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Satpute K, Rathod R, Hall T. Reliability and measurement properties of upper cervical flexion-extension range of motion testing in people with cervicogenic headache and asymptomatic controls. J Man Manip Ther 2024; 32:182-189. [PMID: 37647294 PMCID: PMC10956903 DOI: 10.1080/10669817.2023.2251869] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 08/18/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVE The objective was to determine reliability of sagittal plane range of motion (ROM) assessment in a healthy population and in people with cervicogenic headache (CGH). METHODS Upper cervical flexion/extension ROM was measured using an iPhone magnetometer sensor and retraction/protraction ROM measured by linear displacement. Two independent raters evaluated these movements in 33 subjects with CGH and 33 age and gender matched asymptomatic healthy controls on two occasions. Measurement procedures were standardized; and the order of testing randomized. Reliability, standard error of measurement (SEM) and minimum detectable change (MDC) were calculated. RESULTS Subjects comprised 30 females and 36 males. The iPhone method demonstrated high reliability (ICC >0.82) with SEM values ranging from 0.62 to 1.0 and MDC values ranging from 1.70 to 4.81 respectively. Evaluation of linear displacement demonstrated moderate reliability (ICC >64). with SEM values ranging from 0.38 to 1.91 and MDC values ranging from 1.05 to 1.63 respectively. Compared to healthy controls, upper cervical flexion, retraction and protraction ROM was significantly less in the CGH group with mean difference of 6.50°, 1.52 cm and 2.34 cm respectively. DISCUSSION Upper cervical spine sagittal plane ROM can be measured with moderate to high reliability and was found to be more restricted in people with CGH.
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Affiliation(s)
- Kiran Satpute
- Department of Musculoskeletal Physiotherapy, Smt. Kashibai Navale College of Physiotherapy, Pune, India
| | - Rashi Rathod
- Smt. Kashibai Navale College of Physiotherapy, Pune, India
| | - Toby Hall
- Curtin School of Allied Health, Curtin University, Perth, Australia
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Patil DS, Tikhile P, Gangwani N. Effectiveness of Nonpharmacological Measures on Improving Headache Score, Strength, Pain, and Quality of Life in Cervicogenic Headaches: A Systematic Review. Cureus 2024; 16:e57361. [PMID: 38699082 PMCID: PMC11063809 DOI: 10.7759/cureus.57361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/31/2024] [Indexed: 05/05/2024] Open
Abstract
Cervicogenic headache (CGH) is a common condition affecting a significant portion of the population and is effectively managed through various interventions, including nonpharmacological approaches. Physical therapy plays a crucial role in CGH management, with numerous studies supporting its effectiveness. This systematic review aimed to evaluate the effectiveness of specific nonpharmacological physical therapy interventions for CGH. A comprehensive search was conducted across various databases (PubMed, Medline, PEDro, and Cochrane Library) for randomized controlled trials (RCTs) published between January 2017 and January 2023 investigating the effectiveness of specific nonpharmacological physical therapy interventions for CGH. We employed manual searches to capture potentially missed studies. Independent reviewers screened all studies based on predefined eligibility criteria. Extracted data included methodology, specific interventions, outcome measures (headache score, strength, pain, and quality of life (QOL)), and study conclusions. Eight RCTs were identified as meeting all inclusion criteria and were thus included in the data synthesis. The findings from these trials revealed a diverse range of nonpharmacological physical therapy interventions, including but not limited to manual therapy, exercise therapy, and multimodal approaches. Specifically, the interventions demonstrated significant improvements in headache scores, strength, pain levels, and overall QOL among individuals with CGH. These results underscore the multifaceted benefits of physical therapy in managing CGH and highlight its potential as a comprehensive treatment option. This review identified eight relevant RCTs investigating nonpharmacological interventions for CGH. Despite the promising findings, this review acknowledges several limitations, including the limited sample size and the heterogeneity of interventions across studies. These limitations emphasize the necessity for further research to elucidate optimal intervention strategies and refine treatment protocols. Nevertheless, the comprehensive analysis presented herein reinforces the pivotal role of physical therapy in not only alleviating pain but also enhancing function and improving the QOL for individuals suffering from CGH.
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Affiliation(s)
- Deepali S Patil
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Priya Tikhile
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Nikita Gangwani
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Ma D, Maimaitimin A, Wang Y. A Novel Ultrasound-Guided "Three in One" Approach Plus Interfascial Plane Blocks for the Treatment of Cervicogenic Headache. Local Reg Anesth 2024; 17:1-8. [PMID: 38323022 PMCID: PMC10843979 DOI: 10.2147/lra.s446667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/16/2024] [Indexed: 02/08/2024] Open
Abstract
Objective Cervicogenic headache (CEH) is a condition resulting from upper cervical spine dysfunction and associated structural and soft tissue abnormalities, significantly impacting patients' quality of life. To acquire better therapeutic results, we presented a novel ultrasound-guided "three in one" approach plus interfascial plane (IFP) blocks for the treatment of CEH. This approach allows for the modulation of C2 dorsal root ganglion (DRG), third occipital nerve (TON), and C3 medial branch with one-point puncture. Additionally, it allows for IFP blocks between the upper neck and occipital muscles within the same scanning plane. Patients and Methods We evaluated patients diagnosed with CEH from July 2021 to December 2022 in our pain clinic. We included those who did not respond to conservative treatment and single occipital nerve block, therefore received nerve block or pulsed radiofrequency (PRF) using the "Three in One" approach plus IFP blocks. The accuracy of the ultrasound-guided C2 DRG puncture procedures was confirmed through fluoroscopy with C-arm and the sensory testing of PRF. The therapeutic effect of these interventions was assessed using the numerical rating scale (NRS) scores during telephone follow-ups at 1, 3, and 6 months. Results Utilizing the "Three in One" approach, a total of 5 patients diagnosed with CEH underwent nerve block plus IFP blocks, while 2 patients underwent PRF plus IFP blocks. Employing ultrasound-guided C2 DRG puncture procedures, the needle tip's correct placement was confirmed through both fluoroscopy and sensory testing of PRF. Notably, none of the cases experienced any complications associated with the approach. Subsequent follow-up assessments revealed an improvement in the NRS scores for CEH in all patients. Conclusion The ultrasound-guided "Three in One" approach plus IFP blocks may be a potential effective method for the treatment of CEH.
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Affiliation(s)
- Danxu Ma
- Department of Anesthesiology and Pain Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Abulaihaiti Maimaitimin
- Department of Rheumatology and Immunology, Moyu Uighur Medicine Hospital, Xinjiang, People’s Republic of China
| | - Yun Wang
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
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Kılınç HE, Öz M, Berberoğlu U, Özel Aslıyüce Y, Onan D, Fanuscu A, Ülger Ö. Cross-cultural adaptation, reliability and validity of the Turkish version of the Henry Ford Hospital Headache Disability Inventory (HDI/T) in patients with cervicogenic headache. Disabil Rehabil 2024; 46:820-827. [PMID: 36788454 DOI: 10.1080/09638288.2023.2178679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 02/03/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE Cultural adaptation to Henry Ford Hospital Headache Disability Inventory (HDI) and investigating the validity and reliability of this inventory. METHODS International standards were followed in conducting the cultural adaption of Henry Ford Hospital Headache Disability Inventory Turkish version (HDI-T). Test-Retest reliability (intraclass correlation coefficient, ICC) and internal consistency (Cronbach's alpha) were included in the psychometric assessments; Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to assess the structural validity; and construct validity was performed by examining relationship the HDI-T between the Headache Impact Test-6 (HIT- 6), Neck Disability Index (NDI), Perceived Stress Scale-14 (PSS-14), and Nottingham Health Profile (NHP). RESULTS HDI-T showed excellent test-retest reliability (ICC =0.901), excellent internal consistency (Cronbach's a = 0.935), and low to high correlation with Headache Impact Test-6 (HIT-6), Neck Disability Index (NDI), Perceived Stress Scale-14 (PSS-14) and Nottingham Health Profile (NHP). Following EFA, two factors (emotional and functional) were extracted, accounting for 50.734% of the total variation. The dimensional structure of the HDI-T obtained in the EFA was confirmed by CFA. CONCLUSION The HDI-T is a reliable and valid instrument to determine the symptoms and disability in the Turkish population with cervicogenic headaches.Implications for RehabilitationHenry Ford Hospital Headache Disability Inventory Turkish version (HDI-T) is an outcome measure with high validity and reliability to obtain objective data in the determination of disability due to cervicogenic headache.HDI-T is recommended for all rehabilitation professionals to evaluate both the disability levels before rehabilitation and the changes during the rehabilitation process in patients with cervicogenic headaches in the Turkish population.Physiotherapists, orthopedists and neurosurgeons can also use HDI-T to objectively evaluate the secondary effects of their treatment for neck problems.
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Affiliation(s)
- Hasan Erkan Kılınç
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Müzeyyen Öz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Utku Berberoğlu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Yasemin Özel Aslıyüce
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Dilara Onan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Aybüke Fanuscu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Özlem Ülger
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Zhou J, Ho A, Ghaffari-Rafi A, Castillo J, Kim K. Headache relief 10 years after cervical disc arthroplasty: multicenter randomized clinical trial post hoc analysis. J Neurosurg Spine 2024; 40:54-61. [PMID: 37856387 DOI: 10.3171/2023.8.spine23524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/02/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Headache relief after anterior cervical spine surgery has been reported. No study, however, has followed patients out to 10 years to assess the durability of headache improvement. The authors analyzed a group of patients with a 10-year follow-up after one- or two-level cervical disc arthroplasty (CDA) from an FDA investigational device exemption (IDE) study. METHODS The authors performed a post hoc analysis of 189 patients treated with CDA from the 9 highest enrolling sites in a prospective multicenter randomized US FDA IDE clinical trial. Patients had one- or two-level CDA at contiguous levels from C3 to C7 using the Mobi-C device. The authors evaluated headache scores from the headache section of the Neck Disability Index (NDI), along with associated demographic variables (age, sex, race, ethnicity, and BMI). Preoperative and 10-year postoperative headache scores were analyzed. Primary analysis was conducted via the Wilcoxon rank-sum test, followed by univariate and multivariable logistic regression. RESULTS After accounting for age, BMI, race, ethnicity, and sex, there was sustained headache improvement 10 years after CDA (p = 0.04). Preoperatively, the median NDI score was 3.00 (IQR 1.00-4.00) and after 10 years it was 1.00 (IQR 0.00-2.00), with a decrease in the NDI score by 1.00 point (95% CI 0.00-2.00, p = 0.04). For one-level CDA, the median NDI score was 3.00 (IQR 1.00-4.00) preoperatively but 1.00 (IQR 0.00-2.00) at 10 years, with an estimated reduction in the NDI score of 1 point (95% CI 1.00-2.00, p < 0.0001). For two-level CDA, the median NDI score was 3.00 (IQR 1.75-4.00) preoperatively and 1.00 (IQR 0.00-2.00) at 10 years, with an estimated reduction in the NDI score of 1 point (95% CI 1.00-2.00, p < 0.0001). CONCLUSIONS Headache relief provided by cervical CDA, for symptomatic C3-7 cervical spondylosis, was sustained even 10 years after surgery. There was no difference in headache improvement between the one- and two-level CDA groups, or among BMI, sex, race, and ethnicity strata.
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Affiliation(s)
- James Zhou
- 1Department of Neurosurgery, University of California, Davis, Sacramento, California; and
| | - Alison Ho
- 2Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California
| | - Arash Ghaffari-Rafi
- 1Department of Neurosurgery, University of California, Davis, Sacramento, California; and
| | - Jose Castillo
- 1Department of Neurosurgery, University of California, Davis, Sacramento, California; and
| | - Kee Kim
- 1Department of Neurosurgery, University of California, Davis, Sacramento, California; and
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Pairan MS, Abdul Halim S. Intracranial Aneurysm: A Rare Neurological Finding in Ankylosing Spondylitis. Cureus 2023; 15:e49509. [PMID: 38152807 PMCID: PMC10752629 DOI: 10.7759/cureus.49509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 12/29/2023] Open
Abstract
Ankylosing spondylitis can present with various extra-articular manifestations. Vascular complications due to aortic aneurysm or aortitis have been documented. However, an association with intracranial vascular aneurysm is rarely reported. We report a case of a young male with positive HLA B27 ankylosing spondylitis, with extra-articular involvements, presented with recurrent unilateral headache. He was found to have an unruptured anterior communicating artery aneurysm. It was confirmed by a cerebral angiogram, and he was treated conservatively.
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Affiliation(s)
| | - Sanihah Abdul Halim
- Department of Internal Medicine (Neurology), School of Medical Sciences, Universiti Sains Malaysia, Kelantan, MYS
- Department of Brain and Behaviour Cluster, School of Medical Sciences, Hospital Universiti Sains Malaysia, Kelantan, MYS
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Yuan H, Strutner S, Yuh C, Anand S, Chauhan G, Prem A, Shah S, Schuster NM. Debunking myths in headache diagnosis for the pain practitioner. Reg Anesth Pain Med 2023:rapm-2023-104803. [PMID: 37816519 DOI: 10.1136/rapm-2023-104803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/18/2023] [Indexed: 10/12/2023]
Abstract
With headache being one of the most common chief complaints, it is essential for pain practitioners to interpret and differentiate a variety of headache characteristics to accurately diagnose and treat specific headache disorders. Certain misconceptions often lead to misdiagnosis. This article presents and discusses six myths about several common headache disorders (migraine, tension-type headache, cluster headache, cervicogenic headache, sinus headache, and occipital neuralgia) often encountered in clinical practice. The discussion is based primarily on the International Classification of Headache Disorders, 3rd edition and the latest studies. Recognizing and understanding the intricacies behind key headache diagnoses will help providers devise appropriate plans to better care for their patients.
