly lower for clinical groups compared to the control group. INTERPRETATION Stiffness seems not to be altered among tension type headache and migraine patients. However, patients seem prone to display a larger right-left asymmetry of axial rotation and a reduction in the motion range tolerance, emphasizing the likely link between the cervical discomfort and these pathologies. Any difference is observed in the elastic behavior of the upper cervical spine between the two primary headache populations. However, further investigations are needed to confirm these previous results taking various specific clinical characteristics into consideration.
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58
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Effectiveness of a Treatment Involving Soft Tissue Techniques and/or Neural Mobilization Techniques in the Management of Tension-Type Headache. Arch Phys Med Rehabil 2017; 98:211-219.e2. [DOI: 10.1016/j.apmr.2016.08.466] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 08/10/2016] [Accepted: 08/15/2016] [Indexed: 01/03/2023]
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Lyubashina OA, Panteleev SS, Sokolov AY. Inhibitory effect of high-frequency greater occipital nerve electrical stimulation on trigeminovascular nociceptive processing in rats. J Neural Transm (Vienna) 2016; 124:171-183. [PMID: 27677650 DOI: 10.1007/s00702-016-1626-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 09/20/2016] [Indexed: 12/19/2022]
Abstract
Electrical stimulation of the greater occipital nerve (GON) has recently shown promise as an effective non-pharmacological prophylactic therapy for drug-resistant chronic primary headaches, but the neurobiological mechanisms underlying its anticephalgic action are not elucidated. Considering that the spinal trigeminal nucleus (STN) is a key segmental structure playing a prominent role in pathophysiology of headaches, in the present study we evaluated the effects of GON electrical stimulation on ongoing and evoked firing of the dura-sensitive STN neurons. The experiments were carried out on urethane/chloralose-anesthetized, paralyzed and artificially ventilated male Wistar rats. Extracellular recordings were made from 11 neurons within the caudal part of the STN that received convergent input from the ipsilateral facial cutaneous receptive fields, dura mater and GON. In each experiment, five various combinations of the GON stimulation frequency (50, 75, 100 Hz) and intensity (1, 3, 6 V) were tested successively in 10 min interval. At all parameter sets, preconditioning GON stimulation (250 ms train of pulses applied before each recording) produced suppression of both the ongoing activity of the STN neurons and their responses to electrical stimulation of the dura mater. The inhibitory effect depended mostly on the GON stimulation intensity, being maximally pronounced when a stimulus of 6 V was applied. Thus, the GON stimulation-induced inhibition of trigeminovascular nociceptive processing at the level of STN has been demonstrated for the first time. The data obtained can contribute to a deeper understanding of neurophysiological mechanisms underlying the therapeutic efficacy of GON stimulation in primary headaches.
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Affiliation(s)
- Olga A Lyubashina
- Laboratory of Cortico-Visceral Physiology, Pavlov Institute of Physiology of the Russian Academy of Sciences, 6 Nab. Makarova, Saint Petersburg, 199034, Russia. .,Department of Neuropharmacology, Valdman Institute of Pharmacology, First Saint-Petersburg Pavlov State Medical University, 6/8 Lev Tolstoy Street, Saint Petersburg, 197022, Russia.
