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Onan D, Arıkan H, Martelletti P. The Effect of OnabotulinumtoxinA on Headache Intensity and Number of Monthly Headache Days in Individuals with Chronic Migraine with Different Levels of Neck Disability. Toxins (Basel) 2023; 15:685. [PMID: 38133189 PMCID: PMC10747931 DOI: 10.3390/toxins15120685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
One of the treatment methods used in chronic migraine is OnabotulinumtoxinA. The effects of OnabotulinumtoxinA on headache intensity (HI) and number of monthly headache days (NMHD) in chronic migraine (CM) patients classified according to neck disability levels are unknown. Our aim was to investigate the effect of OnabotulinumtoxinA on the HI and the NMHD in individuals with CM with different levels of neck disability. One hundred sixteen patients were enrolled in the study. The OnabotulinumtoxinA protocol was administered as per Follow-the-Pain PREEMPT. The Neck Disability Index was used to evaluate neck disability. Primary outcome measures were headache intensity, assessed with the Visual Analogue Scale, and the number of monthly headache days recorded from patients' diaries. Secondary outcome measures were migraine disability, assessed with the Migraine Disability Assessment Test, and quality-of-life, assessed with the Headache Impact Test-6. All assessments were made at baseline and end of the treatment. The OnabotulinumtoxinA treatment showed a greater improvement effect in the number of monthly headache days (p = 0.000) and migraine disability (p = 0.000) parameters in the severe and complete disability groups. CM patients with complete and severe neck disability received the most benefit in reducing the NMHD at 3 months after OnabotulinumtoxinA treatment, but the HI decreased at a similar level in all neck disability groups.
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Affiliation(s)
- Dilara Onan
- Department of Physiotherapy and Rehabilitation, Faculty of Heath Sciences, Yozgat Bozok University, Yozgat 66100, Turkey;
| | - Halime Arıkan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Tokat Gaziosmanpasa University, Tokat 60000, Turkey;
| | - Paolo Martelletti
- School of Health Sciences, Unitelma Sapienza University, 00161 Rome, Italy
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Carvalho G, Quinn R, Luedtke K. Migraine patients' experiences with and expectations from physiotherapy. Musculoskelet Sci Pract 2023; 66:102803. [PMID: 37331925 DOI: 10.1016/j.msksp.2023.102803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/01/2023] [Accepted: 06/10/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Neck pain is prevalent in migraine and a common reason to receive physiotherapy. There is no information as to the type of modalities patients receive and whether these are perceived as effective and matching expectations. METHODS A survey was designed with closed and open-ended questions allowing for quantitative evaluation and qualitative insights into experiences and expectations. The survey was available online from June-November 2021 and was disseminated in the German migraine league (patient organization) and via social media. Open questions were summarized using qualitative content analysis. Differences between receiving and not receiving physiotherapy were analyzed through Chi2 or Fisher's Test. Categories within groups through Chi2-goodness-of-fit-test and multivariate logistic regression indicated perceived clinical improvement. RESULTS 149 (123 received physiotherapy) patients completed the questionnaire. Patients receiving physiotherapy had higher pain intensity (p < 0.001) and migraine frequency (p = 0.017). Most participants received 6 sessions or less (38%) (past 12 months) of manual therapy (82%) and soft-tissue techniques (61%). 63% perceived benefits after manual therapy, and 50% after soft-tissue techniques. Logistic regression revealed that ictal and interictal neck pain (OR: 9.12 and 6.41, respectively) and receiving manual therapy (OR: 5.52) are associated with improvement. Mat exercises and higher migraine frequency increased the odds for no improvement or worsening (OR: 0.25 and 0.65, respectively). Expectations included individualized and targeted treatment from a specialized physiotherapist (39%), easier access, more and longer sessions (28%), manual therapy (78%), soft-tissue techniques (72%) and education (26%). CONCLUSION sThis first study on migraine patients' views on physiotherapy can serve as insight for researchers for future studies and clinicians to improve future care.
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Affiliation(s)
- Gabriela Carvalho
- Institute of Health Sciences, Department of Physiotherapy, Universität zu Lübeck, Lübeck, Germany
| | - Rebecca Quinn
- Institute of Health Sciences, Department of Physiotherapy, Universität zu Lübeck, Lübeck, Germany
| | - Kerstin Luedtke
- Institute of Health Sciences, Department of Physiotherapy, Universität zu Lübeck, Lübeck, Germany.
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3
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Bevilaqua-Grossi D, Pinheiro-Araujo CF, Carvalho GF, Florencio LL. Neck pain repercussions in migraine - The role of physiotherapy. Musculoskelet Sci Pract 2023; 66:102786. [PMID: 37291009 DOI: 10.1016/j.msksp.2023.102786] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/26/2023] [Accepted: 05/27/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Migraine is a neurological and disabling disease whose peripheral manifestations can be addressed with physiotherapy. These manifestations can include pain and hypersensitivity to muscular and articular palpation in the neck and face region, a higher prevalence of myofascial trigger points, limitation in global cervical motion, especially in the upper segment (C1-C2), and forward head posture with worse muscular performance. Furthermore, patients with migraine can present cervical muscle weakness and greater co-activation of antagonists in maximum and submaximal tasks. In addition to musculoskeletal repercussions, these patients can also present balance impairment and a greater risk of falls, especially when chronicity of migraine frequency is present. The physiotherapist is a relevant player in the interdisciplinary team and can help these patients to control and manage their migraine attacks. PURPOSE This position paper discusses the most relevant musculoskeletal repercussions of migraine in the craniocervical area under the perspective of sensitization and disease chronification, besides addressing physiotherapy as an important strategy for evaluating and treating these patients. IMPLICATIONS Physiotherapy as a non-pharmacological treatment option in migraine treatment may potentially reduce musculoskeletal impairments related to neck pain in this population. Disseminating knowledge about the different types of headaches and the diagnostic criteria can support physiotherapists who compose a specialized interdisciplinary team. Furthermore, it is important to acquire competencies in neck pain assessment and treatment approaches according to the current evidence.
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Affiliation(s)
- Debora Bevilaqua-Grossi
- Health Sciences Department, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, Monte Alegre, Ribeirão Preto, SP, Brazil.
| | - Carina F Pinheiro-Araujo
- Health Sciences Department, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, Monte Alegre, Ribeirão Preto, SP, Brazil.
| | - Gabriela F Carvalho
- Institute of Health Sciences, Academic Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), University of Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany.
| | - Lidiane L Florencio
- Department of Physiotherapy, Occupational Therapy, Physical Medicine and Rehabilitation, King Juan Carlos University, Madrid, 28922, Alcorcón, Spain.
