Cervical musculoskeletal impairments in the 4 phases of the migraine cycle in episodic migraine patients

Abstract

Objective To assess cervical musculoskeletal impairments during the 4 phases of a migraine cycle in episodic migraine patients, controlling for the presence of concomitant neck pain. Methods Differences in cervical musculoskeletal impairments were assessed during the 4 migraine phases in episodic migraine patients and compared with healthy controls controlling for concomitant neck pain. Cervical musculoskeletal impairments were assessed as follow: cervical active range of motion; flexion rotation test; craniocervical flexion test and calculation of activation pressure score; the total number of myofascial trigger points in head/neck muscles; the number of positivevertebral segments (headache’s reproduction) during passive accessory intervertebral movement; pressure pain thresholds over C1, C2, C4, C6 vertebral segments bilaterally, trigeminal area, hand, and leg. Signs of pain sensitization were assessed by evaluating mechanical pain threshold over trigeminal area and hand, pressure pain thresholds, and the wind-up ratio. The Bonferroni-corrected p-value (05/4 = 0.013) was adopted to assess the difference between groups, while a p-value of 0.05 was considered significant for the correlation analysis. Results A total of 159 patients and 52 controls were included. Flexion rotation test and craniocervical flexion test were reduced in all 4 phases of the migraine cycle versus healthy controls (p < 0.001). The number of myofascial trigger points and positive vertebral segments was increased in all 4 phases of the migraine cycle versus healthy controls (p < 0.001). Flexion, extension, and total cervical active range of motion and cervical pressure pain thresholds were reduced in episodic migraine in the ictal phase versus controls (p < 0.007) with no other significant differences. Outside the ictal phase, the total cervical active range of motion was positively correlated with trigeminal and leg pressure pain threshold (p < 0.026), the number of active myofascial trigger points and positive positive vertebral segments were positively correlated with higher headache frequency (p=0.045), longer headache duration (p < 0.008), and with headache-related disability (p = 0.031). Cervical pressure pain thresholds were positively correlated with trigeminal, hand, and leg pressure pain threshold (p < 0.001), and trigeminal and leg mechanical pain thresholds (p < 0.005), and negatively correlated with the wind-up ratio (p < 0.004). Conclusion In all phases of the migraine cycle, independent of the presence of concomitant neck pain, episodic migraine patients showed reduced flexion rotation test and craniocervical flexion test and an increased number of myofascial trigger points and passive accessory vertebral segments. These impairments are correlated with enhanced headache duration, headache-related disability, and signs of widespread pain sensitization. Reduction in active cervical movement and increased mechanical hyperalgesia of the cervical was consistent in ictal episodic migraine patients and the subgroups of episodic migraine patients with more pronounced widespread sensitization.

Headache and orofacial pain: A traffic-light prognosis-based management approach for the musculoskeletal practice

“…Statistically, the two most common differential diagnoses for MSK HA are the most common primary HA types: TTH and migraine. Additionally, some pieces of evidence support the upper neck involvement in the clinical presentations of both TTH (42, 57, 58) and migraine (8,59). Interestingly, in migraine, cervical MSK findings may be real or apparent due to hypersensitivity which may lead to subjective neck complaints without objective neck impairments (6,60,61) and, therefore, should be carefully checked.…”

“…Due to the convergence of sensory input from the upper cervical spine and the trigeminal nerve into the trigeminocervical nucleus of the brainstem, nociception from both the upper neck and the masticatory system has the potential to play a role in the neurophysiology of primary HA ( Figure 1 ) ( 4 , 5 ). However, although patients with migraine are very likely to complain about neck pain, it is shown that their cervical spine is not necessarily objectively impaired ( 6 – 8 ). Since primary HAs lack specific underlying pathology, they are considered a pain disorder, and as such, management approaches are multi-disciplinary and include among other treatment modalities, physiotherapy with some evidence to support it ( 9 ).…”

Prevalence of Neck Pain and Awareness of Ergonomics among Microscope Users

“…Excessive force, repetitive motion, bad posture or extended stationary position, and vibration are among the activities that might cause neck discomfort issues. 14,15 The fourth most common cause of disability, neck discomfort, has a yearly prevalence rate of above 30%. 16 Whether the pain is mechanical or neuropathic can be determined by the history and physical examination.…”

Cervical muscle parameters and allodynia in migraine and cervical pain—A controlled study

“…Recently, Liang et al (2021) suggested that the presence of neck pain in persons with migraine does not necessarily indicate altered cervical function, as 61% of the migraine cohort assessed had similar cervical musculoskeletal function than healthy controls. On the other hand, Di Antonio et al (2022) reported that in all phases of the migraine cycle, independent of the presence of concomitant neck pain, episodic migraine patients showed altered cervical function, demonstrated by the reduced flexion rotation test and craniocervical flexion test and an increased number of myofascial trigger points and positive test for the passive accessory vertebral segments. However, the cervical range of motion and cervical pressure pain threshold were altered only in the ictal phase.…”

“…On the other hand, Di Antonio et al. (2022) reported that in all phases of the migraine cycle, independent of the presence of concomitant neck pain, episodic migraine patients showed altered cervical function, demonstrated by the reduced flexion rotation test and craniocervical flexion test and an increased number of myofascial trigger points and positive test for the passive accessory vertebral segments. However, the cervical range of motion and cervical pressure pain threshold were altered only in the ictal phase.…”