| | - Sergey S Panteleev
- Laboratory of Cortico-Visceral Physiology, Pavlov Institute of Physiology of the Russian Academy of Sciences, 6 Nab. Makarova, Saint Petersburg, 199034, Russia.,Department of Neuropharmacology, Valdman Institute of Pharmacology, First Saint-Petersburg Pavlov State Medical University, 6/8 Lev Tolstoy Street, Saint Petersburg, 197022, Russia
| | - Alexey Y Sokolov
- Laboratory of Cortico-Visceral Physiology, Pavlov Institute of Physiology of the Russian Academy of Sciences, 6 Nab. Makarova, Saint Petersburg, 199034, Russia.,Department of Neuropharmacology, Valdman Institute of Pharmacology, First Saint-Petersburg Pavlov State Medical University, 6/8 Lev Tolstoy Street, Saint Petersburg, 197022, Russia
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60
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Nöbel M, Feistel S, Ellrich J, Messlinger K. ATP-sensitive muscle afferents activate spinal trigeminal neurons with meningeal afferent input in rat - pathophysiological implications for tension-type headache. J Headache Pain 2016; 17:75. [PMID: 27565510 PMCID: PMC5001961 DOI: 10.1186/s10194-016-0668-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/17/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Tension-type headache and other primary headaches may be triggered or aggravated by disorders of pericranial muscles, which is possibly due to convergent or collateral afferent input from meningeal and muscular receptive areas. In rodent models high extracellular concentrations of ATP caused muscle nociception and central sensitization of second order neurons. In a rat model of meningeal nociception we asked if spinal trigeminal activity induced by ATP can be modulated by local anaesthesia of distinct muscles. METHODS Ongoing activity was recorded from spinal trigeminal neurons with afferent input from the cranial dura mater, the temporal muscle and neck muscles. The stable ATP analogue α,β-methylene adenosine 5'-triphosphate (α,β-meATP, 10 mM) was injected into the ipsilateral temporal muscle, 30 min later followed by injection of local anaesthetics (lidocaine, 2 %) into the ipsilateral neck muscles and/or the temporal muscle. RESULTS Injection of α,β-meATP into the temporal muscle caused progressive increase in ongoing activity of most of the spinal trigeminal neurons within 30 min. Injection of lidocaine into the neck muscles and/or the temporal muscle reduced this activation to previous levels within 10 min. CONCLUSIONS Distinct spinal trigeminal neurons processing meningeal nociceptive information are under the control of convergent afferent input from several pericranial muscles. Blockade of at least one of these inputs can normalize central trigeminal activity. This may explain why therapeutic manipulations of head muscles can be beneficial in primary headaches.
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Affiliation(s)
- Moritz Nöbel
- Institute of Physiology and Pathophysiology, Friedrich-Alexander-University of Erlangen-Nürnberg, Universitätsstr. 17, 91054, Erlangen, Germany
| | - Stephan Feistel
- Institute of Physiology and Pathophysiology, Friedrich-Alexander-University of Erlangen-Nürnberg, Universitätsstr. 17, 91054, Erlangen, Germany
| | - Jens Ellrich
- Institute of Physiology and Pathophysiology, Friedrich-Alexander-University of Erlangen-Nürnberg, Universitätsstr. 17, 91054, Erlangen, Germany.,Department of Health Science and Technology, Medical Faculty, Aalborg University, Aalborg, Denmark
| | - Karl Messlinger
- Institute of Physiology and Pathophysiology, Friedrich-Alexander-University of Erlangen-Nürnberg, Universitätsstr. 17, 91054, Erlangen, Germany.
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International consensus on the most useful physical examination tests used by physiotherapists for patients with headache: A Delphi study. ACTA ACUST UNITED AC 2016; 23:17-24. [PMID: 27183831 DOI: 10.1016/j.math.2016.02.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 02/17/2016] [Accepted: 02/18/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND A wide range of physical tests have been published for use in the assessment of musculoskeletal dysfunction in patients with headache. Which tests are used depends on a physiotherapist's clinical and scientific background as there is little guidance on the most clinically useful tests. OBJECTIVES To identify which physical examination tests international experts in physiotherapy consider the most clinically useful for the assessment of patients with headache. DESIGN/METHODS Delphi survey with pre-specified procedures based on a systematic search of the literature for physical examination tests proposed for the assessment of musculoskeletal dysfunction in patients with headache. RESULTS Seventeen experts completed all three rounds of the survey. Fifteen tests were included in round one with eleven additional tests suggested by the experts. Finally eleven physical examination tests were considered clinically useful: manual joint palpation, the cranio-cervical flexion test, the cervical flexion-rotation test, active range of cervical movement, head forward position, trigger point palpation, muscle tests of the shoulder girdle, passive physiological intervertebral movements, reproduction and resolution of headache symptoms, screening of the thoracic spine, and combined movement tests. CONCLUSIONS Eleven tests are suggested as a minimum standard for the physical examination of musculoskeletal dysfunctions in patients with headache.
