Which Examination Tests Detect Differences in Cervical Musculoskeletal Impairments in People With Migraine? A Systematic Review and Meta-Analysis

Abstract

Background Most patients with migraine report associated neck pain. Whether neck pain is a symptom of migraine or an indicator for associated cervical musculoskeletal impairment has not yet been determined. Physical examination tests to detect cervical impairments in people with headache have been suggested, but results have not been evaluated systematically and combined in meta-analyses. Purpose The purpose of this study was to identify musculoskeletal impairments in people with migraine and people who were healthy (healthy controls) by reviewing published data on physical examination results. Data Sources PubMed, CINAHL, Web of Science, and the Cochrane Register of Clinical Trials were searched for studies published prior to December 2017. Study Selection Publications investigating physical examination procedures that are feasible for use in a physical therapy setting for patients with migraine and healthy controls were independently selected by 2 researchers. Data Extraction One researcher extracted the data into predesigned data extraction tables. Entries were checked for correctness by a second researcher. The Downs and Black Scale was used for risk-of-bias assessment by 2 reviewers independently. Data Synthesis Thirty-five studies (involving 1033 participants who were healthy [healthy controls] and 1371 participants with migraine) were included in the qualitative synthesis, and 18 were included in the meta-analyses (544 healthy controls and 603 participants with migraine). Overall, studies were rated as having a low to moderate risk of bias. Included studies reported 20 different test procedures. Combined mean effects indicated that 4 of the tests included in the meta-analyses distinguished between patients and controls: range of cervical motion, flexion-rotation, pressure pain thresholds, and forward head posture in a standing position. Limitations Manual joint testing and evaluation of trigger points were the 2 most frequently investigated tests not included in the meta-analyses because of heterogeneity of reporting and procedures. Conclusions Three tests confirmed the presence of musculoskeletal impairments in participants with migraine when combined in meta-analyses. Pressure pain thresholds added information on sensory processing. Additional tests might be useful but require standardized protocols and reporting.

Fluctuations in local and widespread mechanical sensitivity throughout the migraine cycle: a prospective longitudinal study

“…We did not distinguish between episodic and chronic migraine, and did not create subgroups for people with or without aura as both groups demonstrate lower PPTs compared to healthy participants [15,17,35]. Moreover, creating subgroups for migraine was not possible due to the low numbers of people with migraine with aura and those with chronic migraine.…”

“…Recent reviews show that people with migraine have significantly higher mechanical sensitivity expressed by lower pressure pain thresholds than healthy participants in the cephalic region during the interictal phase, but there is inconsistent evidence for differences in mechanical sensitivity in the extra-cephalic region [15][16][17]. Moreover, most studies are performed in the interictal phase, with only a small number of studies also including the ictal phase; and none of the included studies measured mechanical sensitivity in all four phases of the migraine cycle in the cephalic and extra-cephalic region [15,16].…”

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

“…As done in a recent systematic review26 and recommended by the Cochrane Handbook for Systematic Reviews of Interventions,32 risk of bias will be assessed (except for the diagnostic accuracy studies) using the Downs and Black Scale,33 but excluding those items that have been proposed to assess interventions. Each trial will be independently assessed and scored by two reviewers (AS and KL) in terms of risk of bias, and a third reviewer (DF) will intervene in the case of disagreement.…”

“…Two systematic reviews24 25 have attempted to assess the usefulness of physical examination and manual examination, respectively, for the differential diagnosis of CGH, and a further systematic review26 was directed at elucidating which examination tests can be useful to detect musculoskeletal impairment in migraine sufferers. In addition, another systematic review27 assessed diagnostic accuracy of headache measurement instruments.…”

Teenage Girl with Migraine Whose Symptoms Resolve with a Therapeutic Neck Exercise Program: A Case Report

“…Check for updates graine [2][3][4][5]. And in a study with fascinating implications for the role of neck problems in migraineurs, 75% of 144 patients with migraine with or without aura reported neck pain with their migraines.…”