Neck pain associated with migraine does not necessarily reflect cervical musculoskeletal dysfunction.
cervical
headache
migraine
musculoskeletal
neck pain
Journal
Headache
ISSN: 1526-4610
Titre abrégé: Headache
Pays: United States
ID NLM: 2985091R
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
revised:
07
03
2021
received:
15
10
2020
accepted:
01
04
2021
entrez:
2
7
2021
pubmed:
3
7
2021
medline:
15
12
2021
Statut:
ppublish
Résumé
To identify how frequently the neck pain associated with migraine presents with a pattern of cervical musculoskeletal dysfunction akin to cervical musculoskeletal disorders, and to determine if pain hypersensitivity impacts on cervical musculoskeletal function in persons with migraine. Many persons with migraine experience neck pain and often seek local treatment. Yet neck pain may be part of migraine symptomology and not from a local cervical source. If neck pain is of cervical origin, a pattern of musculoskeletal impairments with characteristics similar to idiopathic neck pain should be present. Some individuals with migraine may have neck pain of cervical origin, whereas others may not. However, previous studies have neglected the disparity in potential origins of neck pain and treated persons with migraine as a homogenous group, which does not assist in identifying the origin of neck pain in individuals with migraine. This cross-sectional, single-blinded study was conducted in a research laboratory at the University of Queensland, Australia. Persons with migraine (total n = 124: episodic migraine n = 106, chronic migraine = 18), healthy controls (n = 32), and persons with idiopathic neck pain (n = 21) were assessed using a set of measures typically used in the assessment of a cervical musculoskeletal disorder, including cervical movement range and accuracy, segmental joint dysfunction, neuromuscular and sensorimotor measures. Pain hypersensitivity was assessed using pressure pain thresholds and the Allodynia Symptom Checklist. People with migraine with diagnoses of comorbid neck disorders were excluded. Cluster analysis was performed to identify how participants grouped on the basis of their performance across cervical musculoskeletal assessments. Post hoc analyses examined the effects of pain hypersensitivity on musculoskeletal function, and if any symptoms experienced during testing were related to musculoskeletal function. Two distinct clusters of cervical musculoskeletal function were found: (i) neck function similar to healthy controls (n = 108) and (ii) neck dysfunction similar to persons with neck pain disorders (n = 69). Seventy-six of the individuals with migraine (62 with neck pain and 14 without neck pain) were clustered as having normal cervical musculoskeletal function, whereas the remaining 48 with neck pain had cervical dysfunction comparable with a neck disorder. Musculoskeletal dysfunction was not related to pain hypersensitivity or symptoms experienced during testing. Neck pain when present with migraine does not necessarily indicate the existence of cervical musculoskeletal dysfunction. Skilled assessment without reliance only on the person reporting symptoms is needed to identify actual cervical dysfunction. Treatments suitable for neck musculoskeletal disorders would seem inappropriate for the individuals without cervical dysfunction. Future studies evaluating any potential effects of such treatments should only select participants with neck pain of cervical origin.
Sections du résumé
OBJECTIVE
To identify how frequently the neck pain associated with migraine presents with a pattern of cervical musculoskeletal dysfunction akin to cervical musculoskeletal disorders, and to determine if pain hypersensitivity impacts on cervical musculoskeletal function in persons with migraine.
BACKGROUND
Many persons with migraine experience neck pain and often seek local treatment. Yet neck pain may be part of migraine symptomology and not from a local cervical source. If neck pain is of cervical origin, a pattern of musculoskeletal impairments with characteristics similar to idiopathic neck pain should be present. Some individuals with migraine may have neck pain of cervical origin, whereas others may not. However, previous studies have neglected the disparity in potential origins of neck pain and treated persons with migraine as a homogenous group, which does not assist in identifying the origin of neck pain in individuals with migraine.