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Leininger B, Brønfort G, Haas M, Schmitt J, Evans RL, Levin M, Westrom K, Goldsmith CH. Spinal rehabilitative exercise or manual treatment for the prevention of tension-type headache in adults. Cochrane Database Syst Rev 2016; 2016:CD012139. [PMID: 28066156 PMCID: PMC5214999 DOI: 10.1002/14651858.cd012139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the short- and long-term effects of manual treatment and spinal rehabilitative exercise for the prevention of tension-type headache in adults.
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Affiliation(s)
- Brent Leininger
- Integrative Health & Wellbeing Research Program, Center for Spirituality & Healing, University of Minnesota, Minneapolis, MN, USA
| | - Gert Brønfort
- Integrative Health & Wellbeing Research Program, Center for Spirituality & Healing, University of Minnesota, Minneapolis, MN, USA
| | | | | | - Roni L Evans
- Integrative Health & Wellbeing Research Program, Center for Spirituality & Healing, University of Minnesota, Minneapolis, MN, USA
| | - Morris Levin
- Neurology, UCSF School of Medicine, San Francisco, California, USA
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Comparative analysis of head-tilt and forward head position during laptop use between females with postural induced headache and healthy controls. J Bodyw Mov Ther 2015; 20:533-41. [PMID: 27634075 DOI: 10.1016/j.jbmt.2015.11.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 11/14/2015] [Accepted: 11/19/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To compare 1) maximum manually induced head-protraction, head-tilt and forward head position and 2) the evolution of head-tilt and forward head position during a laptop-task between a headache- and control-group. METHODS Angles for maximum head-protraction, head-tilt and forward head position of 12 female students with postural induced headache and 12 female healthy controls were calculated at baseline and while performing a laptop-task. RESULTS The headache-group demonstrated an increased passive head-protraction of 22.30% compared to the control-group. The ratio of forward head position during habitual sitting to the maximum head-protraction differed significantly (p = 0.046) between headache-group (1.4 ± 0.4) and the control-group (1.1 ± 0.2). The headache-group showed a biphasic forward head position and head-tilt profile. These profiles differed significantly (p < 0.05) between groups and were negatively correlated (rE = -0.927). CONCLUSION The headache-group showed a larger passive head-protraction with a habitual forward head-position further located from the end-range. During the laptop-task forward head position and head-tilt behaved biphasically with a more static forward head position and a more dynamic head-tilt.
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Florencio LL, de Oliveira AS, Carvalho GF, Tolentino GDA, Dach F, Bigal ME, Fernández-de-las-Peñas C, Bevilaqua Grossi D. Cervical Muscle Strength and Muscle Coactivation During Isometric Contractions in Patients With Migraine: A Cross-Sectional Study. Headache 2015; 55:1312-22. [PMID: 26388193 DOI: 10.1111/head.12644] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This cross-sectional study investigated potential differences in cervical musculature in groups of migraine headaches vs. non-headache controls. Differences in cervical muscle strength and antagonist coactivation during maximal isometric voluntary contraction (MIVC) were analyzed between individuals with migraine and non-headache subjects and relationships between force with migraine and neck pain clinical aspects. METHOD A customized hand-held dynamometer was used to assess cervical flexion, extension, and bilateral lateral flexion strength in subjects with episodic migraine (n=31), chronic migraine (n = 21) and healthy controls (n = 31). Surface electromyography (EMG) from sternocleidomastoid, anterior scalene, and splenius capitis muscles were recorded during MIVC to evaluate antagonist coactivation. Comparison of main outcomes among groups was conducted with one-way analysis of covariance with the presence of neck pain as covariable. Correlations between peak force and clinical variables were demonstrated by Spearman's coefficient. RESULTS Chronic migraine subjects exhibited lower cervical extension force (mean diff. from controls: 4.4 N/kg; mean diff from episodic migraine: 3.7 N/kg; P = .006) and spent significantly more time to generate peak force during cervical flexion (mean diff. from controls: 0.5 seconds; P = .025) and left lateral-flexion (mean diff. from controls: 0.4 seconds; mean diff. from episodic migraine: 0.5 seconds; P = .007). Both migraine groups showed significantly higher antagonist muscle coactivity of the splenius capitis muscle (mean diff. from controls: 20%MIVC, P = .03) during cervical flexion relative to healthy controls. Cervical extension peak force was moderately associated with the migraine frequency (rs: -0.30, P = .034), neck pain frequency (rs: -0.26, P = .020), and neck pain intensity (rs: -0.27, P = .012). CONCLUSION Patients with chronic migraine exhibit altered muscle performance, took longer to reach peak of force during some cervical movements, and had higher coactivation of the splenius capitis during maximal isometric cervical flexion contraction. Finally, patients with migraine reported the presence of neck and head pain complaints during maximal isometric voluntary cervical contractions.