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Affiliation(s)
- Hsiangkuo Yuan
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Samantha Strutner
- School of Medicine, University of California, Irvine, Irvine, California, USA
| | - Clara Yuh
- Department of Physical Medicine & Rehabilitation, University of California, Irvine, Irvine, California, USA
| | - Suwarna Anand
- Department of Anesthesiology, University of Mississippi University Hospital, Jackson, Mississippi, USA
| | - Gaurav Chauhan
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anand Prem
- Department of Anesthesiology, University of Mississippi University Hospital, Jackson, Mississippi, USA
| | - Shalini Shah
- Department of Anesthesiology & Perioperative Care, University of California, Irvine, Orange, California, USA
| | - Nathaniel M Schuster
- Headache and Pain Neurologist, Center for Pain Medicine, Department of Anesthesiology, University of California, San Diego, La Jolla, California, USA
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Amoudi M, Nairat Q. The Magnitude of Physical and Sensory Impairments in Post-traumatic and Non-traumatic Cervicogenic Headaches: A Comparative Study. Cureus 2023; 15:e47146. [PMID: 38021687 PMCID: PMC10651224 DOI: 10.7759/cureus.47146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Background Cervicogenic headaches can significantly deteriorate the quality of life of patients and decrease their productivity. Few studies have been conducted to assess the magnitude of physical impairments among patients with non-traumatic and post-traumatic cervicogenic headaches. Therefore, this study was conducted to examine and compare the magnitude of cervical physical impairments among patients with post-traumatic cervicogenic headaches in contrast to patients with non-traumatic cervicogenic headaches, migraine, and a group of sex- and age-matched controls who did not have headaches. Methodology This was a comparative study. A total of 104 patients and 30 sex- and age-matched controls were included. The patients were stratified into three groups: post-traumatic cervicogenic headaches (n = 42), non-traumatic cervicogenic headaches (n = 30), and migraines (n = 32). The cervical active range of motion and proprioception were assessed using a goniometer, the craniovertebral angle was measured while the heads of the subjects rested in a comfortable position, the strength of the cervical flexors and extensors was assessed using a hand-held dynamometer, and endurance of the short cervical flexors was assessed while the subjects were in a supine position with no pillow. Skin roll tests were performed in the trapezius and mandibular areas, and pain was measured using the McGill Pain Questionnaire-Short Form. Results Patients in the post-traumatic cervicogenic headache group reported a significantly higher number of headache days (p < 0.001) compared to the controls, patients with migraines, and those with non-traumatic cervicogenic headaches. Patients with post-traumatic cervicogenic headaches showed a significant reduction in total rotation, flexion and extension, lateral bending, and craniovertebral angle compared to the controls, patients with migraines, and those with non-traumatic cervicogenic headaches. On the other hand, the controls endured significantly longer and had stronger neck flexors and extensors compared to the patients in the migraine, non-traumatic, and post-traumatic cervicogenic headache groups, respectively. Patients with post-traumatic cervicogenic headaches significantly reported higher affective and total pain compared to the controls and patients in the migraine group. Conclusions Patients with post-traumatic cervicogenic headaches had significant deficits in the cervical active range of motion in the different planes, endurance, and strength of cervical flexors and extensors compared to the controls and patients with migraine and non-traumatic cervicogenic headaches. Similarly, patients with post-traumatic cervicogenic headaches reported higher affective pain compared to the controls and patients with migraines. The results of this study indicated that patients with post-traumatic cervicogenic headaches have significantly higher physical impairments compared to patients with non-traumatic cervicogenic headaches. These differences warrant caution when combining data from patients with non-traumatic and post-traumatic cervicogenic headaches.
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Affiliation(s)
- Mosab Amoudi
- Faculty of Allied Medical Sciences, Arab American University, Jenin, PSE
| | - Qais Nairat
- Faculty of Educational Sciences and Teachers' Training, An-Najah National University, Nablus, PSE
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Oshina M, Yamada T, Ohe T. Atypical cervical radiculopathy is often treated as a different disease in other departments. J Spine Surg 2023; 9:242-244. [PMID: 37841794 PMCID: PMC10570637 DOI: 10.21037/jss-23-70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/06/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Masahito Oshina
- Department of Orthopedic Surgery, NTT Medical Center Tokyo, Tokyo, Japan
| | - Takashi Yamada
- Department of Orthopedic Surgery, NTT Medical Center Tokyo, Tokyo, Japan
| | - Takashi Ohe
- Department of Orthopedic Surgery, NTT Medical Center Tokyo, Tokyo, Japan
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Evlice A, Genç H, Uluduz D, Baykan B, Bolay H, Unal-Cevik I, Kissani N, Luvsannorov O, Togha M, Ozge A. Secondary headache disorders in Turkey, the Middle East, Asia, and Africa: A cross-sectional, multicenter study. Cephalalgia 2023; 43:3331024231194024. [PMID: 37592903 DOI: 10.1177/03331024231194024] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
BACKGROUND This multicenter cross-sectional study aimed to determine the frequency and characteristics of secondary headaches in different geographic regions, including Turkey, the Middle East, Asia, and Africa. METHODS Patients were admitted to the study on a particular day each week for five consecutive weeks between 1 April and 16 May 2022. Before the study, all researchers underwent a constructed briefing about the use and code of the ICHD-3 criteria. The study was conducted in two stages. In the first stage, data on secondary headaches were compared between the regions. In the second stage, the sub-diagnoses of secondary headaches were analyzed only in Turkey. RESULTS A total of 4144 (30.0%) of the 13,794 patients reported headaches as the main symptoms at admission. A total of 422 patients were excluded from the study. In total, 1249 (33.4%) of 3722 patients were diagnosed as having secondary headaches (Turkey [n = 1039], Middle East [n = 80], Asia [n = 51], Africa [n = 79]). The frequency of secondary headaches (Turkey 33.6%, Africa 30.1%, Middle East 35.5%, Asia 35.4%) did not differ significantly between the regions (p > 0.05). The most common subtype of secondary headaches was headache attributed to substances or their withdrawal in all the studied regions. There was a female predominance in all regions, but it was lower in Africa than in Turkey. The severity and density of headaches differed significantly between the regions, with patients from Africa reporting milder pain than patients from other regions. In Turkey, the most common sub-diagnoses of secondary headaches were medication overuse headache, idiopathic intracranial hypertension, and cervicogenic headache. CONCLUSION In the present study, one in three patients with a headache had a secondary headache. Headache attributed to substances or their withdrawal was the most common subtype of secondary headaches in all the studied regions. The female predominance of secondary headaches was lower in Africa than in Turkey. The severity and density of headaches differed significantly between regions, with patients from Africa reporting milder pain.
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Affiliation(s)
- Ahmet Evlice
- Department of Neurology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Hamit Genç
- Department of Neurology, University of Health Sciences, Van Training and Research Hospital, Van, Turkey
| | - Derya Uluduz
- Department of Neurology, Istanbul University, Cerrahpasa Faculty of Medicine, İstanbul, Turkey
| | - Betul Baykan
- Istanbul University, Istanbul Faculty of Medicine, EMAR Medical Center, İstanbul, Turkey
| | - Hayrunnisa Bolay
- Department of Neurology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Isin Unal-Cevik
- Department of Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Najib Kissani
- Neuroscience Research Laboratory, Marrakesh Medical School, Cadi Ayyad University, Marrakech, Morocco
| | - Otgonbayar Luvsannorov
- Department of Neurology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Mansoureh Togha
- Department of Neurology, Tehran University of Medical Sciences, Tehran, Iran
| | - Aynur Ozge
- Department of Neurology, Mersin University Faculty of Medicine, Mersin, Turkey
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Hua L, Sha K, Lu H, Han Y, Ou C, Wang JL, Zhang Y. Clinical Efficacy Evaluation of Ultrasound-Guided C2 Dorsal Root Nerve Pulsed Radiofrequency Combined with Stellate Ganglion Block in the Treatment of Cervicogenic Headache: A Retrospective Cohort Study. J Pain Res 2023; 16:2655-2663. [PMID: 37533562 PMCID: PMC10392809 DOI: 10.2147/jpr.s409226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/26/2023] [Indexed: 08/04/2023] Open
Abstract
Purpose To explore the therapeutic effect of C2 dorsal root ganglion pulsed radiofrequency (PRF) combined with stellate ganglion block (SGB) in patients with cervicogenic headache (CEH). Patients and Methods We retrospectively reviewed 90 patients diagnosed with CEH who were admitted to our hospital between May 2019 and May 2022. All patients were divided into three groups (n = 30 each) according to the actual treatment method used: ultrasound-guided SGB, ultrasound-guided C2 dorsal root ganglion PRF treatment, and ultrasound-guided C2 dorsal root ganglion PRF combined with SGB treatment. Patients' pain intensity, sleep, and mood changes were assessed by statistically analyzing their pain visual analog scale (VAS), Pittsburgh Sleep Quality Inventory (PSQI), and short-form McGill Pain Questionnaire affective item scores before and after treatment. Results The post-treatment VAS, PSQI, and McGill scores were significantly decreased in all patients (P < 0.05), and all three scores in ultrasound-guided C2 dorsal root ganglion PRF combined with SGB were lower than those in ultrasound-guided SGB alone and ultrasound-guided C2 dorsal root ganglion PRF alone (P < 0.05). Conclusion The use of ultrasound-guided C2 dorsal root ganglion PRF combined with SGB in patients with CHE is effective in alleviating pain and improving sleep, and deserves to be replicated in the clinic.
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Affiliation(s)
- Lu Hua
- Department of Pain Management, The Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou Southwest Medical University, Luzhou, Sichuan Province646000People’s Republic of China
| | - Kaiyuan Sha
- Department of Pain Management, The Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou Southwest Medical University, Luzhou, Sichuan Province646000People’s Republic of China
| | - HongCheng Lu
- Department of Pain Management, The Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou Southwest Medical University, Luzhou, Sichuan Province646000People’s Republic of China
| | - Ying Han
- Department of Pain Management, The Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou Southwest Medical University, Luzhou, Sichuan Province646000People’s Republic of China
| | - Cehua Ou
- Department of Pain Management, The Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou Southwest Medical University, Luzhou, Sichuan Province646000People’s Republic of China
| | - Jiang-Lin Wang
- Department of Pain Management, The Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
| | - Yue Zhang
- Department of Pain Management, The Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou Southwest Medical University, Luzhou, Sichuan Province646000People’s Republic of China
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Bae S, Jung J, Moon D. Impact of Movement Control Training Using a Laser Device on the Neck Pain and Movement of Patients with Cervicogenic Headache: A Pilot Study. Healthcare (Basel) 2023; 11:healthcare11101439. [PMID: 37239725 DOI: 10.3390/healthcare11101439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 05/03/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
This study verified the effect of movement control training using a laser device on the neck pain and movement of patients with cervicogenic headache. A total of twenty outpatients recruited from two Busan hospitals were equally divided into two groups. The experimental group underwent movement control training with visual biofeedback, while the control group performed self-stretching. Both groups received therapeutic massage and upper cervical spine mobilization. A four-week intervention program was also conducted. Measurement tools including the cervical flexion-rotation test, visual analog scale, Headache Impact Test-6, pressure pain threshold, range of motion, sensory discrimination, and Neck Disability Index helped assess the participating patients before and after the intervention. Additionally, the Wilcoxon signed-rank test and the Mann-Whitney U test helped determine inter and intra-group variations, respectively, before and after the intervention. Most of the measurement regions revealed significant changes post-intervention within the experimental group, while only the cervical flexion-rotation test, visual analog scale, Headache Impact Test-6, and Neck Disability Index indicated significant changes post-intervention within the control group. There were also considerable inter-group differences. Thus, movement control training using a laser device more effectively improves neck pain and movement of patients with cervicogenic headache.
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Affiliation(s)
- Songui Bae
- Department of Physical Therapy, Graduate School, Dong-Eui University, Busan 47340, Republic of Korea
| | - Juhyeon Jung
- Department of Physical Therapy, College of Nursing, Healthcare Sciences and Human Ecology, Dong-Eui University, Busan 47340, Republic of Korea
| | - Dongchul Moon
- Department of Physical Therapy, Gimhae College, Gimhae-si 50811, Republic of Korea
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13
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Daher A, Dar G. Stretching and muscle-performance exercises for chronic nonspecific neck pain: who may benefit most? Physiother Theory Pract 2023:1-14. [PMID: 37133358 DOI: 10.1080/09593985.2023.2207103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Although exercise is the mainstay of treatment for neck pain (NP), uncertainty remains over optimal decision-making concerning who may benefit most from such, particularly in the long term. OBJECTIVE To identify the subgroup of patients with nonspecific NP most likely to benefit from stretching and muscle-performance exercises. METHODS This was a secondary analysis of treatment outcomes of 70 patients (10 of whom dropped out) with a primary complaint of nonspecific NP in one treatment arm of a prospective, randomized, controlled trial. All patients performed the exercises, twice weekly for 6 weeks, and a home exercise program. Blinded outcome measurements were collected at baseline, after the 6-week program, and at a 6-month follow-up. Patients rated their perceived recovery on a 15-point global rating of change scale; a rating of "quite a bit better" (+5) or higher was defined as a successful outcome. Clinical predictor variables were developed via logistic regression analysis to classify patients with NP that may benefit from exercise-based treatment. RESULTS NP duration since onset≤6 months, no cervicogenic headache, and shoulder protraction were independent predictor variables. The pretest probability of success was 47% after the 6-week intervention and 40% at the 6-month follow-up. The corresponding posttest probabilities of success for participants with all three variables were 86% and 71%, respectively; such participants were likely to recover. CONCLUSION The clinical predictor variables developed in this study may identify patients with nonspecific NP likely to benefit most from stretching and muscle-performance exercises in the short and long terms.