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Perreault T, Arendt-Nielson L, Fernández-de-las-Peñas C, Dommerholt J, Herrero P, Hubbard R. Intramuscular Electrical Stimulation for the Treatment of Trigger Points in Patients with Chronic Migraine: A Protocol for a Pilot Study Using a Single-Case Experimental Design. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1380. [PMID: 37629671 PMCID: PMC10456716 DOI: 10.3390/medicina59081380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Trigger points (TrPs) are prevalent in patients with migraine headaches. Needling interventions targeting TrPs in migraine patients may reduce the intensity and frequency of headaches, yet systematic reviews reveal a lack of robust evidence. Intramuscular electrical stimulation (IMES) is a modality that delivers electrical current into muscles and TrPs, with recent studies suggesting it may amplify the therapeutic effects of dry needling peripherally and centrally. This could be advantageous for patients with migraine and symptomatic TrPs. Materials and Methods: This study will implement a multiple baseline single-case experimental design (SCED). In a clinical setting, a SCED study lends itself to conducting research with only a few patients that each serve as their own controls. In this SCED study, four participants with chronic migraine will be enrolled in a non-concurrent manner and randomized to one of four baseline measurement periods (4, 5, 6 or 7 weeks), leading to four potentially different start dates for each participant in the intervention phase. During the intervention phase, patients will receive five sessions of dry needling with IMES, one session per week for five weeks. The primary outcome measure will be headache frequency, i.e., the reduction in the number of headache days over a one-month period using electronic headache diary data from the Migraine Buddy smartphone application. Secondary outcome measures will be changes in mean migraine pain intensity using a numeric pain rating scale (NPRS), migraine disability using the Migraine Disability Assessment Test (MIDAS), the Headache Impact Test (HIT-6), and changes in selected cervical musculoskeletal impairments including pressure pain thresholds (PPTs) over TrPs, the craniocervical flexion test (CCFT), and cervical active range of motion (AROM). Primary and secondary outcome measures will be analyzed separately using both visual and statistical analyses. Results: Actively recruiting participants. This project was approved by the Mass General Brigham Institutional Review Board (protocol #2023P000931) and is registered with ClinicalTrials.gov (NCT05893914). Conclusions: This study will seek to determine the effects of a five-week intervention period of IMES to TrPs in the posterior cervical muscles of subjects with chronic migraine.
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Affiliation(s)
- Thomas Perreault
- Department of Physical Therapy, Wentworth Douglass Hospital, Dover, NH 03820, USA;
| | - Lars Arendt-Nielson
- Center for Neuroplasticity and Pain, SMI, School of Medicine, Aalborg University, DK-9220 Aalborg, Denmark; (L.A.-N.); (C.F.-d.-l.-P.)
- Department of Gastroenterology & Hepatology, Mech-Sense, Clinical Institute, Aalborg University Hospital, DK-9000 Aalborg, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, DK-9000 Aalborg, Denmark
| | - César Fernández-de-las-Peñas
- Center for Neuroplasticity and Pain, SMI, School of Medicine, Aalborg University, DK-9220 Aalborg, Denmark; (L.A.-N.); (C.F.-d.-l.-P.)
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Madrid, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia-Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Madrid, Spain
| | - Jan Dommerholt
- Myopain Seminars, Bethesda, MD 20814, USA;
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Pablo Herrero
- IIS Aragon, Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain;
| | - Ryan Hubbard
- Department of Physical Therapy, Wentworth Douglass Hospital, Dover, NH 03820, USA;
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Meise R, Carvalho GF, Thiel C, Luedtke K. Additional effects of pain neuroscience education combined with physiotherapy on the headache frequency of adult patients with migraine: A randomized controlled trial. Cephalalgia 2023; 43:3331024221144781. [PMID: 36739510 DOI: 10.1177/03331024221144781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Aim To assess the efficacy of pain neuroscience education combined with physiotherapy for the management of migraine.Background Physiotherapy can significantly reduce the frequency of migraine, but the evidence is based only on a few studies. Pain neuroscience education might pose a promising treatment, as it addresses migraine as a chronic pain disease.Methods In this non-blinded randomized controlled trial, migraine patients received physiotherapy + pain neuroscience education or physiotherapy alone, preceded by a three-month waiting period. Primary outcomes were frequency of headache (with and without migraine features), frequency of migraine and associated disability.Results Eighty-two participants were randomized and analyzed. Both groups showed a decrease of headache frequency (p = 0.02, d = 0.46) at post-treatment (physiotherapy: 0.77 days, 95%CI: -0.75 to 2.29 and physiotherapy + pain neuroscience education: 1.25 days, 95%CI: -0.05 to 2.55) and at follow-up (physiotherapy: 1.93, 95%CI: 0.07 to 3.78 and physiotherapy + pain neuroscience education: 3.48 days, 95%CI: 1.89 to 5.06), with no difference between groups (p = 0.26, d = 0.26). Migraine frequency was reduced significantly in the physiotherapy + pain neuroscience education group, and not in the physiotherapy group, at post-treatment (1.28 days, 95%CI: 0.34 to 2.22, p = 0.004) and follow-up (3.05 days, 95%CI: 1.98 to 5.06, p < 0.0001), with a difference between groups at follow-up (2.06 days, p = 0.003). Migraine-related disability decreased significantly in both groups (physiotherapy: 19.8, physiotherapy + pain neuroscience education: 24.0 points, p < 0.001, d = 1.15) at follow-up, with no difference between groups (p = 0.583). Secondary outcomes demonstrated a significant effect of time with no interaction between time and group. No harm or adverse events were observed during the study.Conclusion In comparison to physiotherapy alone, pain neuroscience education combined with physiotherapy can further reduce the frequency of migraine, but had no additional effect on general headache frequency or migraine-related disability.Trial Registration The study was pre-registered at the German Clinical Trials Register (DRKS00020804).
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Affiliation(s)
- Ruth Meise
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck, Universitaet zu Luebeck, Luebeck, Germany
| | - Gabriela Ferreira Carvalho
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck, Universitaet zu Luebeck, Luebeck, Germany
| | - Christian Thiel
- Department of Applied Health Sciences, Hochschule fuer Gesundheit (University of Applied Sciences), Bochum, Germany.,Faculty of Sports Science, Ruhr-University Bochum, Bochum, Germany
| | - Kerstin Luedtke
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck, Universitaet zu Luebeck, Luebeck, Germany
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Zárate-Tejero C, Hidalgo-García C, Lucha-López O, Hernández-Secorún M, Krauss J, Rodríguez-Rubio P. Association between age, sex and cervical and upper cervical rotation tests. Descriptive and correlational study in healthy volunteers. Ther Adv Chronic Dis 2023; 14:20406223231170158. [PMID: 37152351 PMCID: PMC10155033 DOI: 10.1177/20406223231170158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/29/2023] [Indexed: 05/09/2023] Open
Abstract
Background Active cervical spine rotation (ACROM Rot) shows cervical rotation and flexion rotation test (FRT); side-bending rotation test (SBRT) and upper cervical axial rotation test (C0-C2ART) are described to measure upper cervical rotation. The objectives of this study are (1) to describe the normal range of motion (ROM) of ACROM Rot, and the ROM in FRT, SBRT and C0-C2ART tests; (2) to explore the correlation among the four tests and (3) to investigate the influence of age and sex in their ROM. Methods A cross-sectional study was carried out with healthy volunteers from 18 to 75 years of age. Tests were measured using a CROM device and a bubble inclinometer. Descriptive analysis was performed to establish normative data for the ROM tests. Correlation analysis was conducted to understand the relation between upper and global cervical rotation ROM and among the three upper cervical rotation tests. Linear regression models were developed to understand the influence of age and sex in the ROM of all tests. Results Normative values were obtained from 122 healthy volunteers (50% male), by sex and age strata. The degree of correlation ranged between 0.582 (p < 0.01) for FRT and ACROM Rot left and 0.217 (p < 0.05) for SBRT and C0-C2ART left. Linear regression models showed the influence of sex for ACROM Rot right (men -4.64° less than women), SBRT (men -4.1° less than women) left and C0-C2ART right and left (men -2.24° and -1.78° less than women). The age influenced rotation ROM with a decrease for every 10 years of -2.11° and -1.96° for ACROM Rot right and left, of -1.72° and -1.26° for FRT right and left and -0.58° and -0.41° for C0-C2ART right and left in the linear regression models. No association was found between age and SBRT (p = 0.63 for right SBRT and p = 0.49 for left SBRT). Conclusion Weak-to-moderate correlation was found between the upper cervical spine rotation tests and with the ACROM. Women had a larger ROM in ACROM Rot right, SBRT left and C0-C2ART. Decreases in ROM related with age were observed for ACROM Rot, FRT and C0-C2ART but not for SBRT.