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Affiliation(s)
- Lidiane Lima Florencio
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation - Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto-SP, Brazil
| | - Anamaria Siriani de Oliveira
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation - Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto-SP, Brazil
| | - Gabriela Ferreira Carvalho
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation - Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto-SP, Brazil
| | - Gabriella de Almeida Tolentino
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation - Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto-SP, Brazil
| | - Fabiola Dach
- Department of Neurosciences and Behavioral Sciences - Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto-SP, Brazil
| | | | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Débora Bevilaqua Grossi
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation - Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto-SP, Brazil
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Abstract
BACKGROUND Cervicogenic headache (CGH) is defined as headache symptoms originating from the cervical spine. Cervical dysfunction from abnormal posture has been proposed to aggravate or cause CGH, but there are conflicting reports as to whether there is an association between posture and CGH. OBJECTIVE The purpose of this study was to evaluate differences in cervical spinal posture, measured on radiographs, between patients with probable CGH and asymptomatic control participants. DESIGN A single-blinded comparative measurement design was used. METHODS Differences in postural variables from radiographs between participants with CGH (n=30) and age- and sex-matched asymptomatic control participants (n=30) were determined using paired t tests or the nonparametric equivalent. Postural variables were general cervical lordosis (GCL, Cobb angle C2-C7), upper cervical lordosis (UCL, sagittal alignment C2 compared with C3-C4), and C2 spinous process horizontal deviation. Logistic regression determined postural variables, increasing the likelihood of CGH. RESULTS There were no significant differences in posture between the CGH and control groups. The mean GCL was 10.97 degrees (SD=7.50) for the CGH group and 7.17 degrees (SD=5.69) for the control group. The mean UCL was 11.86 degrees (SD=6.46) for the CGH group and 9.44 degrees (SD=4.28) for the control group. The mean C2 spinous process horizontal deviation was 3.00 mm (SD=1.66) for the CGH group and 2.86 mm (SD=2.04) for the control group. However, there was a significant association between greater GCL and an increased likelihood of having CGH (odds ratio=1.08; 95% confidence interval=1.001, 1.191). LIMITATIONS The findings are limited to an association between GCL and posture, as cause and effect cannot be determined. CONCLUSIONS The association between greater GCL and increased likelihood of having CGH suggests that GCL might be considered in the treatment of patients with CGH. However, as the data do not support posture as a cause of CGH, it is unknown whether addressing posture would reduce CGH.