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Affiliation(s)
- Amira Daher
- Department of Physical Therapy, Faculty of Health Studies, Zefat Academic College, Safed, Israel
- Department of Health Systems Administration, Max Stern Academic College of Emek Yezreel, Emek Yezreel, Israel
| | - Gali Dar
- Department of Physical Therapy, Faculty of Social Welfare and Health Studies, University of Haifa, Mount Carmel, Israel
- Physical Therapy Clinic, The Ribstein Center for Sport Medicine Sciences and Research, Wingate Institute, Netanya, Israel
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Chu EY, Mok TKS, Ng GSN, Chu ECP. Pediatric Text Neck Syndrome. Cureus 2023; 15:e38034. [PMID: 37101802 PMCID: PMC10123387 DOI: 10.7759/cureus.38034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2023] [Indexed: 04/28/2023] Open
Abstract
Text neck syndrome is a growing concern in the pediatric population due to the increased use of mobile devices and screens, potentially leading to long-lasting musculoskeletal issues. This case report presents a six-year-old boy with a one-month history of cephalgia and cervicalgia, who initially received insufficient care. After nine months of chiropractic intervention, the patient reported significant improvements in pain relief, neck mobility, and neurological symptoms, supported by radiographic findings. This report emphasizes the importance of early recognition and intervention in pediatric patients, as well as the role of ergonomics, exercise, and proper smartphone usage habits in preventing text neck and maintaining spinal health.
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Affiliation(s)
- Eden Yt Chu
- Chiropractic and Physiotherapy Centre, New York Medical Group, Hong Kong, CHN
| | - Tze Kwan Sharon Mok
- Chiropractic and Physiotherapy Centre, New York Medical Group, Hong Kong, CHN
| | - Gabriel Siu Nam Ng
- Chiropractic and Physiotherapy Centre, New York Medical Group, Hong Kong, CHN
| | - Eric Chun-Pu Chu
- Chiropractic and Physiotherapy Centre, New York Medical Group, Hong Kong, CHN
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Greenbaum T, Emodi-Perlman A. Headache and orofacial pain: A traffic-light prognosis-based management approach for the musculoskeletal practice. Front Neurol 2023; 14:1146427. [PMID: 36895899 PMCID: PMC9990418 DOI: 10.3389/fneur.2023.1146427] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/26/2023] [Indexed: 02/22/2023] Open
Abstract
Introduction Headache (HA) is one of the most prevalent disabling conditions worldwide and is classified as either primary or secondary. Orofacial pain (OFP) is a frequent pain perceived in the face and/or the oral cavity and is generally distinct from a headache, according to anatomical definitions. Based on the up-to-date classification of the International Headache Society, out of more than 300 specific types of HA only two are directly attributed to the musculoskeletal system: The cervicogenic HA and HA attributed to temporomandibular disorders. Because patients with HA and/or OFP frequently seek help in the musculoskeletal practice, a clear and tailored prognosis-based classification system is required to achieve better clinical outcomes. Purpose The aim of perspective article is to suggest a practical traffic-light prognosis-based classification system to improve the management of patients with HA and/or OFP in the musculoskeletal practice. This classification system is based on the best available scientific knowledge based on the unique set-up and clinical reasoning process of musculoskeletal practitioners. Implications Implementation of this traffic-light classification system will improve clinical outcomes by helping practitioners invest their time in treating patients with significant involvement of the musculoskeletal system in their clinical presentation and avoid treating patients that are not likely to respond to a musculoskeletal based intervention. Furthermore, this framework incorporates medical screening for dangerous medical conditions, and profiling the psychosocial aspects of each patient; thus follows the biopsychosocial rehabilitation paradigm.
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Affiliation(s)
- Tzvika Greenbaum
- Department of Physical Therapy, Faculty of Health Sciences, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Alona Emodi-Perlman
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Ekhator C, Urbi A, Nduma BN, Ambe S, Fonkem E. Safety and Efficacy of Radiofrequency Ablation and Epidural Steroid Injection for Management of Cervicogenic Headaches and Neck Pain: Meta-Analysis and Literature Review. Cureus 2023; 15:e34932. [PMID: 36938280 PMCID: PMC10016315 DOI: 10.7759/cureus.34932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Dysfunction of the cervical spine and its anatomical features, mostly innervated by the C1, C2, and C3 spinal nerves, can result in a secondary headache known as cervicogenic headache (CHA), mainly characterized by unilateral pain. The usefulness of pharmaceutical medications and physical therapy is currently the subject of scant literature. Interventional pain management techniques can be applied when conservative treatment is unsuccessful. This study looks at radiofrequency ablation (RFA) and epidural steroid injection (ESI) to identify their safety and efficacy in managing patients with cervicogenic headaches and neck pain. Three databases - PubMed, Cochrane CENTRAL Library, and Embase were searched, and 110 studies were identified. Nine screening processes were included for review and meta-analysis. Statistical evaluation was conducted through STATA version 17 (College Station, TX: StataCorp LLC) and effect measures were reported through random effects model risk ratios. The main subject of focus included three following outcomes: incidences of pain relief, degree and duration of pain, and incidences of adverse effects. The findings showed both interventions relieved pain by a factor of >50%, demonstrating a relative effects risk ratio of 1.45 (-0.50, 3.39) for RFA: pain relief, 84.76 (82.82, 86.69) RFA: adverse effects, and 19.46 (18.80, 20.11) ESI: pain relief at 95% confidence interval. The efficacy of RFA and ESI differ. Both interventions are effective in the reduction of cervicogenic headache pain intensity. However, their complication rates and pain duration are considerably different. With ESI, the headaches can still recur weekly, demanding the use of oral analgesics to deal with them. On the other hand, RFA has a low complication rate. Improving guidance from imaging technologies, RFA has the potential to be the most effective interventional treatment.
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Affiliation(s)
- Chukwuyem Ekhator
- Neuro-Oncology, New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, USA
| | - Alyssa Urbi
- Neuro-Oncology, Brandeis University, Boston, USA
| | - Basil N Nduma
- Internal Medicine, Merit Health Wesley, Hattiesburg, USA
| | - Solomon Ambe
- Neurology, Baylor Scott and White Health, Mckinney, USA
| | - Ekokobe Fonkem
- Neuro-Oncology, Baylor Scott and White Health, Temple, USA
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Xu Y, Gao Y, Jiang L, Wu L, Yin J, Yang Z, Dong Y. Global trends in research on cervicogenic headache: a bibliometric analysis. Front Neurol 2023; 14:1169477. [PMID: 37153673 PMCID: PMC10157175 DOI: 10.3389/fneur.2023.1169477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/06/2023] [Indexed: 05/10/2023] Open
Abstract
Background There has been a marked increase in cervicogenic headaches in recent years, significantly affecting sufferers' daily lives and work. While several treatments exist for this type of headache, their long-term effects could be improved, and additional data from large clinical samples are needed. This study aims to systematically examine the current state of research in cervicogenic headaches through a bibliometric analysis, identify areas of current interest, and provide insight into potential future research directions. Methods This article examines research trends in the field of cervicogenic headache through a bibliometric analysis of scholarly articles in the field of cervicogenic headache over the past four decades. The bibliometric analysis method employed included searching the Web of Science database using topics related to cervicogenic headaches. Inclusion criteria were limited to articles and review papers on cervicogenic headaches published between 1982 and 2022. The retrieved dataset was then analyzed using R software and VOSviewer to identify the major research areas, countries and institutions, the most influential authors, journals and keywords, co-citations in the literature, and co-authorship networks. Results This study analyzed 866 articles published between 1982 and 2022, involving 2,688 authors and generating 1,499 unique author keywords. Neuroscience and neurology were the primary focus, with participation from 47 countries, primarily led by the United States, which has the most published articles (n = 207), connections (n = 29), and citations (n = 5,238). In the cervicogenic headache study, which involved 602 institutions, the University of Queensland received the most significant number of citations (n = 876), and Cephalalgia was the journal with the most published articles and received the most local citations (n = 82) and highest growth (n = 36). Two hundred sixty-nine journals have published articles on cervicogenic headaches. Among researchers studying cervicogenic headache, Sjaastad O had the most published articles (n = 51) and citations (n = 22). The most commonly occurring keyword was "cervicogenic headache." Except for the fourth most impactful paper, as determined by the Local Citation Score, which analyzed clinical treatments, all the top documents emphasized investigating the diagnostic mechanisms of cervicogenic headache. The most commonly occurring keyword was "cervicogenic headache." Conclusion This study used bibliometric analysis to provide a comprehensive overview of the current research on cervicogenic headaches. The findings highlight several areas of research interest, including the need for further investigation into the diagnosis and treatment of cervicogenic headaches, the impact of lifestyle factors on cervicogenic headaches, and the development of new interventions to improve patient outcomes. By identifying these gaps in the literature, this study provides a foundation for guiding future research to improve the diagnosis and treatment of cervicogenic headaches.
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Affiliation(s)
- Yu Xu
- Second Clinical Medical College, Yunnan University of Chinese Medicine, Kunming, Yunnan, China
| | - Ying Gao
- Second Clinical Medical College, Yunnan University of Chinese Medicine, Kunming, Yunnan, China
| | - Lin Jiang
- Second Clinical Medical College, Yunnan University of Chinese Medicine, Kunming, Yunnan, China
| | - Lunhui Wu
- Second Clinical Medical College, Yunnan University of Chinese Medicine, Kunming, Yunnan, China
| | - Jing Yin
- Second Clinical Medical College, Yunnan University of Chinese Medicine, Kunming, Yunnan, China
| | - Zhijun Yang
- Second Clinical Medical College, Yunnan University of Chinese Medicine, Kunming, Yunnan, China
| | - Youkang Dong
- Department of Tuina, The First Affiliated Hospital of Yunnan University of Chinese Medicine, Kunming, Yunnan, China
- Department of Rehabilitation, Lincang Municipal Hospital of Chinese Medicine, Lincang, Yunnan, China
- *Correspondence: Youkang Dong,
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Nambi G, Alghadier M, Ebrahim EE, Vellaiyan A, Tedla JS, Reddy RS, Kakaraparthi VN, Aldhafian OR, Alshahrani NN, Saleh AK. Comparative Effects of Mulligan's Mobilization, Spinal Manipulation, and Conventional Massage Therapy in Cervicogenic Headache-A Prospective, Randomized, Controlled Trial. Healthcare (Basel) 2022; 11. [PMID: 36611567 DOI: 10.3390/healthcare11010107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/01/2023] Open
Abstract
Background: There is ample evidence supporting the use of manual therapy techniques for the treatment of cervicogenic headache (CGH). Objective: The objective of this study was to find and compare the effects of different manual therapy approaches to cervicogenic headache. Methods: A randomized, controlled study was conducted on 84 CGH participants at the university hospital. The participants were divided into a Mulligan mobilization therapy group (MMT; n = 28), a spinal manipulation therapy group (SMT; n = 28), and a control group (Control; n = 28); they received the respective treatments for four weeks. The primary outcome (CGH frequency) and secondary outcomes (CGH pain intensity, CGH disability, neck pain frequency, pain intensity, pain threshold, flexion rotation (right and left), neck disability index, and quality of life scores) were measured at baseline, after 4 weeks, after 8 weeks, and at a 6-month follow-up. The one-way ANOVA test and repeated measures analysis of variance (rANOVA) test were performed to find the difference between the inter- and intra-treatment group effects. Results: Four weeks following training, the MMT group showed a statistically significant difference in the primary (CGH frequency) and secondary (CGH pain intensity, CGH disability, neck pain frequency, neck pain intensity, flexion rotation test, neck disability index, and quality of life) scores than those of the SMT and control groups (p < 0.001). The same difference was seen in the above variables at 8 weeks and at the 6-month follow-up. At the same time, the neck pain threshold level did not show any difference at the 4-week and the 8-week follow-up (p ≥ 0.05) but showed statistical difference at the 6-month follow-up. Conclusion: The study concluded that Mulligan’s mobilization therapy provided better outcomes in cervicogenic headache than those of spinal manipulation therapy and conventional massage therapy.
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19
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Yang L, Li Y, Dai C, Pang X, Li D, Wu Y, Chen X, Peng B. Anterior cervical decompression and fusion surgery for cervicogenic headache: A multicenter prospective cohort study. Front Neurol 2022; 13:1064976. [PMID: 36504652 PMCID: PMC9731211 DOI: 10.3389/fneur.2022.1064976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
Background Cervicogenic headache (CEH) has long been recognized as a referred pain deriving from pathological changes in the upper cervical nerves. However, previous clinical studies found that anterior lower cervical discectomy for the treatment of cervical myelopathy and/or radiculopathy can also help relieve associated headaches. To date, there is still a lack of large sample and prospective study to investigate the effect of anterior cervical decompression and fusion (ACDF) on CEH associated with cervical spondylosis. Methods A total of 656 patients with cervical radiculopathy and/or myelopathy were enrolled in three spinal centers. Among them, 221 patients who were diagnosed with CEH were collected in this study, and 204 completed a 1-year follow-up. The primary endpoint was headache intensity during a 12-month follow-up period measured by the numeric pain rating scale (NPRS). The secondary outcome measures included headache frequency, headache duration, and the neck disability index (NDI). Results Among all 204 patients with CEH who completed a 1-year follow-up, 166 received anterior cervical surgery (surgery group) and 38 received conservative treatment (conservative group). There were statistically significant lower NPRS in the surgical group during follow-up. Between-group differences showed that NPRS in the surgery group was significantly greater improvement at 1 month (2.8, 95% CI: 2.0, 3.6), 3 months (2.6, 95% CI: 1.8, 3.4), 6 months (2.4, 95% CI: 1.6, 3.2), and 12 months (1.5, 95% CI: 0.7, 2.4) (p < 0.05 for all). There were statistically significant lower NDI, less frequent headaches, and lower headache duration in the surgery group during follow-up (p < 0.05 for all). Conclusion This study indicates that ACDF can effectively relieve CEH associated with cervical myelopathy and/or radiculopathy.
