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

Abstract

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.

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

“…Even if changes in mechanical behaviors occurring during acute pain could have a short-term benefit, they often cause long-term mechanical consequences, as increased muscle stiffness and reduced movement variability (54). Thus, the reduction in upper cervical spine passive mobility (7,9,10,(55)(56)(57) and the alteration in cervical motor recruitment (7,9,10,58,59) observed in migraine patients outside the ictal phase could be a consequence of changes in mechanical behaviors observed during the headache phase. This will lead to a vicious cycle where 1) a migraine attack could affect cervical mechanical behaviors with a transitory reduction in active movement and a long-lasting impairment in passive mobility and motor control (54).…”

“…Although headache is the most common, a broader spectrum of symptoms is present in patients with migraine (2). As one of the most frequent concomitant symptoms is neck pain (3,4), the role of cervical musculoskeletal impairments (CMIs) has been widely studied in migraine patients (5–8), leading to the conclusion that this subgroup of patients presents a higher prevalence of CMIs than healthy controls (9,10). However, it is still unclear which mechanism underly the presence of CMIs in the migraine population and their relation with migraine pathophysiology.…”

Postural control impairment in patients with headaches—A systematic review and meta‐analysis

“…24 The methodological quality of studies was assessed through an adapted version of the Downs and Black Risk of Bias Checklist, 25 which is recommended by the Cochrane Handbook for Systematic Reviews of Interventions 21 and used widely in systematic reviews of case-control studies. [26][27][28][29] The scale was adapted by excluding items referring to intervention assessment (items 4, 8, 9, 13, 14, 16, 17, 19, 21-24, and 26). The risk of bias was calculated through the quality index (QI), classifying the studies into low, moderate, or high quality.…”

Cefaleia Cervicogênica

“…5 Moreover, the clinical pattern of penumbra between migraine and cervicogenic headache, due to the involvement of converging regions, makes it difficult to diagnose and to treat them adequately in up to 50% of the cases. 6 The prevalence of cervicogenic headache varies according to the diagnostic criteria used, following the IHS criteria the prevalence is 0.4% 2 , and according to the Cervicogenic Headache International Study Group (CHISG) the prevalence in the population is 4.6% 7 , with the average prevalence within the headache population being approximately 17,8% 3 . The diagnostic criteria will be discussed and detailed later.…”