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Abstract
Headache and facial pain - in particular, temporomandibular disorders (TMDs) - are very prevalent conditions in the general population. TMDs are defined as a collection of symptoms and signs involving masticatory muscles, the temporomandibular joints (TMJs), or both. The pain reported by TMD patients is typically located in the muscles of mastication, in the preauricular area, or in the TMJs. In many cases, headaches and facial pain will occur in the same patient. Much of the research relative to the relationship of these disorders focuses on statistics of association and prevalence data. This review will provide a brief description of the types and classifications of orofacial pains (OFPs), as well as point to relevant research describing the commonalities and potential comorbid nature of these maladies. Finally, several recent papers describing morphologic changes to the brain in headache and TMD individuals will be discussed in an effort to stimulate further research into the potential common pathophysiologic mechanism that may explain the comorbid nature of these disorders.
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Tali D, Menahem I, Vered E, Kalichman L. Upper cervical mobility, posture and myofascial trigger points in subjects with episodic migraine: Case-control study. J Bodyw Mov Ther 2014; 18:569-75. [DOI: 10.1016/j.jbmt.2014.01.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 01/10/2014] [Accepted: 01/29/2014] [Indexed: 11/28/2022]
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68
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Florencio LL, Chaves TC, Carvalho GF, Gonçalves MC, Casimiro ECB, Dach F, Bigal ME, Bevilaqua-Grossi D. Neck pain disability is related to the frequency of migraine attacks: a cross-sectional study. Headache 2014; 54:1203-10. [PMID: 24863346 DOI: 10.1111/head.12393] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Migraine and neck pain can be critical causes of disability. The contribution of neck pain for the overall disability of individuals with migraine remains unknown. OBJECTIVE To contrast the disability experienced by individuals with episodic and chronic migraine with and without neck pain as captured by the Neck Disability Index. METHODS Disability due to neck pain was assessed using the Neck Disability Index in individuals with episodic or chronic migraine seen at a university-based headache center. Neck disability was defined as mild (score ranging from 5 to 14 points), moderate (15-24 points), severe (25-34 points) or complete (35 points or higher). To compare differences between groups, a chi-square test was applied. Log-binomial logistic regression was used to estimate disability as a function of headache status after adjustments for age, time since migraine onset, and headache intensity. RESULTS Sample consisted of 169 individuals, 104 with episodic migraine and 65 with chronic migraine. Any disability due to neck pain happened in 69% of those with episodic migraine, relative to 92% in chronic migraine (P < .001). Individuals with chronic migraine were at a significantly increased risk to have mild (RR = 2.5; CI 95% 1.1-6.1), moderate (RR = 3.7; CI 95% 1.5-8.8) and severe (RR = 5.1; CI 95%2.1-11.9) cervical disability relative to those with episodic migraine. Relative risks remained significant after adjustments. Time since episodic or chronic migraine onset significantly influenced the model (P = .035), but age and headache intensity did not (P = .27; P = .46). CONCLUSION Neck pain significantly adds to the overall disability of individuals with episodic and chronic migraine.
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Affiliation(s)
- Lidiane L Florencio
- Departament of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
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Grondin F, Hall T, Laurentjoye M, Ella B. Upper cervical range of motion is impaired in patients with temporomandibular disorders. Cranio 2014; 33:91-9. [PMID: 25919749 DOI: 10.1179/0886963414z.00000000053] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIMS Clinicians increasingly suggest assessment and treatment of the cervical spine in patients with temporomandibular dysfunction (TMD); however, few studies have investigated upper cervical spine mobility in people who suffer from TMD. The purpose of this study was to investigate whether patients with TMD pain (with or without headache) present with upper cervical spine impairment when compared with asymptomatic subjects. METHODOLOGY A single blind examiner evaluated cervical range of motion (ROM) measures including axial rotation during the flexion-rotation test (FRT) and sagittal plane ROM. Twenty asymptomatic subjects were compared with 37 subjects with pain attributed to TMD, confirmed by the Revised Research Diagnostic Criteria. Subjects with TMD were divided according to the presence of headache (26 without headache TMDNHA, 11 with headache TMDHA). One-way analysis of variance and planned orthogonal comparisons were used to determine differences in cervical mobility between groups. All subjects with TMD were positive on the FRT with restricted ROM, while none were in the control group. RESULTS The analysis of variance revealed significant differences between groups for the FRT F(2,54) = 57.96, P<0.001) and for sagittal ROM [F(2,54) = 5.69, P = 0.006]. Findings show that the TMDHA group had less axial rotation than group TMDNHA, and both TMD groups had less ROM than controls. For sagittal ROM, the only difference was between group TMDHA and controls. CONCLUSIONS Subjects with TMD had signs of upper cervical spine movement impairment, greater in those with headache. Only subjects with TMD and headache had impairment of cervical spine sagittal plane mobility. This study provides evidence for the importance of examination of upper cervical mobility determined by the FRT in patients who suffer from TMD.