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Affiliation(s)
- Liang Yang
- Department of Orthopeadics, Featured Medical Center of Chinese People's Armed Police Forces, Tianjing, China,Department of Orthopeadics, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yongchao Li
- Department of Orthopeadics, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Chen Dai
- Department of Orthopeadics, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiaodong Pang
- Department of Orthopeadics, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Duanming Li
- Department of Orthopeadics, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ye Wu
- Department of Orthopeadics, Beijing 304th Hospital, Beijing, China
| | - Xiongsheng Chen
- Department of Orthopeadics, Spine Center, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, China,Xiongsheng Chen
| | - Baogan Peng
- Department of Orthopeadics, The Third Medical Center of Chinese PLA General Hospital, Beijing, China,*Correspondence: Baogan Peng
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Hu JQ, Zhang J, Ru B, Cai WJ, Liu WL, Guo R, Ji ZW, Wan Q, Xu LH, Cheng Y, Zhang J, Li S. Computed tomography-guided radiofrequency ablation of cervical intervertebral discs for the treatment of refractory cervicogenic headache: A retrospective chart review. Headache 2022; 62:839-847. [PMID: 35864604 DOI: 10.1111/head.14361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 05/18/2022] [Accepted: 05/18/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the feasibility and efficacy of computed tomography (CT)-guided radiofrequency ablation (RFA) of cervical intervertebral discs for the treatment of discogenic cervicogenic headache (CEH). BACKGROUND Some patients with CEH experience no obvious therapeutic effect after conventional therapy, particularly patients with refractory CEH originating from abnormal cervical intervertebral discs. Treatment for this type of CEH remains poorly characterized. METHODS Using a single intervention arm, pretest/posttest design, we retrospectively analyzed the data of patients who underwent CT-guided RFA of cervical intervertebral discs for CEH at the Pain Medicine Center of Zhejiang Provincial People's Hospital from January 2017 to April 2021. If conservative treatment failed in patients with discogenic CEH, we classified the patients as having refractory CEH and performed RFA of cervical intervertebral discs. We used a numeric rating scale (NRS) to assess pain intensity for 6 months. We also compared therapeutic outcome of patients with different characteristics. RESULTS A total of 44 patients who underwent CT-guided RFA of cervical intervertebral discs were enrolled and 41 of them were analyzed in the present study. The preoperative median (25th, 75th) NRS score was 4 (4, 5), and it was significantly reduced to 1 (0, 4) 6 months after RFA (p < 0.001). The number of patients with ≥50% of their pain relieved after 6 months was 28 of 41 (68%). No serious treatment-related complications occurred in this study. Compared with single-level RFA, multi-level RFA shows greater effects on pain intensity reduction (p = 0.032) and pain relief rate (p = 0.047) of patients. CONCLUSION In patients who have discogenic CEH, CT-guided RFA of the cervical intervertebral discs appears to be a promising treatment with no serious complications.
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Affiliation(s)
- Jia-Qi Hu
- Department of Pain, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Juan Zhang
- Department of Pain, Zhejiang University of Traditional Chinese Medicine First Affiliated Hospital, Zhejiang University of Traditional Chinese Medicine, Hangzhou, China
| | - Bin Ru
- Department of Pain, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Wen-Jun Cai
- Department of Pain, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Wen-Long Liu
- Department of Pain, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Ran Guo
- Department of Pain, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Zhong-Wei Ji
- Department of Pain, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Quan Wan
- Department of Pain, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Lang-Hai Xu
- Department of Pain, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Yan Cheng
- Department of Pain, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Jie Zhang
- Department of Orthopedics, Lu'an Hospital of Chinese Medicine, Anhui College of Traditional Chinese Medicine, Lu'an, China
| | - Shun Li
- Department of Pain, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
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Yılmaz ZÇ, Güler N, Noyan A. Superficial cervical plexus block on pain control in patients with temporomandibular joint internal derangement with headache: a retrospective cohort study. Quintessence Int 2022; 53:512-521. [PMID: 35274514 DOI: 10.3290/j.qi.b2793235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Temporomandibular disorders (TMDs) are a group of disorders with varied pathophysiology and clinical manifestations. Masticatory and cervical motor systems have a functional relationship. Superficial cervical muscles have greater hyperactivity in myogenous and mixed TMDs than in healthy individuals, demonstrating an abnormal pattern of contraction. This study aimed to demonstrate the effects of superficial cervical plexus block (SCPB) anesthesia during arthrocentesis in patients with temporomandibular joint (TMJ) internal derangement and headache. METHOD AND MATERIALS This retrospective cohort study included 2 men and 23 women with cervicogenic headache and TMJ internal derangement treated by arthrocentesis, and 40 TMJs with established cervicogenic headaches. The average follow-up period was 9.36 ± 2.679 months. TMJ and muscle pain during mastication, maximum and non-assisted mouth opening, and lateral excursion were recorded. Pain and dysfunction were determined using the visual analog scale. Patients were monitored before, during, and after arthrocentesis while inducing SCPB anesthesia, and vital findings were recorded. In addition, skin surface temperature was measured. RESULTS Patients experienced a significant increase in their clinical values. Changes in non-assisted mouth opening (mean from 29.65 ± 6.31 to 33.3 ± 5.21 mm) (P < .05), assisted mouth opening (mean from 38.98 ± 7.62 to 43.35 ± 6.17 mm), right excursions (mean from 7.28 ± 2.08 to 9.13 ± 1.86 mm), and left excursions (mean from 7.48 ± 1.71 to 8.90 ± 1.82 mm) were statistically significant (P < .05). Patients were relieved after SCPB, resulting in decreased pain and hemodynamic values. Increase in mean temperature after SCPB was statistically significant (P = .002, P < .05). CONCLUSION This study presents a straightforward novel protocol, clinically efficient for arthrocentesis on pain control in patients with TMJ internal derangement and cervicogenic headache.
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22
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Ding F, Liu Z, Li R, Wang C, Lu Y. Acupuncture plus massage for cervicogenic headache: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e28736. [PMID: 35089247 PMCID: PMC8797556 DOI: 10.1097/md.0000000000028736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Cervicogenic headache (CGH), one of the most common headaches. It is characterized by pain starting from the neck and gradually involving the eyes, frontal and temporal regions. Acupuncture and massage therapy has been widely used in the treatment of CGH, the purpose of this study was to evaluate the effectiveness and safety of acupuncture combined with massage in the treatment of CGH. METHODS The databases of PubMed, Embase, Cochrane library, Medicine, Web of Science, China National Knowledge Infrastructure, Wan-Fang Database, China Biomedical Literature Service System, and Chongqing VIP Chinese Science will be searched. This study will include randomized controlled trials of acupuncture combined with massage in the treatment of CGH published before November 2021. The primary outcomes included the overall efficiency, visual simulation score, neck activity score, quality of life score, and adverse reactions as secondary outcomes were assessed. Cochrane bias risk assessment tool will be used for literature data screening and quality evaluation, and using RevMan5.4 to collect data for statistical analysis. We then will use the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the overall quality of evidence supporting the primary outcomes. RESULTS This systematic review will provide a high-quality synthesis to evaluate the efficacy and safety of acupuncture combined with massage therapy in the treatment of CGH, providing a reference for the safe and effective treatment plan. CONCLUSION This study provides evidence that acupuncture combined with massage is effective and safe for patients with CGH. SYSTEMATIC REVIEW REGISTRATION INPLASY2021120049U1.
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Geist K, Frierson E, Hudson O, Lavin S, Myers M, McDaniel L, Carter V. The utilization of dry needling and an upper extremity exercise program for individuals with cervicogenic headaches: A pilot study. Cranio 2021:1-11. [PMID: 34689708 DOI: 10.1080/08869634.2021.1994226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate whether a combination of dry-needling treatments and upper extremity neuromuscular reeducation exercises can significantly improve neck pain and/or headache-related disability, joint position error, cervical range of motion, and pain pressure threshold in individuals suffering from cervicogenic headache (CGH). METHODS This study is a quasi-experimental design. Seven participants met the inclusion criteria and received dry needling to three muscles that reproduced the participant's headache symptoms and completed the Neck Disability Index (NDI), Headache Disability Inventory (HDI), Visual Analog Scale (VAS), and Numeric Pain Rating Scale (NPRS). Participants performed an exercise regimen designed to address strength and mobility of cervical and scapulothoracic musculature. RESULTS There were significant improvements seen in cervical range of motion and neck pain-related disability (NDI) during the 4-week treatment period. CONCLUSION Dry needling and neuromuscular re-education (NMR) exercises could be effective components of treatment for individuals suffering from CGH to reduce disability and pain.
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Affiliation(s)
- Kathleen Geist
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Elizabeth Frierson
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Olivia Hudson
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Sarah Lavin
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Maddy Myers
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Leda McDaniel
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Vincent Carter
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
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Mingels S, Dankaerts W, van Etten L, Bruckers L, Granitzer M. Exploring multidimensional characteristics in cervicogenic headache: Relations between pain processing, lifestyle, and psychosocial factors. Brain Behav 2021; 11:e2339. [PMID: 34473413 PMCID: PMC8553329 DOI: 10.1002/brb3.2339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/03/2021] [Accepted: 08/09/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Although multidimensional interventions including physiotherapy, psychology, and education are generally recommended in managing headache, and to prevent chronification, such approach is lacking in cervicogenic headache (CeH). Therefore, exploring CeH within a biopsychosocial framework is deemed an essential first step. METHODS Non-randomized cross-sectional design to compare pain processing, lifestyle, and psychosocial characteristics between 18 participants with CeH (CeH group) (40.2 ± 10.9 years) and 18 matched controls (control group) (39.2 ± 13.1 years). Pain processing characteristics included degree of central sensitization (Central Sensitization Inventory), and (extra)-cephalic pressure pain thresholds (kPa/cm²/s). Lifestyle characteristics included sleep quality (Pittsburgh Sleep Quality Index), physical activity, screen time, and sedentary time (hours a week). Psychosocial characteristics included degree of depression, anxiety and stress (Depression Anxiety Stress Scale-21), and quality of life (Headache Impact Test-6). RESULTS Pain processing characteristics: More (p = .04) participants in the CeH group showed higher degrees of central sensitization compared to the control group. Lower (p < .05) (extra)-cephalic pressure pain thresholds were revealed in the CeH group compared to the control group for each muscle. Lifestyle and psychosocial characteristics: Compared to the control group, sleep quality and headache-related quality of life were worse (p < .0001) in the CeH group. Severe to extreme stress was experienced by more participants in the CeH group (p = .02). Further, significant relations between pain processing and (1) lifestyle characteristics and (2) psychosocial characteristics were seen in the CeH group. CONCLUSION Exploring multidimensional characteristics in CeH exposed relations between pain processing, lifestyle, and psychosocial characteristics. These novel findings fill a gap in the current scientific literature, and highlight the need for outcome research targeting lifestyle and psychosocial factors.
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Affiliation(s)
- Sarah Mingels
- REVAL Rehabilitation Research Centre, Faculty of Rehabilitation Sciences and Physiotherapy, Hasselt University, Hasselt, Belgium
| | - Wim Dankaerts
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Leuven University, Leuven, Belgium
| | - Ludo van Etten
- Department of Biometrics, Zuyd Hogeschool, Heerlen, The Netherlands
| | - Liesbeth Bruckers
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Hasselt, Belgium
| | - Marita Granitzer
- REVAL Rehabilitation Research Centre, Faculty of Rehabilitation Sciences and Physiotherapy, Hasselt University, Hasselt, Belgium
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25
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Roland SB, Pripp AH, Msomphora MR, Kvarstein G. The efficacy of botulinum toxin A treatment for tension-type or cervicogenic headache: a systematic review and meta-analysis of randomized, placebo-controlled trials. Scand J Pain 2021; 21:635-652. [PMID: 34090319 DOI: 10.1515/sjpain-2021-0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/04/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The pathogeneses of chronic tension-type headache (CTTH) and cervicogenic headache (CEH) are not well established. Peripheral activation or sensitization of myofascial nociceptors is suggested as a potential mechanism and injections of botulinum toxin (BONTA) have thus been used in the treatment for both headache conditions. BONTA inhibits the release of acetylcholine at the neuromuscular junction and inhibits contraction of skeletal muscles. If the pain is precipitated by increased tone in cervical muscles, local injections of BONTA could represent a prophylactic measure. However, the treatment is still controversial, and a thorough assessment of the current evidence is required. This review aims to assess the evidence of BONTA injection as a prophylactic treatment for CTTH and CEH by reviewing and examining the quality of placebo-controlled, randomized trials. METHODS Data sources: we searched in the following databases: PubMed (including Medline), Embase, Cochrane Central register of Controlled Trials, Cinahl, Amed, SCOPUS and Google Scholar including other repository sources. Both MeSH and free keywords were used in conducting the systematic search in the databases. The search covered publications from the root of the databases to November 2020. STUDY ELIGIBILITY CRITERIA The review included RCTs, comparing single treatment of BONTA with placebo on patients with CTTH or CEH above 18 years of age, by measuring pain severity/relief or headache frequency. DATA EXTRACTION The following data were extracted: year of publication, country, setting, trial design, number of participants, injection procedure, BONTA dosages, and clinical outcome measures. STUDY APPRAISAL To assess validity and quality, and risk of bias, the Oxford Pain Validity Scale, Modified Jadad Scale, last version of Cochrane Collaboration's tool for assessing risk of bias (RoB 2), and the CONSORT 2010 Checklist were used. The trials were assessed, and quality scored independently by two of the reviewers. A quantitative synthesis and meta-analyses of headache frequency and intensity were performed. RESULTS We extracted 16 trials, 12 on prophylactic BONTA treatment for CTTH and four on CEH. Of these 12 trials (8 on CTTH and 4 on CEH) were included in the quantitative synthesis. A majority of the trials found no significant difference on the primary outcome measure when BONTA treatment was compared with placebo. Three "positive" trials, reporting significant difference in favor of BONTA treatment, but two of these were hampered by low validity and quality scores and high risk of bias. CONCLUSIONS There is no clear clinical evidence supporting prophylactic treatment with BONTA for CTTH or CEH.