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Affiliation(s)
- Carlos Zárate-Tejero
- Physiotherapy Department, Faculty of Medicine
and Health Sciences, Universitat Internacional de Catalunya, Barcelona,
Spain
| | | | | | - Mar Hernández-Secorún
- Unidad de Investigación en Fisioterapia,
Facultad de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza,
Spain
| | - John Krauss
- School of Health Sciences, Oakland University,
Rochester, MI, USA
| | - Pere Rodríguez-Rubio
- Physiotherapy Department, Faculty of Medicine
and Health Sciences, Universitat Internacional de Catalunya, Barcelona,
Spain
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Onan D, Bentivegna E, Martelletti P. OnabotulinumtoxinA Treatment in Chronic Migraine: Investigation of Its Effects on Disability, Headache and Neck Pain Intensity. Toxins (Basel) 2022; 15:29. [PMID: 36668849 PMCID: PMC9862733 DOI: 10.3390/toxins15010029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/12/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
Neck disability and pain are frequently encountered problems in patients with chronic migraine (CM). The long-term stimuli of neurons in the trigeminocervical junction may explain this situation. OnabotulinumtoxinA (ONA) treatment is one of the proven treatments for CM; however, there is no study data on the efficacy of ONA treatment on neck disability and pain in CM patients. Therefore, we aimed to investigate the effect of ONA treatment on disability, neck pain and headache intensity in CM patients. One hundred thirty-four patients who met the inclusion criteria were included in the study. ONA treatment was administered at a dose of 195 U to 39 sites in total as per Follow-the-Pain PREEMPT protocol. The disability was evaluated with the Neck Disability Index and the Migraine Disability Assessment; pain intensity was evaluated with the Visual Analogue Scale; the monthly number of headache days were recorded; quality of life was evaluated with the Headache Impact Test. All assessments were recorded at baseline and 3 months after treatment. After the treatment, neck−migraine disabilities decreased from severe to mild for neck and moderate for migraine (p < 0.001). Neck pain and headache intensities decreased by almost half (p < 0.001). The median number of monthly headache days decreased from 20 days to 6 days (p < 0.000). The quality-of-life level decreased significantly from severe to substantial level (p < 0.001). According to our results, ONA treatment was effective in reducing neck-related problems in CM patients. Long-term follow-up results may provide researchers with more comprehensive results in terms of the treatment of chronic migraine−neck-related problems.
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Affiliation(s)
- Dilara Onan
- Spine Health Unit, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara 06230, Türkiye
- Department of Clinical and Molecular Medicine, Sapienza University, 000189 Rome, Italy
| | - Enrico Bentivegna
- Department of Clinical and Molecular Medicine, Sapienza University, 000189 Rome, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, 000189 Rome, Italy
- Regional Referral Headache Centre, Sant’Andrea Hospital, 000189 Rome, Italy
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Paquin JP, Dumas JP, Gérard T, Tousignant-Laflamme Y. A perspective on the use of the cervical flexion rotation test in the physical therapy management of cervicogenic headaches. Arch Physiother 2022; 12:26. [PMID: 36476405 PMCID: PMC9730562 DOI: 10.1186/s40945-022-00153-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 08/24/2022] [Accepted: 10/03/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The Cervical Flexion-Rotation Test (CFRT) is widely used in the assessment of upper cervical spine mobility impairments and in the diagnosis of cervicogenic headache (CGH) by physiotherapist. Many studies investigated its different properties, and the results show that the CFRT has good construct validity in the measurement of C1-C2 rotation as well as good to excellent reliability. PURPOSE In this theoretical paper, we explore the value and point out two methodological issues associated to the CFRT, one related to the procedures and another related to its diagnostic accuracy. RESULTS Our analysis indicate that there are many confounding factors that could affect the CFRT cut-off's accuracy, which are likely to overestimate the diagnosis properties of CFRT. Potential solutions are discussed. Moreover, the gold standard (manual examination) used to examine the validity of the CFRT for the diagnosis of CGH appears to be far from perfect - we could argue that the diagnostic properties of the CFRT for CGH might be biased and the likelihood ratios are likely to be overestimated. However, it could be relevant to explore if results of the CFRT could be considered as a treatment-effect modifier. Maybe the CFRT could be more valuable as a prognostic factor? CONCLUSION The quality of evidence supporting the validity of the CFRT is most likely biased. In the absence of a better gold standard, maybe the CFRT could be a more valuable test to establish the patient's prognosis and help the clinician to choose the most appropriate treatment options.
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Affiliation(s)
- Jean-Philippe Paquin
- grid.265696.80000 0001 2162 9981Laboratoire de Recherche Biomécanique et Neurophysiologique en Réadaptation Neuro- musculosquelettique(BioNR), Université du Québec à Chicoutimi (UQAC), G7H 2B1 Saguenay, Qc Canada ,grid.265696.80000 0001 2162 9981Department of health sciences, Université du Québec à Chicoutimi (UQAC), G7H 2B1 Saguenay, Qc Canada
| | - Jean-Pierre Dumas
- grid.86715.3d0000 0000 9064 6198School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue Nord, J1H 5N4 Sherbrooke, QC Canada
| | - Thomas Gérard
- grid.411172.00000 0001 0081 2808Research Center of the CHUS (CRCHUS), Centre hospitalier universitaire de Sherbrooke (CHUS), Sherbrooke, Qc Canada ,Cabinet de kinésithérapie, 7 rue Antigna, 45000 Orléans, Loiret, France
| | - Yannick Tousignant-Laflamme
- grid.86715.3d0000 0000 9064 6198School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue Nord, J1H 5N4 Sherbrooke, QC Canada ,grid.411172.00000 0001 0081 2808Research Center of the CHUS (CRCHUS), Centre hospitalier universitaire de Sherbrooke (CHUS), Sherbrooke, Qc Canada
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9
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Onan D, Martelletti P. Does the Intensity of the Headache Differ According to the Level of Neck Disability in Chronic Migraine Patients? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16307. [PMID: 36498380 PMCID: PMC9740960 DOI: 10.3390/ijerph192316307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
Chronic migraine (CM) patients who report a high frequency and intensity of headaches also report neck pain (NP) and neck disability (ND) in neck activities that require stability. In this context, CM patients may report different headache intensities at different levels of ND. Our aim in this study is to investigate whether the intensity of headaches differs according to the level of ND in CM patients. Headache intensity and NP intensity were evaluated with the Visual Analog Scale (VAS), and ND was evaluated with the Neck Disability Index (NDI). A total of 142 patients who met the inclusion criteria were included in the study. The mean age was 53.24 ± 12.08 years. The median number of monthly headache days was 20. According to VAS, the median headache intensity was 10(4-10) cm and the median of NP intensity was 9(1-10) cm. The mean NDI was 28.45 ± 10.28. There was a difference in headache intensity between mild and severe disability levels (p = 0.007, Z = -3.289); headache intensity between mild and complete disability levels (p = 0.000, Z = -4.421); and headache intensity between moderate and complete disability levels (p = 0.004, Z = -2.212). Although the difference in headache intensity between ND levels is small, a median increase of 2 cm in headache intensity at mild ND levels may result in complete ND. A median increase of 1 cm in headache intensity at the moderate ND level may cause complete disability in the neck. According to our results, the intensity of headaches of CM patients differed according to the level of ND. We consider our results to be clinically important in this context.