METHODS
This cross-sectional, single-blinded study was conducted in a research laboratory at the University of Queensland, Australia. Persons with migraine (total n = 124: episodic migraine n = 106, chronic migraine = 18), healthy controls (n = 32), and persons with idiopathic neck pain (n = 21) were assessed using a set of measures typically used in the assessment of a cervical musculoskeletal disorder, including cervical movement range and accuracy, segmental joint dysfunction, neuromuscular and sensorimotor measures. Pain hypersensitivity was assessed using pressure pain thresholds and the Allodynia Symptom Checklist. People with migraine with diagnoses of comorbid neck disorders were excluded. Cluster analysis was performed to identify how participants grouped on the basis of their performance across cervical musculoskeletal assessments. Post hoc analyses examined the effects of pain hypersensitivity on musculoskeletal function, and if any symptoms experienced during testing were related to musculoskeletal function.
RESULTS
Two distinct clusters of cervical musculoskeletal function were found: (i) neck function similar to healthy controls (n = 108) and (ii) neck dysfunction similar to persons with neck pain disorders (n = 69). Seventy-six of the individuals with migraine (62 with neck pain and 14 without neck pain) were clustered as having normal cervical musculoskeletal function, whereas the remaining 48 with neck pain had cervical dysfunction comparable with a neck disorder. Musculoskeletal dysfunction was not related to pain hypersensitivity or symptoms experienced during testing.
CONCLUSIONS
Neck pain when present with migraine does not necessarily indicate the existence of cervical musculoskeletal dysfunction. Skilled assessment without reliance only on the person reporting symptoms is needed to identify actual cervical dysfunction. Treatments suitable for neck musculoskeletal disorders would seem inappropriate for the individuals without cervical dysfunction. Future studies evaluating any potential effects of such treatments should only select participants with neck pain of cervical origin.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
882-894Subventions
Organisme : Physiotherapy Research Foundation, Australian Physiotherapy Association
ID : PG18-009
Informations de copyright
© 2021 American Headache Society.
Références
Calhoun AH, Ford S, Millen C, Finkel AG, Truong Y, Nie Y. The prevalence of neck pain in migraine. Headache. 2010;50:1273-1277.
Lampl C, Rudolph M, Deligianni CI, Mitsikostas DD. Neck pain in episodic migraine: premonitory symptom or part of the attack? J Headache Pain. 2015;16:80.
Hvedstrup J, Kolding LT, Younis S, Ashina M, Schytz HW. Ictal neck pain investigated in the interictal state-a search for the origin of pain. Cephalalgia. 2020;40:614-624.
Bevilaqua Grossi D, Gonçalves MC, Carvalho GF, et al. Additional effects of a physical therapy protocol on headache frequency, pressure pain threshold, and improvement perception in patients with migraine and associated neck pain: a randomized controlled trial. Arch Phys Med Rehabil. 2016;97:866-874.
Luedtke K, Starke W, von Korn K, Szikszay TM, Schwarz A, May A. Neck treatment compared to aerobic exercise in migraine: a preference-based clinical trial. Cephalalgia Rep. 2020;3:1-9.
Rist PM, Hernandez A, Bernstein C, et al. The impact of spinal manipulation on migraine pain and disability: a systematic review and meta-analysis. Headache. 2019;59:532-542.
Viana M, Khaliq F, Zecca C, et al. Poor patient awareness and frequent misdiagnosis of migraine: findings from a large transcontinental cohort. Eur J Neurol. 2020;27:536-541.
Rota E, Zucco R, Guerzoni S, et al. Migraine awareness in Italy and the myth of “cervical arthrosis”. Headache. 2020;60:81-89.
Bartsch T. Migraine and the neck: new insights from basic data. Curr Pain Headache Rep. 2005;9:191-196.
Wöber C, Brannath W, Schmidt K, et al. Prospective analysis of factors related to migraine attacks: the PAMINA study. Cephalalgia. 2007;27:304-314.
Johnston MM, Jordan SE, Charles AC. Pain referral patterns of the C1 to C3 nerves: implications for headache disorders. Ann Neurol. 2013;74:145-148.