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Affiliation(s)
- Sissel Breivold Roland
- Department of Orthopedics, Finnmark Hospital Trust, Hammerfest, Norway.,Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Pain Clinic, Division of Surgical Medicine and Intensive Care, University Hospital of North Norway, Tromsø, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Mbachi Ruth Msomphora
- Research and Publishing Support, Department of Library services, UiT The Arctic University of Norway, Tromsø, Norway
| | - Gunnvald Kvarstein
- Pain Clinic, Division of Surgical Medicine and Intensive Care, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Qian X, Ma D, Liu J, Pan T, Wang H, Hu Z, Wang Z, Qi W. Assessment of the efficacy of tuina on treating cervicogenic headache: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26224. [PMID: 34087902 PMCID: PMC8183763 DOI: 10.1097/md.0000000000026224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 05/18/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Cervicogenic headache is a secondary headache characterized by unilateral headache, symptoms, and signs of neck involvement. It is often worsened by neck movement, sustained awkward head position, or external pressure over the upper cervical or occipital region on the symptomatic side. In this systematic review, we aimed to evaluate the efficacy and safety of massage therapy for the treatment of cervicogenic headache. METHODS We searched the China National Knowledge Infrastructure, Chinese Scientific Journal Database, Wanfang Database, China Doctoral Dissertations Full-Text Database, China Master's Theses Full-Text Database, Cochrane Central Register of Controlled Trials, PubMed, and Embase. We will select all eligible studies published on or before April 1, 2021. We will use Review Manager 5.4, provided by the Cochrane Collaborative Network for statistical analysis. We then assessed the quality and risk of the included studies and observed the outcome measures. RESULTS This meta-analysis further confirmed the benefits of tuina in the treatment of cervicogenic headache. CONCLUSION The purpose of this meta-analysis was to explore the effect of tuina on patients with cervicogenic headache and to provide more options for clinicians and patients to treat cervicogenic headache. ETHICS AND DISSEMINATION This systematic review will evaluate the efficacy and safety of tuina in the treatment of cervicogenic headache. Since all the data included were published, the systematic review did not require ethical approval. REGISTRATION NUMBER INPLASY202150053.
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Affiliation(s)
- Xin Qian
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun
| | - Dongyang Ma
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun
| | - Jiayi Liu
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun
| | - Ting Pan
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun
| | - Haili Wang
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun
| | - Zhe Hu
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun
| | - Zhaohui Wang
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun
- Bao’an Authentic traditional chinese medicine Therapy Hospital, Shenzhen, China
| | - Wei Qi
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun
- Bao’an Authentic traditional chinese medicine Therapy Hospital, Shenzhen, China
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Bakhtadze MA, Lusnikova IV, Kuzminov KO, Bolotov DA. [The Second Short Form of the McGill Pain Questionnaire as the useful additional tool for differential diagnostics of migraine and cervicogenic headache]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:70-76. [PMID: 33834721 DOI: 10.17116/jnevro202112103170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To study the effectiveness of the Second Short Form of the McGill Pain Questionnaire (SF-MPQ-2) as an instrument for assessment and comparison of quantitative characteristics of pain in patients with chronic musculoskeletal impairment of the cervical spine and nonspecific neck pain accompanied by chronic migraine or cervicogenic headache (CeH). MATERIAL AND METHODS Forty-nine patients, aged from 19 to 60 years (mean age 42.8±10.4), were divided into 2 comparable by age and gender groups with migraine (n=18) and CeH (n=31). Neck pain and headache intensity was measured by the 11-points Numerical Rating Scale (NRS). Quality of pain and related symptoms were measured by SF-MPQ-2. Multidisciplinary and multimodal approaches were applied for treatment, including several modalities of manual therapy. RESULTS Headache intensity was higher in the migraine group in comparison with the CeH group (7.8±1.7 vs 6.0±1.5, respectively; p<0.05). No significant differences in neck pain intensity were found (6.2±1.8 vs 5.3±1.7; p=0.08). Patients with migraine usually chose more descriptors than patients with CeH (14 vs 4, respectively) and higher range of their intensity (p<0.001). By the end of treatment session, the number of descriptors and their intensity decreased significantly on all SF=MPQ-2 scales (p<0.001) in both groups. Most patients of migraine and CeH group were satisfied with treatment (83% and 97%, respectively) and marked «much improved» and «very much improved» on the 7-point Patient Global Impression of Change scale. CONCLUSION SF-MPQ-2 is a useful tool for differential diagnosis of migraine and CeH, as it contains the sufficient number of descriptors and the scale for measuring their intensity.
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Affiliation(s)
- M A Bakhtadze
- Pirogov Russian National Research Medical University, Moscow, Russia.,Center for Manual Therapy, Department of Healthcare, Moscow, Russia
| | - I V Lusnikova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - K O Kuzminov
- Pirogov Russian National Research Medical University, Moscow, Russia.,Center for Manual Therapy, Department of Healthcare, Moscow, Russia
| | - D A Bolotov
- Pirogov Russian National Research Medical University, Moscow, Russia.,Center for Manual Therapy, Department of Healthcare, Moscow, Russia
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Park MS, Choi HJ, Yang JS, Jeon JP, Kang SH, Cho YJ. Clinical Efficacy of Pulsed Radiofrequency Treatment Targeting the Mid-cervical Medial Branches for Intractable Cervicogenic Headache. Clin J Pain 2021; 37:206-210. [PMID: 33346997 PMCID: PMC7960145 DOI: 10.1097/ajp.0000000000000911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 12/02/2020] [Accepted: 12/09/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Cervicogenic headache has been known to originate from the convergence of the upper 3 cervical and trigeminal afferents. The administration of conservative treatments, interventional procedures, and more recently, pulsed radiofrequency, has been used to relieve cervicogenic headache. In this study, the authors evaluated the clinical efficacy and safety of pulsed radiofrequency targeting the mid-cervical medial branches. MATERIALS AND METHODS From September 2012 until December 2017, 395 patients were diagnosed with cervicogenic headache based on the third edition of the International Classification of Headache Disorders. The authors treated them conservatively at first, and those patients with nonresolution of pain were treated with mid-cervical medial branches block applied from C3 to C5 twice. Subsequently, if any patient continued to experience persistent pain, the authors classified them as having intractable cervicogenic headache and performed pulsed radiofrequency treatment targeting the mid-cervical medial branches from C3 to C5 bilaterally. The authors analyzed their demographics and used a Visual Analogue Scale to assess their pain for 12 months. RESULTS Fifty-seven patients were enrolled in this study. The mean age was 49.8 years, and the mean duration of symptoms was 47.7 months. The mean Visual Analogue Scale score was 6.21 before pulsed radiofrequency treatment, and it improved to 1.54 immediately after the procedure without the symptoms recurring for a minimum of 12 months. There were no severe complications, such as vascular or nerve injuries. CONCLUSIONS In patients with intractable cervicogenic headache, pulsed radiofrequency treatment targeting the mid-cervical medial branches resulted in a satisfactory, long-lasting outcome without serious complications.
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Wong CK, Ziaks L, Vargas S, DeMattos T, Brown C. Sequencing and Integration of Cervical Manual Therapy and Vestibulo-oculomotor Therapy for Concussion Symptoms: Retrospective Analysis. Int J Sports Phys Ther 2021; 16:12-20. [PMID: 33604130 PMCID: PMC7872443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 07/24/2021] [Indexed: 11/11/2023] Open
Abstract
BACKGROUND After concussion many people have cervicogenic headache, visual dysfunction, and vestibular deficits that can be attributed to brain injury, cervical injury, or both. While clinical practice guidelines outline treatments to address the symptoms that arise from the multiple involved systems, no preferred treatment sequence for post-concussion syndrome has emerged. PURPOSE This study sought to describe the clinical and patient-reported outcomes for people with post-concussion symptoms after a protocol sequenced to address cervical dysfunction and benign paroxysmal positional vertigo within the first three weeks of injury, followed by integrated vision and vestibular therapy. STUDY DESIGN Retrospective longitudinal cohort analysis. METHODS Records from a concussion clinic for 38 patients (25 male 13 female, aged 26.9±19.7 years) with post-concussion symptoms due to sports, falls, assaults, and motor vehicle accident injuries were analyzed. Musculoskeletal, vision, and vestibular system functions were assessed after pragmatic treatment including early cervical manual therapy and canalith repositioning treatment-when indicated-integrated with advanced vision and vestibular rehabilitation. Patient-reported outcomes included the Post-Concussion Symptom Scale (PCSS) for general symptoms; and for specific symptoms, the Dizziness Handicap Index (DHI), Convergence Insufficiency Symptom Scale (CISS), Activities-specific Balance Confidence scale (ABC), and the Brain Injury Vision Symptom Survey (BIVSS). Paired t-tests with Bonferroni correction to minimize familywise error (p<0.05) were used to analyze the clinical and patient-reported outcomes. RESULTS After 10.4±4.8 sessions over 57.6±34.0 days, general symptoms improved on the PCSS (p=0.001, 95%CI=12.4-30.6); and specific symptoms on the DHI (p<0.001, 95%CI=14.5-33.2), CISS (p<0.002, 95%CI=7.1-18.3), ABC (p<0.024, 95%CI=-.3 - -.1), and BIVSS (p<0.001, 95%CI=13.4-28.0). Clinical measures improved including cervical range-of-motion (55.6% fully restored), benign paroxysmal positional vertigo symptoms (28/28, fully resolved), Brock string visual convergence (p<0.001, 95%CI=3.3-6.3), and score on the Balance Error Scoring System (p<0.001, 95%CI=5.5-11.6). CONCLUSION A rehabilitation approach for post-concussion syndrome that sequenced cervical dysfunction and benign paroxysmal positional vertigo treatment within the first three weeks of injury followed by integrated vision and vestibular therapy improved clinical and patient-reported outcomes. Level of Evidence: 2b.
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De Andres J, Formicola GL, Rubio-Haro R, De Andres-Serrano C. Updated management of occipital nerve stimulator lead migration: case report of a technical challenge. Scand J Pain 2021; 21:415-420. [PMID: 34387963 DOI: 10.1515/sjpain-2020-0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/01/2020] [Indexed: 11/15/2022]
Abstract
Electrode migration is a challenge, even with adequate anchoring techniques, due to the high mechanical stress on components of occipital nerve stimulation (ONS) for headache disorders. When a lead displacement of an ONS implant is diagnosed, there are currently different approaches described for its management. Nevertheless current neuromodulation devices are designed like a continuum of components without any intermediate connector, and if a lead displacement is diagnosed, the solution is the complete removal of the electrode from its placement, and its repositioning through an ex-novo procedure. The described technique can allow ONS leads to be revised while minimizing the need to reopen incisions over the IPG, thus improving patients' intraoperative and postoperative discomfort, shortening surgical time and medical costs, reasonably reducing the incidence of infective postoperative complications.
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Affiliation(s)
- Jose De Andres
- Anesthesia, Critical Care and Multidisciplinary Pain Management Department, Valencia University General Hospital, Avda. Tres Cruces, s/n 46014, Valencia, Spain.,Anesthesia Unit, Surgical Specialties Department, School of Medicine, University of Valencia, Valencia, Spain
| | - Giuseppe Luca Formicola
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Pain Management Department of Valencia University General Hospital, Milan, Italy
| | - Ruben Rubio-Haro
- Anesthesia Critical Care and Pain Management Department, Valencia University General Hospital, Valencia, Spain
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Martínez-Merinero P, Aneiros Tarancón F, Montañez-Aguilera J, Nuñez-Nagy S, Pecos-Martín D, Fernández-Matías R, Achalandabaso-Ochoa A, Fernández-Carnero S, Gallego-Izquierdo T. Interaction between Pain, Disability, Mechanosensitivity and Cranio-Cervical Angle in Subjects with Cervicogenic Headache: A Cross-Sectional Study. J Clin Med 2021; 10:jcm10010159. [PMID: 33466533 PMCID: PMC7796513 DOI: 10.3390/jcm10010159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/21/2020] [Accepted: 01/02/2021] [Indexed: 12/25/2022] Open
Abstract
The relationship between the forward head posture and mechanosensitivity in subjects with a cervicogenic headache (CGH) remains uncertain. The aim of the study was to evaluate if there was a relationship between the tissue mechanosensitivity and cranio-cervical angle (CCA) that was moderated by pain intensity and/or disability in subjects with CGH. A convenience sample of 102 subjects was recruited. The CCA was measured with photographs, using a postural assessment software. The pain intensity was measured with a visual analogue scale (VAS), and the disability was measured with the Northwick Park Questionnaire. The pressure pain threshold (PPT) was measured at the spinous process of C2, the upper trapezius and splenius capitis muscles, and the median nerve. Simple moderation multiple regression analyses were constructed. There was a positive relationship between PPT at C2 and CCA, but a nonsignificant relationship for the PPT measured at the muscles and median nerve. The effect of PPT at C2 over CCA was moderated by pain intensity (R2 = 0.17; R2 change = 0.06; p < 0.05) but not disability. The Johnson–Neyman analysis revealed a cut-off point for the statistical significance of 4.66 cm in VAS. There seems to be a positive relationship between PPT at C2 and CCA, which is positively moderated by pain intensity in subjects with CGH.
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Affiliation(s)
- Patricia Martínez-Merinero
- Physiotherapy Department, Faculty of Health, Exercise and Sport, European University, Villaviciosa de Odón, 28660 Madrid, Spain;
| | | | - Javier Montañez-Aguilera
- Department of Physiotherapy, Universidad Cardenal Herrera-CEU, 46115 Alfara del Patriarca, Spain;
| | - Susana Nuñez-Nagy
- Department of Physiotherapy and Nursing, Alcalá University, 28871 Alcalá de Henares, Spain; (S.N.-N.); (D.P.-M.); (S.F.-C.); (T.G.-I.)
| | - Daniel Pecos-Martín
- Department of Physiotherapy and Nursing, Alcalá University, 28871 Alcalá de Henares, Spain; (S.N.-N.); (D.P.-M.); (S.F.-C.); (T.G.-I.)