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Affiliation(s)
- Dilara Onan
- Spine Health Unit, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara 06230, Turkey
- Department of Clinical and Molecular Medicine, Sapienza University, 000189 Rome, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, 000189 Rome, Italy
- Regional Referral Headache Centre, Sant’Andrea Hospital, 000189 Rome, Italy
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10
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Siu WS, Shih YF, Lee SY, Hsu CY, Wei MJ, Wang TJ, Lin HC, Lin YL. Alterations in kinematics of temporomandibular joint associated with chronic neck pain. J Oral Rehabil 2022; 49:860-871. [PMID: 35699317 DOI: 10.1111/joor.13347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 05/26/2022] [Accepted: 06/02/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Temporomandibular disorder (TMD) is an umbrella term for pain and dysfunction of the temporomandibular joint (TMJ) and its associated structures. Patients with TMD show changes in TMJ kinematics and masticatory muscle activation. TMD is commonly comorbid with non-specific chronic neck pain (NCNP), which may be one of the risk factors for TMD. OBJECTIVES This study aimed to investigate whether patients with NCNP have altered TMJ kinematics and masticatory muscle activity. METHODS This was a cross-sectional exploratory study including 19 healthy participants and 20 patients with NCNP but without TMD symptoms. TMJ kinematics was measured during mouth opening and closing, jaw protrusion and jaw lateral deviation. Surface electromyography was used to record the muscle activity of the anterior temporalis, masseter, sternocleidomastoid and upper trapezius while clenching. Furthermore, cervical posture, cervical range of motion (ROM) and pressure-pain threshold of the neck and masticatory muscles were measured. RESULTS Compared with the healthy group, the NCNP group showed significantly reduced upper cervical rotation ROM (p = .041) and increased condylar path length (p = .02), condylar translation (opening p = .034, closing p = .011) and mechanical pain sensitivity of the upper trapezius (p = .018). Increased condylar translation was significantly correlated with reduced upper cervical mobility and poor cervical posture (r = -0.322 to -0.397; p = .012-.046). CONCLUSION Increased condylar translation and path length in patients with NCNP may indicate poor control of TMJ articular movement, which may result from neck pain or may be a compensation for limited neck mobility. Evaluation of excessive TMJ translation may be considered in patients with NCNP.
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Affiliation(s)
- Weng-Sam Siu
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Fen Shih
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shyh-Yuan Lee
- Department of Dentistry, National Yang Ming Chiao Tung University, Taiwan.,Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Dentistry, Taipei City Hospital, Taipei, Taiwan
| | - Chih-Yu Hsu
- Department of Dentistry, National Yang Ming Chiao Tung University, Taiwan.,Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Min-Ju Wei
- Department of Physical Medicine and Rehabilitation, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Tzyy-Jiuan Wang
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsiu-Chen Lin
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan
| | - Yin-Liang Lin
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
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11
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Only cervical vertebrae C0-C2, not C3 are relevant for subgrouping migraine patients according to manual palpation and pain provocation: secondary analysis of a cohort study. BMC Musculoskelet Disord 2022; 23:379. [PMID: 35459169 PMCID: PMC9034562 DOI: 10.1186/s12891-022-05329-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Subgrouping of migraine patients according to the pain response to manual palpation of the upper cervical spine has been recently described. Based on the neuroanatomy and the convergence of spinal and trigeminal nerves in the trigeminocervical complex, the cervical segments C1 to C3 are potentially relevant. To date it has not been investigated whether palpation results of all upper cervical segments are based on one underlying construct which allows combining the results of several tests. Therefore, the aim of this secondary analysis of a cohort study was to determine whether results from all three segments form one construct. METHODS Seventy-one migraine patients with chronic or frequent episodic migraine diagnosed according to the international headache society classification version 3 were examined by one physiotherapist. Manual palpation using a posterior to anterior pressure was performed on the upper three cervical vertebrae unilaterally left and right. The results of the palpation according to the patients' responses were combined using factor analysis. In addition, item response theory (IRT) was used to investigate the structure of the response pattern as well as item difficulty and discrimination. FINDINGS Factor analysis (principal component) showed that the palpation of C3 loads less onto the underlying construct than the palpation of C1 and C2. Considering a cut-off value > 1.0, the eigenvalues of all three segments do not represent one underlying construct. When excluding the results from C3, remaining items form one construct. The internal consistency of the pain response to palpation of C1 and C2 is acceptable with a Cronbach's alpha of 0.69. IRT analysis showed that the rating scale model fits best to the pain response pattern. The discrimination value (1.24) was equal for all items. Item difficulty showed a clear hierarchical structure between the palpation of C1 and C2, indicating that people with a higher impairment are more likely to respond with referred pain during palpation of C2. CONCLUSION Statistical analysis confirms that results from the palpation of the cervical segments C1 and C2 in migraine patients can be combined. IRT analysis confirmed the ordinal pattern of the pain response and showed the higher probability of a pain response during palpation of C2. The pain response to C3 palpation is not relevant for unidimensional IRT analysis. TRIAL REGISTRATION German registry of clinical trials (DRKS00015995), Registered 20. December 2018, https://www.drks.de/drks_web/setLocale_EN.do.
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12
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Al-Khazali HM, Younis S, Al-Sayegh Z, Ashina S, Ashina M, Schytz HW. Prevalence of neck pain in migraine: A systematic review and meta-analysis. Cephalalgia 2022; 42:663-673. [PMID: 35166137 DOI: 10.1177/03331024211068073] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Neck pain is a frequent complaint among patients with migraine and seems to be correlated with the headache frequency. Neck pain is more common in patients with chronic migraine compared to episodic migraine. However, prevalence of neck pain in patients with migraine varies among studies. OBJECTIVE To estimate the prevalence of neck pain in patients with migraine and non-headache controls in observational studies. METHODS A systematic literature search on PubMed and Embase was conducted to identify studies reporting prevalence of neck pain in migraine patients. This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data was extracted by two independent investigators and results were pooled using random-effects meta-analysis. The protocol was registered with PROSPERO (CRD42021264898). RESULTS The search identified 2490 citations of which 30 contained relevant original population based and clinic-based data. Among these, 24 studies provided data eligible for the analysis. The meta-analysis for clinic-based studies demonstrated that the pooled relative frequency of neck pain was 77.0% (95% CI: 69.0-86.4) in the migraine group and 23.2% (95% CI:18.6-28.5) in the non-headache control group. Neck pain was more frequent in patients with chronic migraine (87.0%, 95% CI: 77.0-93.0) compared to episodic migraine (77.0%, 95% CI: 69.0-84.0). Neck pain was 12 times more prevalent in migraine patients compared to non-headache controls and two times more prevalent in patients with chronic migraine compared to episodic migraine. The calculated heterogeneity (I2 values) ranged from 61.3% to 72.0%. CONCLUSION Neck pain is a frequent complaint among patients with migraine. The heterogeneity among the studies emphasize important aspects to consider in future research of neck pain in migraine to improve our understanding of the driving mechanisms of neck pain in a major group of migraine patients.