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Watson DH, Drummond PD. Cervical Referral of Head Pain in Migraineurs: Effects on the Nociceptive Blink Reflex. Headache 2014; 54:1035-45. [DOI: 10.1111/head.12336] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2014] [Indexed: 12/16/2022]
Affiliation(s)
- Dean H. Watson
- School of Psychology; Murdoch University; Perth WA Australia
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71
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A proposed diagnostic classification of patients with temporomandibular disorders: implications for physical therapists. J Orthop Sports Phys Ther 2014; 44:182-97. [PMID: 24579796 DOI: 10.2519/jospt.2014.4847] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
SYNOPSIS Physical therapists have an important role on the interprofessional team to provide care for people with temporomandibular disorders (TMDs). Diagnostic classification is a challenge in this population, given the complexities inherent in presentations of headache and orofacial pain, and is critical to selecting the appropriate intervention. The objectives of this paper were (1) to characterize the epidemiology and pathophysiology of the TMDs most commonly seen in the outpatient clinic, (2) to describe a systems screen to be used in the physical therapy examination to determine the need for interprofessional referral, and (3) to propose an approach for physical therapists to examine, evaluate, and classify patients with TMDs, based on previously validated methodologies. A modification of the diagnostic framework of the International Headache Society has provided the basis for the systems screen of people presenting with orofacial pain. The physical therapy examination and evaluation is based on the Diagnostic Criteria for TMD, developed and validated by a consortium of specialists from the American Academy of Orofacial Pain. LEVEL OF EVIDENCE Diagnosis, level 5.
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Orofacial manual therapy improves cervical movement impairment associated with headache and features of temporomandibular dysfunction: A randomized controlled trial. ACTA ACUST UNITED AC 2013; 18:345-50. [DOI: 10.1016/j.math.2012.12.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 11/22/2012] [Accepted: 12/18/2012] [Indexed: 11/19/2022]
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Abstract
Although tension-type headache is ubiquitous, only a relatively small percentage of the population has these headaches occurring with sufficient frequency and severity to cause them to seek out medical attention. This small group, however, may have substantial impact from their disease on productivity and quality of life. Assessment of the headaches includes assessment for other headache disorders that may overlap it, such as a chronic migraine. Additionally, coexisting diseases that may contribute to the process, such as mood disorders and mechanical disorders of the spine and neck, require investigation. Treatment is optimized by appropriate use of acute medications and preventive treatments that may include drugs in the antidepressant classes along with nonpharmacologic modalities and other alternative treatments ranging from biofeedback to manual therapy to the use of botulinum toxin type A injections.
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Affiliation(s)
- Frederick Freitag
- Department of Neurosciences, Baylor University Medical Center, Dallas, TX 75231, USA.
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74
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Abstract
Refractory migraine has long been a challenge to all headache specialists. This subgroup of migraine patients experience disability and impaired quality of life, despite optimal treatment. This article reviews the proposed definitions and epidemiology of refractory migraine, as well as the pathophysiology that may contribute to the genesis of this disorder. Aspects of treatment, including pharmacological, complementary/adjunct, and invasive approaches, are reviewed. Comorbid factors, medication overuse, potential pitfalls to treatment, and areas for future investigation are highlighted.
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Affiliation(s)
- Elliott Schulman
- Lankenau Medical Center and Lankenau Institute for Medical Research, Wynnewood, PA, USA
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