Szikszay TM, Hoenick S, von Korn K, et al. Which examination tests detect differences in cervical musculoskeletal impairments in people with migraine? A systematic review and meta-analysis. Phys Ther. 2019;99:549-569.
Liang Z, Galea O, Thomas L, Jull G, Treleaven J. Cervical musculoskeletal impairments in migraine and tension type headache: a systematic review and meta-analysis. Musculoskelet Sci Pract. 2019;42:67-83.
Thoomes-de Graaf M, Thoomes E, Fernández-de-las-Peñas C, Plaza-Manzano G, Cleland JA. Normative values of cervical range of motion for both children and adults: a systematic review. Musculoskelet Sci Pract. 2020;49:e102182.
Jull G, Amiri M, Bullock-Saxton J, Darnell R, Lander C. Cervical musculoskeletal impairment in frequent intermittent headache. Part 1: subjects with single headaches. Cephalalgia. 2007;27:793-802.
Getsoian SL, Gulati SM, Okpareke I, Nee RJ, Jull GA. Validation of a clinical examination to differentiate a cervicogenic source of headache: a diagnostic prediction model using controlled diagnostic blocks. BMJ Open. 2020;10:e035245.
Jørgensen R, Ris I, Falla D, Juul-Kristensen B. Reliability, construct and discriminative validity of clinical testing in subjects with and without chronic neck pain. BMC Musculoskelet Disord. 2014;15:408-422.
Juul T, Langberg H, Enoch F, Søgaard K. The intra- and inter-rater reliability of five clinical muscle performance tests in patients with and without neck pain. BMC Musculoskelet Disord. 2013;14:339-353.
Luedtke K, Starke W, May A. Musculoskeletal dysfunction in migraine patients. Cephalalgia. 2018;38:865-875.
Nahman-Averbuch H, Shefi T, Schneider VJ, et al. Quantitative sensory testing in patients with migraine: a systematic review and meta-analysis. Pain. 2018;159:1202-1223.
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629-808.
Sjaastad O, Fredriksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache. 1998;38:442-445.
Sjaastad O. Cervicogenic headache: comparison with migraine without aura; Vågå study. Cephalalgia. 2008;28(suppl. 1):18-20.
Vernon H. The Neck Disability Index: state-of-the-art, 1991-2008. J Manipulative Physiol Ther. 2008;31:491-502.
Yang M, Rendas-Baum R, Varon SF, Kosinski M. Validation of the Headache Impact Test (HIT-6™) across episodic and chronic migraine. Cephalalgia. 2010;31:357-367.
Lipton RB, Bigal ME, Ashina S, et al. Cutaneous allodynia in the migraine population. Ann Neurol. 2008;63:148-158.
Sarig Bahat H, Chen X, Reznik D, Kodesh E, Treleaven J. Interactive cervical motion kinematics: sensitivity, specificity and clinically significant values for identifying kinematic impairments in patients with chronic neck pain. Man Ther. 2015;20:295-302.
Hall TM, Briffa K, Hopper D, Robinson K. Comparative analysis and diagnostic accuracy of the cervical flexion-rotation test. Headache. 2010;11:391-397.
Hall T, Robinson K. The flexion-rotation test and active cervical mobility-a comparative measurement study in cervicogenic headache. Man Ther. 2004;9:197-202.
Ogince M, Hall T, Robinson K, Blackmore AM. The diagnostic validity of the cervical flexion-rotation test in C1/2-related cervicogenic headache. Man Ther. 2007;12:256-262.
Jull G, Bogduk N, Marsland A. The accuracy of manual diagnosis for cervical zygapophyseal joint pain syndromes. Med J Aust. 1988;148:233-236.
Van Wyk L, Jull G, Vicenzino B, Greaves M, O'Leary S. A comparison of craniocervical and cervicothoracic muscle strength in healthy individuals. J Appl Biomech. 2010;26:400-406.
Jull GA, O'Leary SP, Falla DL. Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test. J Manipulative Physiol Ther. 2008;31:525-533.