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Affiliation(s)
- Haidar Muhsen Al-Khazali
- Danish Headache Center, 70590Rigshospitalet Glostrup, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Samaira Younis
- Danish Headache Center, 70590Rigshospitalet Glostrup, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Zainab Al-Sayegh
- Danish Headache Center, 70590Rigshospitalet Glostrup, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Sait Ashina
- Danish Headache Center, 70590Rigshospitalet Glostrup, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Comprehensive Headache Center, Departments of Neurology and Anesthesia, 1859Beth Israel Deaconess Medical Center, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Messoud Ashina
- Danish Headache Center, 70590Rigshospitalet Glostrup, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Henrik W Schytz
- Danish Headache Center, 70590Rigshospitalet Glostrup, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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13
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Coutinho ADDF, Oliveira-Souza AISD, Sales LR, Araújo de Oliveira D. Immediate effect of a motor control exercise target to the neck muscles on upper cervical range of motion and motor control in patients with temporomandibular disorder. HEADACHE MEDICINE 2021. [DOI: 10.48208/headachemed.2021.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
ObjectiveTo evaluate whether a single specific motor control training session for the neck flexor and deep extensor muscles improves upper cervical range of motion and neck motor control in patients with temporomandibular disorder (TMD) and compare them to a group without TMD. MethodsThis is a before and after, controlled study. The TMD group included women aged between 18-45 years old, complaining of pain in the orofacial region in the last 6 months and diagnosed with masticatory myofascial pain according to Research Diagnostic Criteria (RDC/MD). The control group included match-controls without TMD. The participants were evaluated to global and upper (Flexion Rotation Test - FRT) neck range of motion (ROM) and to neck motor control (Cranio-Cervical Flexion Test - CCFT). They were treated with a protocol of specific motor control exercises targeted to flexor and extensor neck muscles for 30 minutes. One day after the protocol the patients were reevaluated. ResultsA total of 23 volunteers were evaluated. The TMD group showed immediate improvement in left cervical rotation (p=0.043) and right FRT (p=0.036), while the control group did not show any improvement. There was no difference between the groups before and after treatment in relation to cervical movements. Regarding cervical motor control in both groups, the highest prevalence was of results between 24 and 26 mmHg after treatment, different from before the intervention (20 and 22 mmHg) in both groups.ConclusionA single session of specific neck motor control training only improved the left cervical rotation and upper right rotation in the TMD group, but not in the control group. There is no difference at the end of treatment between the groups. Volunteers with TMD showed improvement in the pattern of motor control of the neck when compared to volunteers without TMD.
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14
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Anarte-Lazo E, Carvalho GF, Schwarz A, Luedtke K, Falla D. Differentiating migraine, cervicogenic headache and asymptomatic individuals based on physical examination findings: a systematic review and meta-analysis. BMC Musculoskelet Disord 2021; 22:755. [PMID: 34479514 PMCID: PMC8417979 DOI: 10.1186/s12891-021-04595-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Migraine and cervicogenic headache (CGH) are common headache disorders, although the large overlap of symptoms between them makes differential diagnosis challenging. To strengthen differential diagnosis, physical testing has been used to examine for the presence of musculoskeletal impairments in both conditions. This review aimed to systematically evaluate differences in physical examination findings between people with migraine, CGH and asymptomatic individuals. METHODS The databases MEDLINE, PubMed, CINAHL, Web of Science, Scopus, EMBASE were searched from inception until January 2020. Risk of bias was assessed with the Downs and Black Scale for non-randomized controlled trials, and with the Quality Assessment of Diagnostic Accuracy Studies tool for diagnostic accuracy studies. When possible, meta-analyses with random effect models was performed. RESULTS From 19,682 articles, 62 studies were included in this review and 41 were included in the meta-analyses. The results revealed: a) decreased range of motion [°] (ROM) on the flexion-rotation test (FRT) (17.67, 95%CI:13.69,21.65) and reduced neck flexion strength [N] (23.81, 95%CI:8.78,38.85) in CGH compared to migraine; b) compared to controls, migraineurs exhibit reduced flexion ROM [°] (- 2.85, 95%CI:-5.12,-0.58), lateral flexion ROM [°] (- 2.17, 95% CI:-3.75,-0.59) and FRT [°] (- 8.96, 95%CI:-13.22,-4.69), reduced cervical lordosis angle [°] (- 0.89, 95%CI:-1.72,-0.07), reduced pressure pain thresholds over the cranio-cervical region [kg/cm2], reduced neck extension strength [N] (- 11.13, 95%CI:-16.66,-5.6) and increased activity [%] of the trapezius (6.18, 95%CI:2.65,9.71) and anterior scalene muscles (2.87, 95%CI:0.81,4.94) during performance of the cranio-cervical flexion test; c) compared to controls, CGH patients exhibit decreased neck flexion (- 33.70, 95%CI:-47.23,-20.16) and extension (- 55.78, 95%CI:-77.56,-34.00) strength [N]. CONCLUSION The FRT and neck flexion strength could support the differential diagnosis of CGH from migraine. Several physical tests were found to differentiate both headache types from asymptomatic individuals. Nevertheless, additional high-quality studies are required to corroborate these findings. STUDY REGISTRATION Following indications of Prisma-P guidelines, this protocol was registered in PROSPERO on 21/05/2019 with the number CRD42019135269 . All amendments performed during the review were registered in PROSPERO, indicating the date and what and why was changed.
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Affiliation(s)
- E Anarte-Lazo
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), College of Life and Environmental Sciences, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - G F Carvalho
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Institute of Health Sciences, University of Luebeck, Luebeck, Germany
| | - A Schwarz
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Institute of Health Sciences, University of Luebeck, Luebeck, Germany
| | - K Luedtke
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Institute of Health Sciences, University of Luebeck, Luebeck, Germany
| | - D Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), College of Life and Environmental Sciences, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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15
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Neck Active Movements Assessment in Women with Episodic and Chronic Migraine. J Clin Med 2021; 10:jcm10173805. [PMID: 34501252 PMCID: PMC8432227 DOI: 10.3390/jcm10173805] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 12/28/2022] Open
Abstract
We aimed to compare movement parameters and muscle activity during active cervical spine movements between women with episodic or chronic migraine and asymptomatic control. We also assessed the correlations between cervical movement measures with neck-related disability and kinesiophobia. Women with episodic (n = 27; EM) or chronic (n = 27; CM) migraine and headache-free controls (n = 27; CG) performed active cervical movements. Cervical range of motion, angular velocity, and percentage of muscular activation were calculated in a blinded fashion. Compared to CG, the EM and CM groups presented a reduced total range of motion (p < 0.05). Reduced mean angular velocity of cervical movement was also observed in both EM and CM compared to CG (p < 0.05). Total cervical range of motion and mean angular velocity showed weak correlations with disability (r = −0.25 and −0.30, respectively; p < 0.05) and weak-to-moderate correlations with kinesiophobia (r = −0.30 and −0.40, respectively; p < 0.05). No significant correlation was observed between headache features and total cervical range of motion or mean angular velocity (p > 0.05). No differences in the percentage of activation of both flexors and extensors cervical muscles during active neck movements were seen (p > 0.05). In conclusion, episodic and chronic migraines were associated with less mobility and less velocity of neck movements, without differences within muscle activity. Neck disability and kinesiophobia are negative and weakly associated with cervical movement.
