Can physical testing be used to distinguish between migraine and cervicogenic headache sufferers? A protocol for a systematic review

Anarte, Ernesto; Carvalho, Gabriela Ferreira; Schwarz, Annika; Luedtke, Kerstin; Falla, Deborah

doi:10.1136/bmjopen-2019-031587

Cited by 7 publications

(8 citation statements)

References 32 publications

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“…The protocol for this systematic review was registered with PROSPERO (CRD42019135269) and published [ 24 ]. This review was conducted following the recommendations from the Cochrane Handbook of Systematic Review of Interventions [ 25 ] where possible and the reporting of the systematic review was conducted in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines [ 26 , 27 ].…”

Section: Methodsmentioning

confidence: 99%

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Differentiating migraine, cervicogenic headache and asymptomatic individuals based on physical examination findings: a systematic review and meta-analysis

Anarte‐Lazo

Carvalho

Schwarz

et al. 2021

BMC Musculoskelet Disord

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Background Migraine and cervicogenic headache (CGH) are common headache disorders, although the large overlap of symptoms between them makes differential diagnosis challenging. To strengthen differential diagnosis, physical testing has been used to examine for the presence of musculoskeletal impairments in both conditions. This review aimed to systematically evaluate differences in physical examination findings between people with migraine, CGH and asymptomatic individuals. Methods The databases MEDLINE, PubMed, CINAHL, Web of Science, Scopus, EMBASE were searched from inception until January 2020. Risk of bias was assessed with the Downs and Black Scale for non-randomized controlled trials, and with the Quality Assessment of Diagnostic Accuracy Studies tool for diagnostic accuracy studies. When possible, meta-analyses with random effect models was performed. Results From 19,682 articles, 62 studies were included in this review and 41 were included in the meta-analyses. The results revealed: a) decreased range of motion [°] (ROM) on the flexion-rotation test (FRT) (17.67, 95%CI:13.69,21.65) and reduced neck flexion strength [N] (23.81, 95%CI:8.78,38.85) in CGH compared to migraine; b) compared to controls, migraineurs exhibit reduced flexion ROM [°] (− 2.85, 95%CI:-5.12,-0.58), lateral flexion ROM [°] (− 2.17, 95% CI:-3.75,-0.59) and FRT [°] (− 8.96, 95%CI:-13.22,-4.69), reduced cervical lordosis angle [°] (− 0.89, 95%CI:-1.72,-0.07), reduced pressure pain thresholds over the cranio-cervical region [kg/cm2], reduced neck extension strength [N] (− 11.13, 95%CI:-16.66,-5.6) and increased activity [%] of the trapezius (6.18, 95%CI:2.65,9.71) and anterior scalene muscles (2.87, 95%CI:0.81,4.94) during performance of the cranio-cervical flexion test; c) compared to controls, CGH patients exhibit decreased neck flexion (− 33.70, 95%CI:-47.23,-20.16) and extension (− 55.78, 95%CI:-77.56,-34.00) strength [N]. Conclusion The FRT and neck flexion strength could support the differential diagnosis of CGH from migraine. Several physical tests were found to differentiate both headache types from asymptomatic individuals. Nevertheless, additional high-quality studies are required to corroborate these findings. Study registration Following indications of Prisma-P guidelines, this protocol was registered in PROSPERO on 21/05/2019 with the number CRD42019135269. All amendments performed during the review were registered in PROSPERO, indicating the date and what and why was changed.

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Section: Methodsmentioning

confidence: 99%

“…For diagnostic accuracy, we collected sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-) and positive and negative predictive values (PPV and NPV). Definition of these concepts can be found in the protocol for this systematic review [ 24 ].…”

Section: Methodsmentioning

confidence: 99%

Differentiating migraine, cervicogenic headache and asymptomatic individuals based on physical examination findings: a systematic review and meta-analysis

Anarte‐Lazo

Carvalho

Schwarz

et al. 2021

BMC Musculoskelet Disord

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“…The medical literature sets clear differentiations between these symptoms. 6 , 7 These distinctions refer to the character of the pain, pain location, the frequency of pain, the intensity of the pain and accompanying symptoms. 6 - 8 Treating these conditions has also been linked to most reported cases of toxicological effects due to overdose of medications taken by patients.…”