- Research Institute of Physical Therapy and Pain, Alcalá University, 28871 Alcalá de Henares, Spain;
| | - Rubén Fernández-Matías
- Research Institute of Physical Therapy and Pain, Alcalá University, 28871 Alcalá de Henares, Spain;
| | - Alexander Achalandabaso-Ochoa
- Research Institute of Physical Therapy and Pain, Alcalá University, 28871 Alcalá de Henares, Spain;
- Department of Health Sciences, Universidad de Jaén, 23071 Jaén, Spain
- Correspondence:
| | - Samuel Fernández-Carnero
- Department of Physiotherapy and Nursing, Alcalá University, 28871 Alcalá de Henares, Spain; (S.N.-N.); (D.P.-M.); (S.F.-C.); (T.G.-I.)
- Research Institute of Physical Therapy and Pain, Alcalá University, 28871 Alcalá de Henares, Spain;
| | - Tomás Gallego-Izquierdo
- Department of Physiotherapy and Nursing, Alcalá University, 28871 Alcalá de Henares, Spain; (S.N.-N.); (D.P.-M.); (S.F.-C.); (T.G.-I.)
- Research Institute of Physical Therapy and Pain, Alcalá University, 28871 Alcalá de Henares, Spain;
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Pang X, Liu C, Peng B. Anterior Cervical Surgery for the Treatment of Cervicogenic Headache Caused by Cervical Spondylosis. J Pain Res 2020; 13:2783-2789. [PMID: 33173327 PMCID: PMC7646456 DOI: 10.2147/jpr.s275680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/29/2020] [Indexed: 01/03/2023] Open
Abstract
Study Design Retrospective study. Objective To report the efficacy of anterior cervical surgery for the relief of cervicogenic headache (CEH) caused by cervical spondylosis. Methods From January 2014 to December 2016, a total of 166 cases of cervical radiculopathy and/or myelopathy received anterior cervical decompression and fusion (ACDF) in our institution, among which 50 cases (mean age 44.7 years) were accompanied by CEH and followed up at 3, 6, 12, and 24 months postoperatively, respectively. Neck pain and headache scores according to neck disability index (NDI) were documented for all patients at regular intervals. The results measured at different follow-up time point were compared statistically. Results All 50 patients reported neck pain and headache at the same time before surgery. The average NDIs for neck pain before and after surgery were 2.86 (95% CI: 2.7–3.0) preoperatively, 0.98 (95% CI: 0.8–1.1) at 3 months, 0.68 (95% CI: 0.5–0.9) at 6 months, 0.62 (95% CI: 0.5–0.8) at 12 months, and 0.60 (95% CI: 0.4–0.8) at 24 months postoperatively, respectively. The average NDIs for CEH before and after surgery were 2.32 (95% CI: 2.2–2.5) preoperatively, 0.62 (95% CI: 0.5–0.8) at 3 months, 0.60 (95% CI: 0.4–0.8) at 6 months, 0.56 (95% CI: 0.4–0.7) at 12 months, and 0.50 (95% CI: 0.3–0.7) at 24 months postoperatively, respectively. The neck pain and headache improved in all cases and the NDI score of neck pain or headache at each follow-up point after surgery was significantly different from that before surgery (P <0.001). The simple correlation analysis between neck pain and headache was performed, and the Pearson coefficient r was 0.71, indicating a positive correlation between neck pain NDI and headache NDI. No serious surgical complications were found. Conclusion Our study suggests that patients with cervical spondylosis complicated with CEH are always accompanied by neck pain. ACDF can not only relieve neck pain but also improve the accompanying CEH.
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Affiliation(s)
- Xiaodong Pang
- Department of Spinal Surgery, The Third Medical Center of Chinese PLA General Hospital, Beijing 100039, People's Republic of China
| | - Chunyu Liu
- Department of Spinal Surgery, The Third Medical Center of Chinese PLA General Hospital, Beijing 100039, People's Republic of China
| | - Baogan Peng
- Department of Spinal Surgery, The Third Medical Center of Chinese PLA General Hospital, Beijing 100039, People's Republic of China
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Lin Q, Zhou WZ, Wang Y, Yang CY, Luo NS, Fan XY, Kou RZ, Wang L, Hou T, Fan GQ. [Horizontal penetration needling method for headache]. Zhongguo Zhen Jiu 2020; 40:1193-1197. [PMID: 33788487 DOI: 10.13703/j.0255-2930.20200114-k0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The manipulation and key points of professor FAN Gang-qi 's horizontal penetration needling method for headache were introduced. This acupuncture method selects local acupoints of head, including occipital acupoint group, temporal acupoint group, frontal acupoint group and vertex acupoint group. The needles are shallowly and horizontally inserted at acupoints, with needle end towards the focus or headache site. The needle retaining time is long (6 h). This method is commonly used in the treatment of migraine, cervicogenic headache and tension-type headache. The manipulation is standard with better repeatability.
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Affiliation(s)
- Qi Lin
- Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Wen-Zhu Zhou
- Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Yue Wang
- Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Chun-Yan Yang
- Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Ni-Sha Luo
- Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Xiang-Ying Fan
- Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Ren-Zhong Kou
- Department of Encephalopathy, Nanjing Hospital of TCM, Nanjing University of Chinese Medicine, Nanjing 210001, Jiangsu Province
| | - Lin Wang
- Department of Encephalopathy, Nanjing Hospital of TCM, Nanjing University of Chinese Medicine, Nanjing 210001, Jiangsu Province
| | - Teng Hou
- Department of Encephalopathy, Nanjing Hospital of TCM, Nanjing University of Chinese Medicine, Nanjing 210001, Jiangsu Province
| | - Gang-Qi Fan
- Department of Encephalopathy, Nanjing Hospital of TCM, Nanjing University of Chinese Medicine, Nanjing 210001, Jiangsu Province
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Womack A, Butts R, Dunning J. Dry needling as a novel intervention for cervicogenic somatosensory tinnitus: a case study. Physiother Theory Pract 2020; 38:1319-1327. [PMID: 33000979 DOI: 10.1080/09593985.2020.1825579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Tinnitus is defined as conscious perception of sound in the absence of a corresponding external stimulus. A condition that affects 10 - 15% of the adult population, tinnitus may be caused by an interaction between the somatosensory and auditory system, more formally known as somatosensory tinnitus. Cervicogenic somatosensory tinnitus is a subgroup of somatosensory tinnitus involving anatomical structures and physiological mechanisms associated with the cervical spine. A limited number of studies have reported inconsistent outcomes for treating cervicogenic somatosensory tinnitus with conservative treatment strategies such as manual therapy and exercise. However, dry needling is a skilled, manual therapy intervention that has recently gained popularity among the physical therapy profession that may be useful for both evaluating and treating the condition. The following case report describes the use of dry needling to evaluate and treat a patient with cervical somatosensory tinnitus and concurrent cervicogenic headaches. Physical therapy that targeted the muscles of the upper cervical spine with dry needling resulted in a meaningful reduction in cervicogenic somatosensory tinnitus, and the improvements persisted at 1-year follow-up. Further research, including randomized control trials, is warranted to fully determine the potential of dry needling to treat cervicogenic somatosensory tinnitus.
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Affiliation(s)
- Aaron Womack
- Alliance Health Midwest Rehabilitation, Midwest City, OK, USA.,American Academy of Manipulative Therapy, Montgomery, AL, USA
| | - Raymond Butts
- American Academy of Manipulative Therapy, Montgomery, AL, USA.,Research Physical Therapy Specialists, Columbia, SC, USA
| | - James Dunning
- American Academy of Manipulative Therapy, Montgomery, AL, USA.,Montgomery Osteopractic Physiotherapy and Acupuncture Clinic, Montgomery, AL, USA
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Kvarstein G, Högström H, Allen SM, Rosland JH. Cryoneurolysis for cervicogenic headache - a double blinded randomized controlled study. Scand J Pain 2020; 20:39-50. [PMID: 31675351 DOI: 10.1515/sjpain-2019-0086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 07/11/2019] [Indexed: 01/15/2023]
Abstract
Background and aims Cervicogenic headache (CEH) is a debilitating condition and analgesics have limited effect. Percutaneous cryoneurolysis is thus still in use although the clinical evidence is lacking. We present a randomized, controlled study to assess the clinical efficacy of cryoneurolysis compared with a corticosteroid combined with a local anaesthetic. Methods In a university-based outpatient pain clinic we performed a randomized, double blinded, comparative study with an 18-week follow-up. After positive diagnostic test blocks 52 eligible patients were randomly allocated in a ratio of 3:2, 31 participants to occipital cryoneurolysis and 21 participants to injections of 1 mL methylprednisolone 40 mg/mL (Depo-Medrol®) combined with 1 mL bupivacaine 5 mg/mL. Results We observed a significant pain reduction of more than 50% in both treatment groups, slightly improved neck function and reduced number of opioid consumers. After 6-7-weeks, however, pain intensity increased gradually, but did not reach baseline within 18 weeks. Although cryoneurolysis provided a more prolonged effect, the group differences did not reach statistical significance. Health related quality of life and psychological distress improved minimally. A large number reported minor and transient side effects, but we found no significant group differences. After 18 weeks, 29% rated the headache as much improved, and 12 (24%) somewhat improved, but a large proportion (78%) reported need for further intervention/treatment. Conclusions Cryoneurolysis provided substantial, but temporary pain relief, and the effect was not significantly different from injections of a corticosteroid combined with a local anaesthetic. Participants were selected by a single test block, and the neurolytic procedure was guided by anatomical landmarks and nerve stimulation. A stricter patient selection and an ultrasound-guided technique might have improved the results. Cryoneurolysis provides temporary pain relief not significantly superior to corticosteroid injection, and the results question the value of occipital cryoneurolysis for a chronic pain condition like CEH. Implications Occipital cryoneurolysis may be considered when non-invasive treatments appear insufficient, but only for patients who have responded substantially to test blocks. A risk of local scar and neuroma formation by repeated cryoneurolysis, leading to neuropathic pain has been discussed by other researchers.
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Affiliation(s)
- Gunnvald Kvarstein
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Clinical Medicine, UIT, The Arctic University of Norway, Tromsø, Norway
| | - Henrik Högström
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | | | - Jan Henrik Rosland
- Department of Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Fernández-de-las-Peñas C, Florencio LL, Plaza-Manzano G, Arias-Buría JL. Clinical Reasoning Behind Non-Pharmacological Interventions for the Management of Headaches: A Narrative Literature Review. Int J Environ Res Public Health 2020; 17:ijerph17114126. [PMID: 32527071 PMCID: PMC7312657 DOI: 10.3390/ijerph17114126] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 12/13/2022]
Abstract
Headache is the clinical syndrome most commonly observed by neurologists in daily practice. Pharmacological and non-pharmacological treatments are commonly used for the management of headaches; however, the clinical reasoning behind these interventions is not properly applied. We conducted a narrative literature review using as data sources for academic PubMed, MEDLINE, EMBASE, AMED, CINAHL, EBSCO, PEDro, Cochrane Database of Systematic Reviews, Cochrane Collaboration Trials Register, and SCOPUS. This narrative literature review mainly considered systematic reviews, meta-analyses, randomised clinical trials, and expert opinions published after the year 2000 discussing clinical reasoning for application of non-pharmacological interventions in individuals with tension-type, migraine, and cervicogenic headaches. After the data extraction, we organized the literature thematically as follows: (1) mapping of theoretical aspects of non-pharmacological interventions; (2) summarizing most updated literature about effectiveness of non-pharmacological interventions grouped by targeted tissue and headache; (3) identifying research gaps in the existing literature and proposing hypotheses for better understanding of current clinical reasoning. We found that there are many non-pharmacological treatment strategies used for headaches, including beyond the tissue-based impairment treatments (bottom-up) and strategies targeting the central nervous system (top down). Bottom-up strategies include joint-biased, soft-tissue biased, or needling interventions, whereas top-down strategies include exercise and cognitive interventions. Evidence shows that the effectiveness of these interventions depends on the application of proper clinical reasoning, since not all strategies are effective for all headaches. For instance, evidence of non-pharmacological interventions is more controversial for migraines than for tension-type or cervicogenic headaches, since migraine pathogenesis involves activation of sub-cortical structures and the trigemino- vascular system, whereas pathogenesis of tension-type or cervicogenic headaches is most associated to musculoskeletal impairments of the cervical spine. We conclude that current literature suggests that not all non-pharmacological interventions are effective for all headaches, and that multimodal, not isolated, approaches seem to be more effective for patients with headaches. Most published studies have reported small clinical effects in the short term. This narrative literature review provides some hypotheses for discrepancies in the available literature and future research. Clinical reasoning should be applied to better understand the effects of non-pharmacological interventions.
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Affiliation(s)
- César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain; (L.L.F.); (J.L.A.-B.)
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia, Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, 28922 Madrid, Spain
- Correspondence:
| | - Lidiane L. Florencio
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain; (L.L.F.); (J.L.A.-B.)
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia, Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, 28922 Madrid, Spain
| | - Gustavo Plaza-Manzano
- Radiology, Rehabilitation and Physiotherapy Department, Universidad Complutense de Madrid, 28040 Madrid, Spain;
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - José L. Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain; (L.L.F.); (J.L.A.-B.)
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia, Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, 28922 Madrid, Spain
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Abstract
BACKGROUND Occipital nerve blocks are commonly used in the treatment of different types of refractory headaches. The procedure is considered safe, and serious complications have rarely been described. CASE PRESENTATION We report a serious complication of occipital nerve blockade secondary to the penetration of local anesthetic and non-steroidal anti-inflammatory drugs into the posterior fossa in a patient affected by type I Arnold Chiari malformation. CONCLUSIONS This case reminds that a proper injection technique is mandatory to avoid potentially severe complications when performing occipital nerve blocks.