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Florencio LL, de Oliveira AS, Pinheiro CF, Will-Lemos T, Dach F, Fernández-de-Las-Peñas C, Bevilaqua-Grossi D. Comparison of cervical muscle isometric force between migraine subgroups or migraine-associated neck pain: a controlled study. Sci Rep 2021; 11:15434. [PMID: 34326451 PMCID: PMC8322422 DOI: 10.1038/s41598-021-95078-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/28/2021] [Indexed: 12/12/2022] Open
Abstract
This study aimed to verify if migraine frequency or migraine-associated neck pain were associated with a reduction of normalized force and altered electromyographic activity during maximal cervical muscle isometric contractions. Additionally, it aimed to assess the correlation of normalized isometric force with years with migraine, headache frequency, headache intensity, migraine-related disability, and severity of cutaneous allodynia. The sample comprises 71 women with migraine (40/31 episodic/chronic, 42/18 with/without neck pain) and 32 women without headache. Cervical muscle isometric force in flexion, extension, and lateral flexion was assessed synchronized with the acquisition of superficial electromyography from the cervical muscles. Women with episodic migraine presented lower normalized isometric force in extension, flexion, and right and left lateral flexions than controls (P < 0.05). Women with migraine and neck pain exhibited lower cervical extension and right/left lateral-flexions normalized isometric force than controls (P < 0.05). No significant differences were observed in antagonist activity. Normalized isometric force in all directions showed weak to moderate correlations with the severity of self-reported symptoms of cutaneous allodynia (- 0.25 ≥ r ≥ - 0.39). No additional linear correlation with clinical migraine features was observed. In conclusion, cervical muscle weakness may be associated with episodic migraine and neck pain concurrent with migraine attacks without altered antagonist activity. Additionally, it may also be related to the severity of cutaneous allodynia.
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Affiliation(s)
- Lidiane Lima Florencio
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922, Madri, Spain. .,Department of Health Sciences, Ribeirão Preto Medical School of the University of São Paulo, Ribeirão Preto, 14049-900, Brazil.
| | - Anamaria Siriani de Oliveira
- Department of Health Sciences, Ribeirão Preto Medical School of the University of São Paulo, Ribeirão Preto, 14049-900, Brazil
| | - Carina Ferreira Pinheiro
- Department of Health Sciences, Ribeirão Preto Medical School of the University of São Paulo, Ribeirão Preto, 14049-900, Brazil
| | - Tenysson Will-Lemos
- Department of Health Sciences, Ribeirão Preto Medical School of the University of São Paulo, Ribeirão Preto, 14049-900, Brazil
| | - Fabíola Dach
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School of the University of São Paulo, Ribeirão Preto, 14049-900, Brazil
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922, Madri, Spain
| | - Débora Bevilaqua-Grossi
- Department of Health Sciences, Ribeirão Preto Medical School of the University of São Paulo, Ribeirão Preto, 14049-900, Brazil.
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de Almeida Tolentino G, Lima Florencio L, Ferreira Pinheiro C, Dach F, Fernández-de-Las-Peñas C, Bevilaqua-Grossi D. Effects of combining manual therapy, neck muscle exercises, and therapeutic pain neuroscience education in patients with migraine: a study protocol for a randomized clinical trial. BMC Neurol 2021; 21:249. [PMID: 34187384 PMCID: PMC8240357 DOI: 10.1186/s12883-021-02290-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/18/2021] [Indexed: 12/22/2022] Open
Abstract
Background Non-pharmacological approaches for the management of migraine exhibit low to moderate effectiveness due to a lack of high-quality randomized clinical trials. In fact, previous studies applied isolated techniques, which were not representative of common clinical practice. A multimodal approach for migraine may benefit these patients more than isolated approaches. This randomized clinical trial aims to determine the effectiveness of a multimodal protocol combining manual therapy, exercise, and therapeutic pain neuroscience education versus the application of manual therapy or pain neuroscience education alone in patients with migraine. Methods This clinical trial will include 75 individuals of both sexes, aged between 18 and 55 years, with migraine. Participants will be randomized into three groups: the therapeutic pain neuroscience education (TPNE; n = 25) group, the manual therapy (MT; n = 25) group, and the multimodal (MM; n = 25) group. The TPNE group will receive one orientation session on migraine and pain self-management, and recommendations for daily active stretching and walking, with subsequent therapist monitoring. The MT group will receive manual therapies targeting musculoskeletal disorders of the cervical spine. The MM group will receive manual therapies targeting musculoskeletal disorders of the cervical spine, active neck exercises, and therapeutic pain neuroscience education. The treatment period will last 12 weeks. The primary outcome will be the headache impact, measured using the Headache Impact Test (HIT-6). Secondary outcomes will include migraine frequency and intensity, cervical mobility and strength parameters, neck pain-related disability, kinesiophobia, cutaneous allodynia, pain-related catastrophizing, quality of life, and self-perception of change. All outcomes will be evaluated at the fourth, eighth, and twelfth weeks of the treatment period. Primary and secondary clinical outcomes, such as headache impact, frequency, and intensity, will also be evaluated at the 1-, 2-, and 4-month follow-ups. Discussion The results of this randomized clinical trial may provide high-quality clinical evidence of the effects of non-pharmacological treatment options for the management of migraine. Trial registration This study was registered under the access code RBR-7s22c75 in the Registro Brasileiro de Ensaios Clínicos (ReBEC) in December 2020.
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Affiliation(s)
- Gabriella de Almeida Tolentino
- Department of Health Sciences - Ribeirão Preto Medical School, University of São Paulo, 3900, Bandeirantes Avenue - Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Lidiane Lima Florencio
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Carina Ferreira Pinheiro
- Department of Health Sciences - Ribeirão Preto Medical School, University of São Paulo, 3900, Bandeirantes Avenue - Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Fabíola Dach
- Department of Neurosciences and Behavioral Sciences - Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Débora Bevilaqua-Grossi
- Department of Health Sciences - Ribeirão Preto Medical School, University of São Paulo, 3900, Bandeirantes Avenue - Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil.
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18
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Xavier NDS, Benatto MT, Florencio LL, Fernández-de-Las-Peñas C, Dach F, Bevilaqua-Grossi D. Are there gender differences in neck pain and musculoskeletal disorders of the cervical spine associated with migraine? PAIN MEDICINE 2021; 22:3021-3029. [PMID: 33739397 DOI: 10.1093/pm/pnab106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate gender differences in clinical characteristics of migraine by examining presence and severity of cutaneous allodynia, migraine-related disability, neck pain and its associated disability, passive mobility of the upper cervical spine, and performance of the deep neck flexor muscles. DESIGN cross-sectional study. SUBJECTS 30 men and 30 women with migraine. METHODS Participants responded to the questionnaires Migraine Disability Assessment questionnaire, 12-item Allodynia Symptom Checklist and Neck Disability Index. The mobility of the upper cervical spine was assessed by using the Flexion-Rotation Test. Performance of the deep neck flexor muscles was evaluated by applying the Craniocervical Flexion Test. Comparison of the groups was carried out by using the Student's t-test or the chi-square test. The prevalence ratio was also calculated. RESULTS Women showed a higher prevalence of cutaneous allodynia (p = 0.001) and a 4 times greater risk of having severe cutaneous allodynia than to men (p = 0.007). No gender differences were observed in migraine-related disability (p = 0.08). Women showed higher prevalence of self-reported neck pain (p = 0.03) and increased risk of having this symptom in comparison to men (Prevalence Ratio=1.69; p = 0.025). However, there were no gender differences in neck pain-related disability (p = 0.25), mobility of the upper cervical spine (p = 0.92), or performance of the deep neck flexor muscles (p = 0.52). CONCLUSION Women with migraine had a higher frequency of self-reported neck pain and higher prevalence and severity of cutaneous allodynia when compared to men. However, the two groups did not differ regarding neck pain-related disability and performance in the physical tests.
