Validation of a clinical examination to differentiate a cervicogenic source of headache: a diagnostic prediction model using controlled diagnostic blocks

Getsoian, Scott; Gulati, Surendra M; Okpareke, Ikenna; Nee, Robert; Jull, Gwendolen

doi:10.1136/bmjopen-2019-035245

Cited by 31 publications

(12 citation statements)

References 47 publications

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“…In accord with previous studies identifying a cervical source of neck pain in headache [ 14 , 15 ], cervical dysfunction in our study was also characterised by a combination of movement, articular and neuromuscular impairments. Other aspects of cervical musculoskeletal function not assessed in our study may also be present in the subgroup of migraineurs with cervical dysfunction.…”

Section: Introductionsupporting

confidence: 91%

Cervical musculoskeletal impairments in migraine

et al. 2021

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Background Neck pain is common and disabling amongst individuals with migraine. Cervical musculoskeletal interventions are often sought but there is currently no evidence to support such interventions for this population. Improved understanding of how cervical musculoskeletal impairments present in migraine can elucidate neck pain mechanisms and guide clinicians and researchers in the management of patients with migraine and neck pain. Main body Migraine hypersensitivity is a major consideration when assessing for cervical impairments as it can aggravate migraine and confound findings. Current evidence of cervical impairments in migraine is limited by disregard for the different underlying causes of neck pain and possible influence of hypersensitivity. Findings of cervical musculoskeletal impairments are mixed within and across studies, indicating that different forms of neck pain are present in migraine. Some migraineurs have neck pain that is part of the migraine symptom complex and therefore exhibit little or no cervical musculoskeletal impairment. Others have a cervical source of neck pain and therefore exhibit a pattern of cervical musculoskeletal impairments akin to that of cervical disorders. The presence of cervical musculoskeletal dysfunction may or may not be related to migraine but knowledge of this is currently lacking which impacts decision making on management. Cervical musculoskeletal interventions may be indicated for migraineurs with identified cervical dysfunction but other factors requiring further clarification include determination of i) patient specific outcomes, ii) impact of co-existing migraine referred neck pain, and iii) potential moderating effects of migraine hypersensitivity on treatment efficacy. Conclusions Physiotherapists should seek a combination of cervical impairments through skilful assessment to identify if cervical musculoskeletal dysfunction is present or not in individual patients. The relevance of cervical dysfunction to migraine and influence of co-existing migraine referred neck pain need to be established through detailed evaluation of pain behaviours and further research. Future clinical trials should define expected treatment outcomes and select individuals with cervical musculoskeletal dysfunction when investigating the efficacy of cervical musculoskeletal interventions.

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Section: Introductionsupporting

confidence: 91%

Cervical musculoskeletal impairments in migraine

et al. 2021

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“…If these two criteria were not met, the segment was rated as asymptomatic. The accuracy of this examination procedure has been proven against diagnostic nerve blocks 16,31 . A symptomatic joint was considered relevant to a participant's neck pain if it was consistent with the side of reported neck pain.…”

Section: Methodsmentioning

confidence: 99%

“…Mild impairments in cervical function, especially when presenting individually, may be normal variations 14 or secondary to sensitization in migraine 9 . Idiopathic neck pain and cervicogenic headache in contrast, are characterized by a predictable pattern of cervical movement, articular and motor impairments 15–18 . A similar pattern of musculoskeletal dysfunction should be present in persons with migraine if the neck pain stems from a cervical musculoskeletal disorder and should not be present if the neck pain is part of the migraine symptom complex.…”

Section: Introductionmentioning

confidence: 99%

Neck pain associated with migraine does not necessarily reflect cervical musculoskeletal dysfunction

et al. 2021

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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...

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“…The most painful symptomatic cervical joint was identified based on both the presence and amount of (1) pain provoked (≥2/10) and ( 2) the assessor's rating of abnormal tissue resistance (at least moderate resistance). [28][29][30] Manual scapular repositioning Manual repositioning of the scapula was performed ipsilateral to the most painful side of the neck (figure 1). Participants sat in an upright position with hands on thighs and feet flat on the floor.…”

Section: Flexion Rotation Testmentioning

confidence: 99%

Response rate and comparison of clinical features associated with positive or negative responses to a scapular positioning test in patients with neck pain and altered scapular alignment: a cross-sectional study

et al. 2021

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ObjectiveTo investigate the frequency and clinical aspects of patients with neck pain who responded and did not respond to scapular repositioning and to determine the clinical features associated with a positive response.DesignCross-sectional study.SettingResearch unit, Department of Physical Therapy, Chiang Mai University.ParticipantsVolunteers with non-specific neck pain aged 18–59 years were recruited between May 2020 and February 2021 from hospitals, clinics, university and community.Outcome measuresClinical data documented were neck pain (intensity, duration and disability), the presence of headache, type of scapular dysfunction, cervical musculoskeletal impairment (range of motion (ROM), flexion rotation test (FRT) and location of any symptomatic cervical joint dysfunction), upper limb functional limitation and self-reported disability. Manual scapular repositioning was performed on the side of neck pain. Participants were categorised as responsive or non-responsive based on a change in pain and/or cervical rotation range.ResultsA total of 219 people with neck pain responded to advertisements, of which 144 were eligible. Of the eligible participants, 107 (74.3%) demonstrated a clinically relevant improvement in either neck pain or rotation range or both following the scapular repositioning and 37 (25.7%) had no relevant improvement. The responsive group had a high incidence of scapular downward rotation, greater neck pain intensity, headache and cervical musculoskeletal impairment (reduced ROM, positive FRT and symptomatic C1-3 dysfunction) compared with the non-responsive group (p<0.05). A logistic regression model revealed that features strongly associated with a positive response were the presence of headache (Exp(B)=6.0, 95% CI 2.3 to 15.8), scapular downward rotation (Exp(B)=5.3, 95% CI 2.3 to 12.6) and a positive FRT (Exp(B)=4.0, 95% CI 1.5 to 10.6).ConclusionAlmost 75% of neck pain patients with altered scapular alignment responded to scapular repositioning. The predominance of upper cervical dysfunction with a downwardly rotated scapular in this group suggests a role of poor axioscapular muscle function which might benefit from rehabilitation.

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Validation of a clinical examination to differentiate a cervicogenic source of headache: a diagnostic prediction model using controlled diagnostic blocks

Cited by 31 publications

References 47 publications

Cervical musculoskeletal impairments in migraine

Cervical musculoskeletal impairments in migraine

Neck pain associated with migraine does not necessarily reflect cervical musculoskeletal dysfunction

Response rate and comparison of clinical features associated with positive or negative responses to a scapular positioning test in patients with neck pain and altered scapular alignment: a cross-sectional study

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