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Affiliation(s)
- Alessandro Pincherle
- Neurology Unit, Department of Medicine, Hopitaux Robert Schuman, Luxembourg, Luxembourg.,Department of Neurorehabilitation, IRCSS Istituto Clinico Scientifico Maugeri, Milan, Italy
| | - Serge Bolyn
- Neurology Unit, Department of Medicine, Hopitaux Robert Schuman, Luxembourg, Luxembourg
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Lee HJ, Cho HH, Nahm FS, Lee PB, Choi E. Pulsed Radiofrequency Ablation of the C2 Dorsal Root Ganglion Using a Posterior Approach for Treating Cervicogenic Headache: A Retrospective Chart Review. Headache 2020; 60:2463-2472. [PMID: 32052873 DOI: 10.1111/head.13759] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/23/2019] [Accepted: 12/23/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate the efficacy and complications of C2 dorsal root ganglion (DRG) pulsed radiofrequency ablation (RFA) for cervicogenic headache (CEH) and to identify factors related to the outcome of the procedure in this retrospective analysis. BACKGROUND Although conventional high-temperature C2 DRG RFA was effective in patients with CEH in previous studies, the effect of pulsed RFA on C2 DRG in cases of CEH has not yet been evaluated. METHODS We examined the electronic medical records of consecutive patients who underwent C2 DRG block for CEH from January 2012 to May 2018 at a pain center. Consequent C2 DRG pulsed RFA was performed for patients in whom the headache recurred after an initial period of relief 24 hours after the C2 DRG block. A successful outcome was defined as at least 50% pain relief at 6 months after C2 DRG pulsed RFA. We also examined variables associated with the outcome and prognostic factors of CEH. RESULTS Fluoroscopy-guided C2 DRG block was performed in 114 patients with CEH. Forty-five patients received C2 DRG pulsed RFA and 40.0% among them (18/45, success group) had ≥50% pain relief after 6 months. There were no post-procedure complications throughout the study period. Significantly more patients in the success group than in the failure group had a definite positive response (≥50% pain relief) to a previous C2 DRG block (P < .001). CONCLUSION C2 DRG pulsed RFA may be an effective treatment for patients with CEH, particularly for patients who have previously experienced definite pain reduction after C2 DRG block. However, the limitations of our study design and small number of patients preclude firm conclusions.
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Affiliation(s)
- Ho-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun Hoo Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seongnam, Republic of Korea
| | - Francis Sahngun Nahm
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seongnam, Republic of Korea.,Department of Anesthesiology and Pain Medicine, Seoul National University, Seoul, Republic of Korea
| | - Pyung-Bok Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seongnam, Republic of Korea.,Department of Anesthesiology and Pain Medicine, Seoul National University, Seoul, Republic of Korea
| | - Eunjoo Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seongnam, Republic of Korea
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Cho PG, Kim TW, Ji GY, Park SH, Yun MJ, Shin DA. Diagnostic Value of Single-Photon Emission Computed Tomography/Computed Tomography Scans with Tc-99m HDP in Cervicogenic Headache. J Clin Med 2020; 9:jcm9020399. [PMID: 32024217 PMCID: PMC7074323 DOI: 10.3390/jcm9020399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/24/2020] [Accepted: 01/30/2020] [Indexed: 11/26/2022] Open
Abstract
A cervicogenic headache (CEH) is difficult to diagnose due to its varied pathology. We evaluated the usefulness of single-photon emission computed tomography/computed tomography (SPECT/CT) in diagnosing CEH and its interventional treatment. Retrospectively, 23 patients diagnosed with CEH between March 2016 to August 2018 were allocated to SPECT/CT (n = 11) and control (n = 12) groups. The SPECT/CT group was further stratified into SPECT/CT(+) and SPECT/CT(-) groups according to the presence of positive findings. Patients in the SPECT/CT group underwent an intra-articular injection at a radiologically verified lesion site, whereas those in the control group underwent third occipital nerve block. Clinical outcomes were evaluated with the visual analog scale (VAS), neck disability index (NDI), and global perceived effect (GPE) scale at baseline, and at one, three, and six months postoperatively. The SPECT/CT group showed less VAS, NDI, and GPE scores at six months postoperatively (2.91 ± 2.30 vs. 4.42 ± 1.62, p = 0.08; 38.00 ± 16.54 vs. 48.7 ± 12.40, p = 0.093; 2.00 ± 1.41 vs. 3.17 ± 1.11, p = 0.039). Successful responders at six months postoperatively were higher in the SPECT/CT(+) group than in the control group (75% vs. 0%). SPECT/CT can identify arthritic changes and accurately define therapeutic targets.
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Affiliation(s)
- Pyung Goo Cho
- Department of Neurosurgery, Ajou University College of Medicine, Suwon-si 16499, Korea;
| | - Tae Woo Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Gyu Yeul Ji
- Department of Neurosurgery, Cham Teun Teun research institute, Seoul 06072, Korea;
| | - Sang Hyuk Park
- Department of Neurosurgery, Hwalgichan Hospital, Ilsan-si 10500, Korea;
| | - Mi Jin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Dong Ah Shin
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul 03722, Korea;
- Correspondence: ; Tel.: +82-2-2228-2150; Fax: +82-2-393-9979
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Zagorulko OI, Medvedeva LA. [The efficacy of therapeutic nerve blocks in patients with cervicogenic headache]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:37-40. [PMID: 31851170 DOI: 10.17116/jnevro201911911137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To compare the efficacy of 2% articaine solution and 2% lidocaine solution used to perform therapeutic nerve blocks of the large occipital nerve in patients with cervicogenic headache. MATERIAL AND METHODS A randomized prospective comparative clinical study was conducted in two groups treated with articaine (n=22) or lidocaine (n=21). The therapeutic great occipital nerve blocks were performed on the 1st, 3d and 5th days of treatment. The efficacy of treatment was assessed by the pain intensity measured with the Visual Analogue scale (VAS) and the duration of individual pain paroxysms on the 5th and 10th days. RESULTS The baseline VAS pain intensity was 6.3±1.2 and 5.9±2.0 centimeters, whereas the duration of individual pain paroxysms was 7.8±2.3 and 9.1±2.8 hours in the articaine group and the lidocaine group, respectively. By the 5th day, there was a more dramatically decrease in VAS pain intensity and duration in the articaine group (up to 3.0±0.8 and 4.3±1.2 centimeters VAS (p<0.05)) compared to the lidocaine group (up to 1.9±0.6 to 4.8±1.3 hours (p<0.05)). By the 10th day, the pain intensity did not differ between groups (1.2±0.5 and 1.7±0.7 centimeters (p>0.05)). The duration of pain episodes was still lower in the articaine group (0.5±0.08 hours) compared to the lidocaine group (2.4±0.8 hours) (p<0.05). CONCLUSION Therapeutic large occipital nerve blocks with 2% solution of articaine show the significant decrease in pain intensity and duration of pain paroxysms in a short period of time for patients with cervicogenic headache.
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Affiliation(s)
- O I Zagorulko
- Petrovsky Russian National Center of Surgery, Moscow, Russia
| | - L A Medvedeva
- Petrovsky Russian National Center of Surgery, Moscow, Russia
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Anarte E, Ferreira Carvalho G, Schwarz A, Luedtke K, Falla D. Can physical testing be used to distinguish between migraine and cervicogenic headache sufferers? A protocol for a systematic review. BMJ Open 2019; 9:e031587. [PMID: 31712341 PMCID: PMC6858106 DOI: 10.1136/bmjopen-2019-031587] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Differential diagnosis of migraine and cervicogenic headache (CGH) can be challenging given the large overlap of symptoms, commonly leading to misdiagnosis and ineffective treatment. In order to strengthen the differential diagnosis of headache, previous studies have evaluated the utility of physical tests to examine for musculoskeletal impairment, mainly in the cervical spine, which could be provoking or triggering headache. However, no systematic review has attempted to evaluate whether physical tests can differentiate CGH from migraine or both conditions from asymptomatic subjects. METHODS/ANALYSIS A systematic review protocol has been designed and is reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). A sensitive topic-based search strategy is planned which will include databases, hand searching of key journals and consultation of relevant leading authors in this field. Terms and keywords will be selected after discussion and agreement. Two independent reviewers will perform the search and select studies according to inclusion and exclusion criteria, including any cohort or observational studies evaluating the topic of this review; a third reviewer will confirm accuracy. A narrative synthesis will be developed for all included studies and, if possible, a meta-analysis will be conducted. The overall quality of the evidence will be assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) checklist for diagnostic accuracy studies and the Downs and Black scale for those studies where the QUADAS-2 checklist cannot be applied. ETHICS AND DISSEMINATION Ethical approval is not required since no patient information will be collected. The results will provide a deeper understanding about the possibility of using physical tests to differentiate cervicogenic headache from migraine and from asymptomatic subjects, which has direct relevance for clinicians managing people with headache. The results will be published in a peer-reviewed journal and presented at scientific conferences. PROSPERO REGISTRATION NUMBER CRD42019135269.
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Affiliation(s)
- Ernesto Anarte
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | | | - Annika Schwarz
- Department of Systems Neuroscience, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Kerstin Luedtke
- Pain and Exercise Research, Universitat zu Lubeck Sektion Medizin, Lubeck, Germany
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Satpute K, Bedekar N, Hall T. Headache symptom modification: the relevance of appropriate manual therapy assessment and management of a patient with features of migraine and cervicogenic headache - a case report. J Man Manip Ther 2019; 28:181-188. [PMID: 31537198 DOI: 10.1080/10669817.2019.1662637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES People who suffer from headache frequently present with multiple headache forms and the precise diagnosis of the dominant headache form can be challenging. This case report describes a headache symptom modification approach in the diagnosis and management of a patient presenting with combined features of chronic migraine and cervicogenic headache (CGH). METHODS A 28-year-old female presented with combined features of chronic migraine and CGH diagnosed according to guidelines published by the International Headache Society. Her main complaints were frequent and severe headache along with frequent neck pain and disability. Symptom modification based on the Mulligan Concept was utilized for assessment of musculoskeletal dysfunction associated with headache which identified upper cervical articular impairment. Impairments were also identified in craniocervical muscle control and endurance. Interventions comprised six sessions of Mulligan manual therapy to address cervical spine impairments, exercise for craniocervical control and endurance, as well as patient education. RESULTS Headache frequency at 6 months follow up was reduced from 16 to 3 days per month and intensity from 72 to 23 on Visual Analogue Scale. Clinically relevant improvements were also found in headache duration, pressure pain thresholds, medication intake and Headache Activities of Daily Living Index post-treatment and continued up to 6 months follow-up without adverse events. DISCUSSION This case report illustrates the use of a manual therapy symptom modification approach in the management of headache. Improvement in headache symptoms and disability suggests that the musculoskeletal impairments and headache symptoms were more a feature of CGH rather than migraine. The mechanisms underlying these changes in symptoms and impairments are discussed.
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Affiliation(s)
- Kiran Satpute
- Department of Kinesiotherapy and Physical Diagnosis, Department of Musculoskeletal Physiotherapy, Smt. Kashibai Navale College of Physiotherapy , Pune, India
| | - Nilima Bedekar
- Department of Musculoskeletal Physiotherapy, Sancheti Institute College of Physiotherapy , Pune, India
| | - Toby Hall
- School of Physiotherapy and Exercise Science, Curtin University , Perth, Australia
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Szikszay TM, Luedtke K, Harry von P. Increased mechanosensivity of the greater occipital nerve in subjects with side-dominant head and neck pain - a diagnostic case-control study. J Man Manip Ther 2018; 26:237-248. [PMID: 30083047 DOI: 10.1080/10669817.2018.1480912] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objectives: To investigate differences in pressure pain thresholds (PPTs) and longitudinal mechanosensitivity of the greater occipital nerve (GON) between patients with side-dominant head and neck pain (SDHNP) and healthy controls. Evaluation of neural sensitivity is not a standard procedure in the physical examination of headache patients but may influence treatment decisions. Methods: Two blinded investigators evaluated PPTs on two different locations bilaterally over the GON as well as the occipitalis longsitting-slump (OLSS) in subjects with SDHNP (n = 38)) and healthy controls (n = 38). Results: Pressure pain sensitivity of the GON was lower at the occiput in patients compared to controls (p = 0.001). Differences in pressure sensitivity of the GON at the nucheal line, or between the dominant headache side and the non-dominant side were not found (p > 0.05). The OLSS showed significant higher pain intensity in SDHNP (p < 0.001). In comparison to the non-dominant side, the dominant side was significantly more sensitive (p = 0.004). Discussion: Palpation of the GON at the occiput and the OLSS may be potentially relevant tests in SDHNP. One explanation for an increased bilateral sensitivity may be sensitization mechanisms. Future research should investigate the efficacy of neurodynamic techniques directed at the GON. Level of Evidence: 3b.