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Affiliation(s)
- Nathan da Silva Xavier
- Department of Health Sciences - Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto-SP, Brazil
| | - Mariana Tedeschi Benatto
- Department of Health Sciences - Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto-SP, Brazil
| | - Lidiane Lima Florencio
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine - Universidad Rey Juan Carlos, Alcorcón, Spain
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine - Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Fabiola Dach
- Department of Neurosciences and Behavioral Sciences - Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto-SP, Brazil
| | - Débora Bevilaqua-Grossi
- Department of Health Sciences - Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto-SP, Brazil
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19
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Intrarater and Interrater Reliability of the Flexion Rotation Test and Cervical Range of Motion in People With Migraine. J Manipulative Physiol Ther 2020; 43:874-881. [DOI: 10.1016/j.jmpt.2019.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 10/31/2019] [Accepted: 11/22/2019] [Indexed: 01/03/2023]
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Luedtke K, Schoettker-Königer T, Hall T, Enns C, Grassold M, Hasselhoff-Styhler P, Neulinger C, Obrocki M, Przyhoda P, Schäfer A. Concurrent validity and reliability of measuring range of motion during the cervical flexion rotation test with a novel digital goniometer. BMC Musculoskelet Disord 2020; 21:535. [PMID: 32781990 PMCID: PMC7422569 DOI: 10.1186/s12891-020-03525-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 07/20/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Headache is a common and costly health problem. Although the pathogenesis of headache is heterogeneous, reported contributing factors are dysfunctions of the upper cervical spine. The flexion rotation test (FRT) is a commonly used diagnostic test to detect upper cervical movement impairment. A digital goniometer may support precise measurement of movement impairment in the upper cervical spine. However, its reliability and validity is not assessed, yet. The aim of this study was to investigate the reliability and validity of the digital goniometer compared to an ultrasound-based movement analysis system. METHODS Two separate cross-sectional studies were conducted using the digital goniometer EasyAngle (Meloq AB, Stockholm, Sweden) for a) investigating the concurrent validity of upper cervical range of motion (ROM) during the FRT and b) determining the inter- and intra-rater reliability in the target population of patients with head and neck pain. Sixty-two participants, 39 with and 23 without head and neck pain, were recruited for the concurrent validity study. For the reliability study, a total of 50 participants were recruited. Intraclass correlation coefficients (ICC) and Bland Altmann plots were used to assess validity and ICC values, Bland Altmann plots as well as Kappa coefficients were used for estimating intra-rater and inter-rater reliability. RESULTS Concurrent validity was strong with an ICC (2,1) of 0.97 for ROM to either side (95%CI = 0.95-0.98). Bland Altman Plots revealed a mean difference between measurement systems of 0.5° for the left and 0.11° for the right side. The inter-rater ICC (2,1) was 0.66 (95%CI 0.47-0.79, p < 0.001, SEM 6.6°), indicating good reliability. The limits of agreement were between 10.25° and - 11.89°, the mean difference between both raters was - 0.82°. Intra-rater reliability for the measurement of ROM during the FRT was between 0.96 (ICC 3,1) for rater 1 and 0.94 (ICC 3,1) for rater 2. CONCLUSIONS The digital goniometer demonstrated strong concurrent validity and good to strong reliability and can be used in clinical practice to accurately determine movement impairment in the upper cervical spine. TRIAL REGISTRATION German Registry of Clinical Trials DRKS00013051 .
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Affiliation(s)
- Kerstin Luedtke
- Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
- Institute of Health Sciences, Academic Physiotherapy, University of Luebeck, Lübeck, Germany
| | - Thomas Schoettker-Königer
- Faculty of Social Work and Health, University of Applied Science and Art (HAWK), Goschentor 1, 31134 Hildesheim, Germany
| | - Toby Hall
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA Australia
| | - Christine Enns
- Faculty of Social Sciences, University of Applied Sciences Bremen, Neustadtswall 30, 28199 Bremen, Germany
| | - Maike Grassold
- Faculty of Social Sciences, University of Applied Sciences Bremen, Neustadtswall 30, 28199 Bremen, Germany
| | - Petra Hasselhoff-Styhler
- Faculty of Social Work and Health, University of Applied Science and Art (HAWK), Goschentor 1, 31134 Hildesheim, Germany
| | - Christian Neulinger
- Faculty of Social Work and Health, University of Applied Science and Art (HAWK), Goschentor 1, 31134 Hildesheim, Germany
| | - Max Obrocki
- Faculty of Social Sciences, University of Applied Sciences Bremen, Neustadtswall 30, 28199 Bremen, Germany
| | - Philipp Przyhoda
- Faculty of Social Work and Health, University of Applied Science and Art (HAWK), Goschentor 1, 31134 Hildesheim, Germany
| | - Axel Schäfer
- Faculty of Social Work and Health, University of Applied Science and Art (HAWK), Goschentor 1, 31134 Hildesheim, Germany
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21
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Immediate and Short-Term Effects of Upper Cervical High-Velocity, Low-Amplitude Manipulation on Standing Postural Control and Cervical Mobility in Chronic Nonspecific Neck Pain: A Randomized Controlled Trial. J Clin Med 2020; 9:jcm9082580. [PMID: 32784959 PMCID: PMC7463842 DOI: 10.3390/jcm9082580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/09/2020] [Accepted: 08/07/2020] [Indexed: 12/12/2022] Open
Abstract
This study aimed to determine the immediate and short-term effects of a single upper cervical high-velocity, low-amplitude (HVLA) manipulation on standing postural control and cervical mobility in chronic nonspecific neck pain (CNSNP). A double-blinded, randomized placebo-controlled trial was performed. Forty-four patients with CNSNP were allocated to the experimental group (n = 22) or control group (n = 22). All participants were assessed before and immediately after the intervention, with a follow-up on the 7th and 15th days. In each evaluation, we assessed global and specific stabilometric parameters to analyze standing postural balance and performed the cervical flexion-rotation test (CFRT) to analyze upper cervical mobility. We obtained statistically significant differences, with a large effect size, in the limited cervical rotation and global stabilometric parameters. Upper cervical HVLA manipulation produced an improvement in the global stabilometric parameters, significantly decreasing the mean values of velocity, surface, path length, and pressure in all assessments (p < 0.001; ƞ 2 p = 0.323–0.856), as well as significantly decreasing the surface length ratio (L/S) on the 7th (−0.219 1/mm; p = 0.008; 95% confidence interval (CI): 0.042–0.395) and 15th days (−0.447 1/mm; p < 0.001; 95% CI: 0.265–0.629). Limited cervical rotation values increased significantly immediately after manipulation (7.409°; p < 0.001; 95% CI: 6.131–8.687) and were maintained during follow-up (p < 0.001). These results show that a single upper cervical HVLA manipulation produces an improvement in standing postural control and increases the rotational range of motion (ROM) in the upper cervical spine in patients with CNSNP.