Section: Introductionmentioning

confidence: 99%

“… 6 , 7 These distinctions refer to the character of the pain, pain location, the frequency of pain, the intensity of the pain and accompanying symptoms. 6 - 8 Treating these conditions has also been linked to most reported cases of toxicological effects due to overdose of medications taken by patients. 9 , 10 Nowadays, the delivery of appropriate patient counseling is considered as an integral part of healthcare provision.…”

Section: Introductionmentioning

confidence: 99%

A pseudo-customer cross-sectional study to evaluate the community pharmacist’s management of migraine in pregnant women

Kubaisi¹,

Hasan²,

Hassan³

et al. 2022

PHARMPRACT

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“…Posttraumatic headache is particularly vexing because of the difficulty establishing causation between head or neck injury and headache onset or exacerbation. Multiple resources can strengthen diagnostic precision including the use of established diagnostic criteria, clinical examination, use of biomarkers, functional testing and symptom self-report (16–18). Integrating multiple sources of data confirmed by consensus clinical judgment may bolster clinical precision in establishing an “ideal” clinical threshold of posttraumatic headache onset.…”

Section: Introductionmentioning

confidence: 99%

Reason to doubt the ICHD-3 7-day inclusion criterion for mild TBI-related posttraumatic headache: A nested cohort study

et al. 2020

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Background Posttraumatic headache is difficult to define and there is debate about the specificity of the 7-day headache onset criterion in the current definition. There is limited evidence available to guide decision making about this criterion. Method A nested cohort study of 193 treatment-seeking veterans who met criteria for persistent headache attributed to mild traumatic injury to the head, including some veterans with delayed headache onset up to 90 days post-injury, was undertaken. Survival analysis examined the proportion of participants reporting headache over time and differences in these proportions based on sex, headache phenotype, and mechanism of injury. Result 127 participants (66%; 95% CI: 59–72%) reported headache onset within 7 days of head injury and 65 (34%) reported headache onset between 8 days and 3 months after head injury. Fourteen percent of participants reported pre-existing migraine before head injury, and there was no difference in the proportion of veterans with pre-existing migraine based on headache onset. Headache onset times were not associated with sex, headache phenotype, or mechanism of injury. There were no significant differences in proportion of veterans with headache onset within 7 days of head injury based on headache phenotype (70% migraine onset within 7 days, 70% tension-type headache within 7 days, 56% cluster headache within 7 days; p ≥ .364). Similar findings were observed for head injury (64% blast, 60% blunt; p = .973). There were no significant differences observed between headache onset groups for psychiatric symptoms (Posttraumatic Stress Disorder Checklist for DSM-5 = 1.3, 95% CI = −27.5, 30.1; Patient Health Questionnaire-9 Item = 3.5, 95% CI = −6.3, 3.7; Generalized Anxiety Disorder Screener = 6.5, 95% CI = −2.7, 15.6). Conclusions Although most of the sample reported headache onset within 7 days of head injury, one-third experienced an onset outside of the diagnostic range. Additionally, veterans with headache onset within 7 days of head injury were not meaningfully different from those with later onset based on sex, headache phenotype, or mechanism of head injury. The ICHD-3 diagnostic criteria for 7-day headache onset should be expanded to 3 months. ClinicalTrials.gov Identifier NCT02419131

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Can physical testing be used to distinguish between migraine and cervicogenic headache sufferers? A protocol for a systematic review

Cited by 7 publications

References 32 publications

Differentiating migraine, cervicogenic headache and asymptomatic individuals based on physical examination findings: a systematic review and meta-analysis

Differentiating migraine, cervicogenic headache and asymptomatic individuals based on physical examination findings: a systematic review and meta-analysis

A pseudo-customer cross-sectional study to evaluate the community pharmacist’s management of migraine in pregnant women

Reason to doubt the ICHD-3 7-day inclusion criterion for mild TBI-related posttraumatic headache: A nested cohort study

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