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Affiliation(s)
| | - Kerstin Luedtke
- University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Shimohata K, Hasegawa K, Onodera O, Nishizawa M, Shimohata T. The Clinical Features, Risk Factors, and Surgical Treatment of Cervicogenic Headache in Patients With Cervical Spine Disorders Requiring Surgery. Headache 2017; 57:1109-1117. [PMID: 28581034 DOI: 10.1111/head.13123] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To clarify the clinical features and risk factors of cervicogenic headache (CEH; as diagnosed according to the International Classification of Headache Disorders-Third Edition beta) in patients with cervical spine disorders requiring surgery. BACKGROUND CEH is caused by cervical spine disorders. The pathogenic mechanism of CEH is hypothesized to involve a convergence of the upper cervical afferents from the C1, C2, and C3 spinal nerves and the trigeminal afferents in the trigeminocervical nucleus of the upper cervical cord. According to this hypothesis, functional convergence of the upper cervical and trigeminal sensory pathways allows the bidirectional (afferent and efferent) referral of pain to the occipital, frontal, temporal, and/or orbital regions. Previous prospective studies have reported an 86-88% prevalence of headache in patients with cervical myelopathy or radiculopathy requiring anterior cervical surgery; however, these studies did not diagnose headache according to the International Classification of Headache Disorders criteria. Therefore, a better understanding of the prevalence rate, clinical features, risk factors, and treatment responsiveness of CEH in patients with cervical spine disorders requiring surgery is necessary. METHODS We performed a single hospital-based prospective cross-sectional study and enrolled 70 consecutive patients with cervical spine disorders such as cervical spondylotic myelopathy, ossification of the posterior longitudinal ligament, cervical spondylotic radiculopathy, and cervical spondylotic myeloradiculopathy who had been scheduled to undergo anterior cervical fusion or dorsal cervical laminoplasty between June 2014 and December 2015. Headache was diagnosed preoperatively according to the International Classification of Headache Disorders-Third Edition beta. The Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire, Neck Disability Index, and a 0-100 mm visual analog scale (VAS) were used to evaluate clinical features, and scores were compared between baseline (ie, preoperatively) and 3, 6, and 12 months post-surgery. RESULTS The prevalence of CEH in our population was 15/70 (21.4%, 95%CI: 11.8% to 31.0%). The main clinical features were dull and tightening/pressing headache sensations in the occipital region. Headache severity was mild (VAS, 32 ± 11 mm) and only one patient reported use of an oral analgesic. Compared to patients without CEH, patients with CEH had higher frequencies of neck pain (86.7% vs. 50.9%; P = .017), cervical range of motion limitation (ROM) (66.7% vs. 38.2%; P = .049), and higher Neck Disability Index scores (14 vs. 3; P < .001). Among the different cervical spine disorders, the prevalence of CEH was highest in cervical spondylotic myeloradiculopathy patients (60%), being ≤ 20% for all other disorders. Surgical treatments including cervical laminoplasty to relieve abnormal pressure on the spinal cord via a posterior approach, were associated with initial improvements in headache VAS that slightly diminished by 12 months post-surgery (P < .001). CONCLUSIONS We report a lower prevalence of CEH in patients with cervical spinal disorders requiring surgery than that reported previously. The main clinical features of CEH were mild, dull, and tightening/pressing headache sensations in the occipital region. Potential risk factors for CEH included neck pain, limited cervical ROM, high Neck Disability Index score, and a diagnosis of cervical spondylotic myeloradiculopathy. The further accumulation of patients in a multi-institutional study may be required in order to discuss the diagnostic criteria and pathophysiology of this condition.
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Affiliation(s)
- Keiko Shimohata
- Department of Anesthesiology, Kameda Daiichi Hospital, Niigata, Japan.,Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | | | - Osamu Onodera
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Masatoyo Nishizawa
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Takayoshi Shimohata
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
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Aguila MER, Rebbeck T, Mendoza KG, De La Peña MGL, Leaver AM. Definitions and participant characteristics of frequent recurrent headache types in clinical trials: A systematic review. Cephalalgia 2017; 38:786-793. [PMID: 28440672 DOI: 10.1177/0333102417706974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Clear definitions of study populations in clinical trials may facilitate application of evidence to clinical populations. This review aimed to explore definitions of study populations in clinical trials on migraine, tension-type headache, cluster headache, and cervicogenic headache. Methods We performed a systematic review of clinical trials investigating treatment efficacy for migraine, tension-type headache, cluster headache, and cervicogenic headache. We extracted data on diagnosis, inclusion criteria and baseline headache characteristics. Results Of the 229 studies reviewed, 205 studies (89.5%) defined their populations in adherence to the International Classification of Headache Disorders (ICHD) criteria. Some studies ( n = 127, 55.5%) specified diagnosing through interview, clinical examination and diary entry. The most commonly reported inclusion criteria were pain intensity for migraine and tension-type headache studies ( n = 123, 66.1% and n = 21, 67.7%, respectively), episode frequency ( n = 5, 71.4%) for cluster headache studies, and neck-related pain for cervicogenic headache studies ( n = 3, 60%). Few studies reported details on the extent to which diagnostic criteria were present at baseline. Conclusions ICHD is routinely used in defining populations in headache studies. Details of baseline headache characteristics were not as consistently reported.
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Affiliation(s)
- Maria-Eliza R Aguila
- 1 University of Sydney, Faculty of Health Sciences, Lidcombe, NSW, Australia.,2 University of the Philippines, College of Allied Medical Professions, Manila, Philippines
| | - Trudy Rebbeck
- 1 University of Sydney, Faculty of Health Sciences, Lidcombe, NSW, Australia.,3 John Walsh Centre of Rehabilitation Research, Kolling Institute of Medical Research, Royal North Shore Hospital, University of Sydney, St. Leonards, NSW, Australia
| | | | | | - Andrew M Leaver
- 1 University of Sydney, Faculty of Health Sciences, Lidcombe, NSW, Australia
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Liu JJ, Cadena G, Panchal RR, Schrot RJ, Kim KD. Relief of Cervicogenic Headaches after Single-Level and Multilevel Anterior Cervical Diskectomy: A 5-Year Post Hoc Analysis. Global Spine J 2016; 6:563-70. [PMID: 27555998 PMCID: PMC4993614 DOI: 10.1055/s-0035-1570086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 10/07/2015] [Indexed: 11/12/2022] Open
Abstract
STUDY DESIGN Prospective study. OBJECTIVE Because single-level disk arthroplasty or arthrodesis in the lower subaxial spine improves headaches after surgery, we studied whether this effect may be better appreciated after two-level arthroplasty. METHODS We performed an independent post hoc analysis of two concurrent prospective randomized investigational device exemption trials for cervical spondylosis, one for single-level treatment and the other for two adjacent-level treatments. RESULTS For the one-level study, baseline mean headache scores significantly improved at 60 months for both the cervical disk arthroplasty (CDA) and anterior cervical diskectomy and fusion (ACDF) groups (p < 0.0001). However, mean improvement in headache scores was not statistically different between the investigational and control groups from 6 months through 60 months. For the two-level study, baseline mean headache scores significantly improved at 60 months for both the CDA and ACDF groups (p < 0.0001). The CDA group demonstrated greater improvement from baseline at all points; this difference was statistically significant at 6, 12, 24, 36, and 48 months but not at 18 and 60 months. CONCLUSION Both CDA and ACDF at either one or two levels are associated with sustained headache relief from baseline. Patients undergoing two-level arthroplasty had significantly greater improvement in headache at all points except for at 18 and 60 months. This difference in improvement was not observed in patients undergoing single-level arthroplasty. The mechanism of greater headache relief after two-level arthroplasty remains unclear.
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Affiliation(s)
- Jonathan J. Liu
- Department of Neurological Surgery, University of California-Davis Medical Center, Sacramento, California, United States
| | - Gilbert Cadena
- Department of Neurological Surgery, University of California-Davis Medical Center, Sacramento, California, United States
| | - Ripul R. Panchal
- Department of Neurological Surgery, University of California-Davis Medical Center, Sacramento, California, United States
| | - Rudolph J. Schrot
- Department of Neurosurgery, Sutter Neuroscience Institute, Sacramento, California, United States; Touro University, Vallejo, California, United States
| | - Kee D. Kim
- Department of Neurological Surgery, University of California-Davis Medical Center, Sacramento, California, United States,Address for correspondence Kee D. Kim, MD 4860 Y Street, Suite 3640, Sacramento, CA 95817United States
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Abstract
A degenerative cervical disc is a pain generator for headaches, and headaches can benefit from cervical prolapse surgery. However, as an alternative intervention for open cervical surgery, no study has reported whether headaches can benefit from cervical nucleoplasty.The objective of this study was to evaluate the efficacy of cervical coblation nucleoplasty in the treatment of cervicogenic headaches.In a prospective cohort study performed between December 2013 and August 2015, 20 patients with cervicogenic headaches undergoing cervical nucleoplasty for shoulder-arm pain were recruited into group C, and 20 patients with cervicogenic headaches undergoing lumbar nucleoplasty for low back pain, matched for age and sex, were recruited into group L. Cervicogenic pain was diagnosed according to the International Headache Society criteria. During the 24-month follow-up, pain visual analog scale (VAS) scores were collected as the primary outcomes, and significant pain relief rate, Neck Disability Index (NDI) headache scores, and Patients Satisfaction Index (PSI) scores were recorded as secondary outcomes to evaluate headache severity and physical function postoperatively.During the 24-month follow-up, a significant decrease in headache VAS scores was observed in group C but not in group L. NDI and PSI scores in group C were better than those in group L. In comparison with the final follow-up, no significant differences in the NDI and PSI scores were found in all observations after surgery. In comparison to group L, ≥50% pain relief was significantly better in group C. No serious complications were observed except for ≤20% of ecchymoma at the needle insertion site.This prospective study indicated that cervicogenic headaches may benefit from nucleoplasty.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jiaxiang Ni
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, Xicheng, Beijing, China
- Correspondence: Jiaxiang Ni, Department of Pain Management, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng, Beijing 100053, China (e-mail: )
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Abstract
Background Headache is the medical problem most commonly observed by neurologists. Non-pharmacological treatments are commonly demanded by individuals with headaches, but their evidence of effectiveness is conflicting. Aim The current review provides an updated discussion on what is supported by current scientific evidence about physical therapies for tension-type headache (TTH), migraine, and cervicogenic headache (CeH), and which gaps there still may be in our understanding of the interventions. Methods PubMed, MEDLINE, EMBASE, AMED, CINAHL, EBSCO, Cochrane Database of Systematic Reviews, Cochrane Collaboration Trials Register, PEDro, and SCOPUS were searched from their inception through March 2015. Results/Discussion Several physical therapies including spinal joint manipulation/mobilization, soft tissue interventions, therapeutic exercises and needling therapies are proposed to be effective for the management of headaches. Current evidence has shown that the effectiveness of these interventions will depend on proper clinical reasoning since not all interventions are equally effective for all headache pain conditions. For instance, evidence of physical therapy in migraine is more controversial than in TTH, since migraine pathogenesis involves activation of sub-cortical structures and the trigemino-vascular system, whereas pathogenesis of TTH is more associated with musculoskeletal disorders, e.g. muscle pain. It seems that multimodal approaches including different interventions are more effective for patients with TTH, migraine and CeH.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- 1 Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.,2 Grupo Excelencia Investigadora URJC-Banco Santander referencia N° 30VCPIGI03: Investigación traslacional en el proceso de salud - enfermedad (ITPSE).,3 Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - María L Cuadrado
- 4 Headache Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,5 Department of Medicine, Universidad Complutense, Madrid, Spain
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Garcia JD, Arnold S, Tetley K, Voight K, Frank RA. Mobilization and Manipulation of the Cervical Spine in Patients with Cervicogenic Headache: Any Scientific Evidence? Front Neurol 2016; 7:40. [PMID: 27047446 PMCID: PMC4800981 DOI: 10.3389/fneur.2016.00040] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 03/08/2016] [Indexed: 12/16/2022] Open
Abstract
Cervical mobilization and manipulation are frequently used to treat patients diagnosed with cervicogenic headache (CEH); however, there is conflicting evidence on the efficacy of these manual therapy techniques. The purpose of this review is to investigate the effects of cervical mobilization and manipulation on pain intensity and headache frequency, compared to traditional physical therapy interventions in patients diagnosed with CEH. A total of 66 relevant studies were originally identified through a review of the literature, and the 25 most suitable articles were fully evaluated via a careful review of the text. Ultimately, 10 studies met the inclusion criteria: (1) randomized controlled trial (RCT) or open RCT; the study contained at least two separate groups of subjects that were randomly assigned either to a cervical spine mobilization or manipulation or a group that served as a comparison; (2) subjects must have had a diagnosis of CEH; (3) the treatment group received either spinal mobilization or spinal manipulation, while the control group received another physical therapy intervention or placebo control; and (4) the study included headache pain and frequency as outcome measurements. Seven of the 10 studies had statistically significant findings that subjects who received mobilization or manipulation interventions experienced improved outcomes or reported fewer symptoms than control subjects. These results suggest that mobilization or manipulation of the cervical spine may be beneficial for individuals who suffer from CEH, although heterogeneity of the studies makes it difficult to generalize the findings.
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Affiliation(s)
- Jodan D Garcia
- Department of Physical Therapy, Georgia State University , Atlanta, GA , USA
| | - Stephen Arnold
- Department of Physical Therapy, Georgia State University , Atlanta, GA , USA
| | - Kylie Tetley
- Department of Physical Therapy, Georgia State University , Atlanta, GA , USA
| | - Kiel Voight
- Department of Physical Therapy, Georgia State University , Atlanta, GA , USA
| | - Rachael Anne Frank
- Department of Physical Therapy, Georgia State University , Atlanta, GA , USA
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Abstract
STUDY DESIGN Case report. BACKGROUND Neck-tongue syndrome (NTS) is defined as neck and/or head pain accompanied by ipsilateral dysesthesia of the tongue with sudden rotation of the head. Proposed causes include compression or irritation of the C2 nerve root as it courses behind the atlantoaxial joint or hypertrophy of the inferior oblique muscle. The primary purpose of this case report was to describe the conservative physical therapy treatment of a patient with uncomplicated NTS. CASE DESCRIPTION The patient was a 13-year-old girl who reported insidious onset of sharp pain in the neck, numbness/tingling of the ipsilateral tongue/face, and tinnitus with cervical rotation. Symptoms occurred several times a week for approximately 10 seconds. Examination revealed impaired function, increased forward head posture, decreased cervical range of motion, and positive neurodynamic assessment. The patient's treatment included manual therapy and exercise for postural stabilization. OUTCOMES Following 8 visits, pain of the neck and tongue numbness had resolved. Score on the Patient-Specific Functional Scale (PSFS), cervical range of motion, and posture had also improved. At the 22-month follow-up, infrequent, momentary symptoms in the neck and dysesthesia of the tongue were reported. The PSFS remained the same. Objective measures were normal. DISCUSSION This case report describes the physical therapy management of an individual with NTS. The management strategy followed a protocol similar to that used for cervicogenic headaches, due to the involvement of the upper cervical spine with both NTS and cervicogenic headache and the lack of evidence for the treatment of NTS. Level of Evidence Therapy, level 4.
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