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22
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Abstract
Background The trigeminal nerve theory has been proposed as a pathophysiological mechanism of migraine; however, its association with the triggers of migraine remains unclear. Cervical disability such as neck pain and restricted cervical rotation, have been associated with not only cervicogenic headaches but also migraine. The presence of cervical disability could worsen of the migraine, and also the response to pharmacologic treatment may be reduced. The aim in this review is to highlight the involvement of cervical disability in migraine, considering contributing factors. Findings In recent years, evidence of neck pain complaints in migraine has been increasing. In addition, there is some recent evidence of cervical musculoskeletal impairments in migraine, as detected by physical assessment. However, the main question of whether neck pain or an associated cervical disability can act as an initial factor leading to migraine attacks still remains. Daily life imposes heavy loads on cervical structures (i.e. muscles, joints and ligaments), for instance, in the forward head position. The repetitive nociceptive stimulation initiating those cervical skeletal muscle positions may amplify the susceptibility to central migraine and contribute to chronicity via the trigeminal cervical complex. Conclusion Further studies are needed to explain the association between cervical disability as a source of pain and the development of migraine. However, evidence suggests that cervical disability needs to be considered in the prevention and treatment of migraine.
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Affiliation(s)
- Naoki Aoyama
- Department of Neurosurgery, JCHO Yokohama Central Hospital, Yokohama, Japan
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23
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Pérez-Benito FJ, Conejero JA, Sáez C, García-Gómez JM, Navarro-Pardo E, Florencio LL, Fernández-de-Las-Peñas C. Subgrouping Factors Influencing Migraine Intensity in Women: A Semi-automatic Methodology Based on Machine Learning and Information Geometry. Pain Pract 2019; 20:297-309. [PMID: 31677218 DOI: 10.1111/papr.12854] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 10/27/2019] [Accepted: 10/31/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Migraine is a heterogeneous condition with multiple clinical manifestations. Machine learning algorithms permit the identification of population groups, providing analytical advantages over other modeling techniques. OBJECTIVE The aim of this study was to analyze critical features that permit the differentiation of subgroups of patients with migraine according to the intensity and frequency of attacks by using machine learning algorithms. METHODS Sixty-seven women with migraine participated. Clinical features of migraine, related disability (Migraine Disability Assessment Scale), anxiety/depressive levels (Hospital Anxiety and Depression Scale), anxiety state/trait levels (State-Trait Anxiety Inventory), and pressure pain thresholds (PPTs) over the temporalis, neck, second metacarpal, and tibialis anterior were collected. Physical examination included the flexion-rotation test, cervical range of cervical motion, forward head position while sitting and standing, passive accessory intervertebral movements (PAIVMs) with headache reproduction, and joint positioning sense error. Subgrouping was based on machine learning algorithms by using the nearest neighbors algorithm, multisource variability assessment, and random forest model. RESULTS For migraine intensity, group 2 (women with a regular migraine headache intensity score of 7 on an 11-point Numeric Pain Rating Scale [where 0 = no pain and 10 = maximum pain]) were younger and had lower joint positioning sense error in cervical rotation, greater cervical mobility in rotation and flexion, lower flexion-rotation test scores, positive PAIVMs reproducing migraine, normal PPTs over the tibialis anterior, shorter migraine history, and lower cranio-vertebral angles while standing than the remaining migraine intensity subgroups. The most discriminative variable was the flexion-rotation test score of the symptomatic side. For migraine frequency, no model was able to identify differences between groups (ie, patients with episodic or chronic migraine). CONCLUSIONS A subgroup of women with migraine who had common migraine intensity was identified with machine learning algorithms.
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Affiliation(s)
- Francisco J Pérez-Benito
- Biomedical Data Science Lab (BDSLab), Instituto Universitario de las Tecnologías de la Información y Comunicaciones (ITACA), Univeritat Politècnica de València, Valencia, Spain
| | - J Alberto Conejero
- Instituto Universitario de Matemática Pura y Aplicada (IUMPA), Universitat Politécnica de València, Valencia, Spain
| | - Carlos Sáez
- Biomedical Data Science Lab (BDSLab), Instituto Universitario de las Tecnologías de la Información y Comunicaciones (ITACA), Univeritat Politècnica de València, Valencia, Spain
| | - Juan M García-Gómez
- Biomedical Data Science Lab (BDSLab), Instituto Universitario de las Tecnologías de la Información y Comunicaciones (ITACA), Univeritat Politècnica de València, Valencia, Spain
| | - Esperanza Navarro-Pardo
- Departamento de Psicología Evolutiva y de la Educación, Universitat de València, València, Spain
| | - Lidiane L Florencio
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain
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24
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Carvalho GF, Schwarz A, Szikszay TM, Adamczyk WM, Bevilaqua-Grossi D, Luedtke K. Physical therapy and migraine: musculoskeletal and balance dysfunctions and their relevance for clinical practice. Braz J Phys Ther 2019; 24:306-317. [PMID: 31813696 DOI: 10.1016/j.bjpt.2019.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/21/2019] [Accepted: 11/21/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Migraine is a primary headache with high levels of associated disability that can be related to a variety of symptoms and comorbidities. The role of physical therapy in the management of migraine is largely unknown. Therefore, the aim of this review is to highlight and critically discuss the current literature and evidence for physical therapy interventions in individuals with migraines. METHODS A narrative review of the literature was performed. RESULTS Physical therapists assessing and treating patients with migraine should focus on two primary aspects: (1) musculoskeletal dysfunctions, and (2) vestibular symptoms/postural control impairment. Signs and symptoms of musculoskeletal and/or vestibular dysfunctions are prevalent among individuals with migraines and different disability levels can be observed depending on the presence of aura or increment of the migraine attacks. CONCLUSION A proper physical examination and interview of the patients will lead to a tailored treatment plan. The primary aim regarding musculoskeletal dysfunctions is to reduce pain and sensitization, and physical therapy interventions may include a combination of manual therapy, exercise therapy, and education. The aim regarding postural control impairment is to optimize function and reduce vestibular symptoms, and interventions should include balance exercises and vestibular rehabilitation. However, consistent evidence of benefits is still lacking due to the lack of and therefore need for tailored and pragmatic clinical trials with high methodological quality.
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Affiliation(s)
- Gabriela Ferreira Carvalho
- Medical Section, Department of Orthopedics and Trauma Surgery, Academic Physiotherapy, Pain and Exercise Research, University of Luebeck, Luebeck, Germany; Department of Systems Neuroscience, University of Hamburg-Eppendorf, Hamburg, Germany; Department of Health Sciences, Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Annika Schwarz
- Department of Health Sciences, Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Tibor Maximilian Szikszay
- Medical Section, Department of Orthopedics and Trauma Surgery, Academic Physiotherapy, Pain and Exercise Research, University of Luebeck, Luebeck, Germany
| | - Waclaw Marceli Adamczyk
- Medical Section, Department of Orthopedics and Trauma Surgery, Academic Physiotherapy, Pain and Exercise Research, University of Luebeck, Luebeck, Germany; Laboratory of Pain Research, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Débora Bevilaqua-Grossi
- Department of Health Sciences, Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Kerstin Luedtke
- Medical Section, Department of Orthopedics and Trauma Surgery, Academic Physiotherapy, Pain and Exercise Research, University of Luebeck, Luebeck, Germany; Laboratory of Pain Research, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland.
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