Chen X, Treleaven J. The effect of neck torsion on joint position error in subjects with chronic neck pain. Man Ther. 2013;18:562-567.
Everitt BS, Landau S, Leese M, Stahl D. Chapter 9. Some final comments and guidelines. In: Everitt BS, Landau S, Leese M, Stahl D, eds. Cluster Analysis. 5th ed. West Sussex, UK: John Wiley; 2011:257-287.
Kaufman L, Rousseeuw PJ. Chapter 2. Partitioning around medoids. In: Kaufman L, Rousseeuw PJ, eds. Finding Groups in Data: An Introduction to Cluster Analysis. Vol. 344. New Jersey: John Wiley; 2005:68-125.
Santos JM, Embrechts M. On the use of the adjusted rand index as a metric for evaluating supervised classification. In: International Conference on Artificial Neural Networks. Berlin, Heidelberg: Springer; 2009:175-184.
Goodman LA, Kruskal WH. Measures of association for cross classifications III: approximate sampling theory. J Am Stat Assoc. 2012;58:310-364.
van der Maaten L, Hinton G. Visualizing data using t-SNE. J Mach Learn Res. 2008;9:2579-2605.
R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2017.
Scher AI, Buse DC, Fanning KM, et al. Comorbid pain and migraine chronicity: the Chronic Migraine Epidemiology and Outcomes Study. Neurology. 2017;89:461-468.
Florencio LL, Chaves TC, Carvalho GF, et al. Neck pain disability is related to the frequency of migraine attacks: a cross-sectional study. Headache. 2014;54:1203-1210.
Bragatto MM, Bevilaqua Grossi D, Benatto MT, et al. Is the presence of neck pain associated with more severe clinical presentation in patients with migraine? A cross-sectional study. Cephalalgia. 2019;39:1500-1508.
Goadsby PJ. Migraine, allodynia, sensitisation and all of that. Eur J Neurol. 2005;53(suppl. 1):10-16.
Peng K-P, May A. Migraine understood as a sensory threshold disease. Pain. 2019;160:1494-1501.
Borkum JM. Migraine triggers and oxidative stress: a narrative review and synthesis. Headache. 2016;56:12-35.
Scholten-Peeters GGM, Coppieters MW, Durge TSC, Castien RF. Fluctuations in local and widespread mechanical sensitivity throughout the migraine cycle: a prospective longitudinal study. Headache. 2020;21:1-11.
Uglem M, Omland PM, Nilsen KB, et al. Does pain sensitivity change by migraine phase? A blinded longitudinal study. Cephalalgia. 2017;37:1337-1349.
Carvalho GF, Luedtke K, Szikszay TM, Bevilaqua Grossi D, May A. Muscle endurance training of the neck triggers migraine attacks. Cephalalgia. 2021;41(3):383-391.
Luedtke K, Allers A, Schulte LH, May A. Efficacy of interventions used by physiotherapists for patients with headache and migraine-systematic review and meta-analysis. Cephalalgia. 2015;36:474-492.
Watson DH, Drummond PD. Cervical referral of head pain in migraineurs: effects on the nociceptive blink reflex. Headache. 2014;54:1035-1045.
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;17:4126-4217.
Lipton RB, Dodick D, Sadovsky R, et al. A self-administered screener for migraine in primary care: the ID Migraine validation study. Neurology. 2003;61:375-382.
Fishbain DA, Cutler R, Cole B, Rosomoff HL, Rosomoff RS. International headache society headache diagnostic patterns in pain facility patients. Clin J Pain. 2001;17:78-93.
Amiri M, Jull G, Bullock-Saxton J, Darnell R, Lander C. Cervical musculoskeletal impairment in frequent intermittent headache. Part 2: subjects with concurrent headache types. Cephalalgia. 2007;27:891-898.
Hennig C. Cluster-wise assessment of cluster stability. Comput Stat Data Anal. 2007;52:258-271.