Musculoskeletal disorders of the upper cervical spine in women with episodic or chronic migraine

Ferracini, Gabriela Natália; Dach, Fabíola; Bevilaqua-Grossi, Débora; Palacios‐Ceña, María; Ordás-Bandera, Carlos; Chaves, Thaís Cristina; Speciali, José Geraldo; Fernández‐de‐las‐Peñas, César

doi:10.23736/s1973-9087.17.04393-3

Cited by 42 publications

(26 citation statements)

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“…Of the 62 studies included, 47 assessed only migraineurs, 9 only patients with cervicogenic headache and 6 both headache types. For those studies assessing cervical musculoskeletal impairments in migraine, diagnostic criteria were based on different editions from the International Classification of Headache Disorders (ICHD) (1st edition [17,[33][34][35][36][37][38], 2nd edition [14,15,19, and 3rd edition [18,[62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78]). We also included two studies which diagnostic criteria were not based on those from ICHD.…”

Section: Studies Characteristicsmentioning

confidence: 99%

“…A total of 2240 patients with migraine, 369 with cervicogenic headache and 1688 asymptomatic individuals were included in this review. Mean ages of each ranged from 22.9 years (SD = 3.5) [14] to 44 years (SD = 5) [69] for migraine, from 24.5 years (SD = 4.8) [81] to 44 years (SD = 11.9) [35] for cervicogenic headache, and from 21.6 years (SD = 0.9) [60] to 44 years (11) [66] for asymptomatic individuals. Only one study included a population with an older mean age [migraineurs, 64 (SD = 3.2); asymptomatic individuals, 65.2 (SD = 3.9)] [80].…”

Section: Studies Characteristicsmentioning

confidence: 99%

“…The physical examinations performed in patients with migraine, cervicogenic headache and asymptomatic individuals are presented in Additional file 2. Among all studies, 23 different tests were identified: balance tests (limits of stability (LOS) [39,64], postural oscillation [41], and others [35,39,41,56,64]), pressure pain threshold (PPT) [14, 33, 37, 42-44, 47-51, 55, 59, 62, 67, 76, 77, 80], neck strength and endurance [18,19,34,53,62,63,70,71,86], craniocervical flexion test (CCFT) [14,18,19,62,68,69], trigger point assessment [18,35,40,45,48,60,73,86], joint position sense error [14,18,34,66,81,84], cervical and cranial tenderness [15,47,79], cervical stiffness [58,60,65], global cervical range of motion (cervical ROM) [14,…”

Section: Physical Examination Testsmentioning

confidence: 99%

“…Results of the meta-analysis showed that range of motion was significantly reduced in patients with migraine for flexion (− 2.85 [95%CI 5.12, − 0.58]), lateral flexion (− 2.17 [95%CI -3.75, − 0.59]) and for the sum of both sides of the FRT (− 8.96 [95%CI 13.22, − 4.69]). These three measurements were considered to have low heterogeneity (I 2 < 40%) [14,19,45,54,60,66,71,73,75]. Post-hoc sensitivity analyses indicated that results for flexion (− 3.57 [95%CI -6.28, − 0.86]) and rotation (− 4.42 [95%CI -6.5, − 2.33]) were significant [14,54,60,66,71,73,75].…”

Section: Migraine Vs Asymptomatic Individualsmentioning

confidence: 99%

“…These three measurements were considered to have low heterogeneity (I 2 < 40%) [14,19,45,54,60,66,71,73,75]. Post-hoc sensitivity analyses indicated that results for flexion (− 3.57 [95%CI -6.28, − 0.86]) and rotation (− 4.42 [95%CI -6.5, − 2.33]) were significant [14,54,60,66,71,73,75]. Forest plots for meta-analysis and post-hoc sensitivity analysis are presented in Additional file 9.…”

Section: Migraine Vs Asymptomatic Individualsmentioning

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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