Gabriela Ferreira Carvalho

Neck Pain Disability Is Related to the Frequency of Migraine Attacks: A Cross-Sectional Study

Migraine and neck pain can be critical causes of disability. The contribution of neck pain for the overall disability of individuals with migraine remains unknown.

Generalized Pressure Pain Hypersensitivity in the Cervical Muscles in Women with Migraine.

OBJECTIVE To investigate the differences in pressure sensitivity in the cervical musculature including the upper trapezius, sternocleidomastoid, suboccipital, levator scapulae, and anterior scalene muscles between women with migraine and healthy controls. DESIGN Cross-sectional study. SUBJECTS Thirty women with migraine and 30 healthy women participated. METHODS Pressure pain thresholds (PPT) were bilaterally assessed over upper trapezius, sternocleidomastoid, suboccipital, levator scapulae, and anterior scalene muscles in a blinded design. Mean values of both sides were pooled for statistical analysis. Comparison between groups was performed by unpaired Student t-test and correlation with headache features with Spearmans correlation test. RESULTS Migraine patients exhibited lower PPT in all muscles compared with controls: upper trapezius (P = 0.046); suboccipital (P < 0.001); sternocleidomastoid (P < 0.001); anterior scalene (P < 0.001), and levator scapulae (P < 0001). No associations were observed between the frequency and the intensity of migraine or years with the disease and PPT. CONCLUSION This study showed generalized pressure pain hypersensitivity in the cervical musculature in women with migraine. Our findings provide support for the physical therapy treatment and evaluation of musculoskeletal cervical spine disorders in individuals with migraine and reinforce that all cervical muscles should be evaluated.

COMPARISON BETWEEN NECK PAIN DISABILITY AND CERVICAL RANGE OF MOTION IN PATIENTS WITH EPISODIC AND CHRONIC MIGRAINE: A CROSS-SECTIONAL STUDY

OBJECTIVE The purpose of this study was to evaluate neck pain-related disability and cervical range of motion (CROM) in patients with episodic migraine (EM) and chronic migraine (CM) and to examine the correlation of both outcomes. METHODS This cross-sectional study consisted of 91 patients with EM and 34 with CM. Cervical range of motion was measured with the CROM device, and pain during the cervical movement was recorded. Self-reported disability related to neck pain was assessed with the Neck Disability Index. RESULTS Patients with CM showed higher Neck Disability Index scores and more moderate and severe disability (P = .01). Severe disability as a result of neck pain was associated with 7.6-fold risk of developing CM (P = .003). No significant differences in CROM were identified between groups. Moderate negative correlations between CROM and disability were found for 4 motions within the CM group (-0.60 <r < -0.39) and with 3 in the EM group (-0.48 < -0.45). Disability was positively and moderately correlated to pain evoked during CROM in both groups (0.34 <r <0.51). CONCLUSION This study found that neck pain was highly prevalent in patients with migraine. Neck pain-related disability increased with increased frequency of the migraine attacks and was associated with the risk of migraine chronicity. The correlation between CROM and neck pain disability was more evident in patients with CM and in patients with pain during cervical movement.

Influence of Migraine and of Migraine Aura on Balance and Mobility – A Controlled Study

Migraine, especially migraine with aura (MA), appears to be a risk factor for ischemic lesions in the posterior fossa. The clinical relevance of the lesions is uncertain. Accordingly, herein, we identified individuals with MA, migraine without aura (MO), and without migraine (controls) in order to investigate their balance and mobility.

Is pressure pain sensitivity over the cervical musculature associated with neck disability in individuals with migraine

The objective was to determine if disability due to neck pain is correlated with pressure pain sensitivity in the cervical muscles in patients with migraine. Thirty-two volunteers with migraine completed the Neck Disability Index (NDI). Pressure pain thresholds (PPT) over the sternocleidomastoid, upper trapezius and suboccipital muscles were also assessed. Data were analyzed using the Spearman correlation coefficient (rs) and linear regression models (α < 0.05). Moderate negative correlations between NDI and PPT were obtained for the sternocleidomastoid (rs = -0.42; p = 0.001), upper trapezius (rs = -0.33; p = 0.001) and suboccipital muscles (rs = -0.41; p = 0.001). The linear regression revealed no association between NDI and PPT of sternocleidomastoid (β = 0.01; R(2) = 0.17), upper trapezius (β = 0.01; R(2) = 0.11) and suboccipital muscles (β = 0.02; R(2) = 0.17). NDI scores and PPT of the cervical muscles correlated moderately and was inversely proportional in patients with migraine, but the association was not linear, so both outcomes should be considered in the assessment of this population.

Additional Effects of a Physical Therapy Protocol on Headache Frequency, Pressure Pain Threshold, and Improvement Perception in Patients With Migraine and Associated Neck Pain: A Randomized Controlled Trial

OBJECTIVE To evaluate the additional effect provided by physical therapy in migraine treatment. DESIGN Randomized controlled trial. SETTING Tertiary university-based hospital. PARTICIPANTS Among the 300 patients approached, 50 women (age range, 18-55y) diagnosed with migraine were randomized into 2 groups: a control group (n=25) and a physiotherapy plus medication group (n=25) (N=50). INTERVENTIONS Both groups received medication for migraine treatment. Additionally, physiotherapy plus medication patients received 8 sessions of physical therapy over 4 weeks, comprised mainly of manual therapy and stretching maneuvers lasting 50 minutes. MAIN OUTCOME MEASURES A blinded examiner assessed the clinical outcomes of headache frequency, intensity, and self-perception of global change and physical outcomes of pressure pain threshold and cervical range of motion. Data were recorded at baseline, posttreatment, and 1-month follow-up. RESULTS Twenty-three patients experienced side effects from the medication. Both groups reported a significantly reduced frequency of headaches; however, no differences were observed between groups (physiotherapy plus medication patients showed an additional 18% improvement at posttreatment and 12% improvement at follow-up compared with control patients, P>.05). The reduction observed in the physiotherapy plus medication patients was clinically relevant at posttreatment, whereas clinical relevance for control patients was demonstrated only at follow-up. For pain intensity, physiotherapy plus medication patients showed statistical evidence and clinical relevance with reduction posttreatment (P<.05). In addition, they showed better self-perception of global change than control patients (P<.05). The cervical muscle pressure pain threshold increased significantly in the physiotherapy plus medication patients and decreased in the control patients, but statistical differences between groups were observed only in the temporal area (P<.05). No differences were observed between groups regarding cervical range of motion. CONCLUSIONS We cannot assume that physical therapy promotes additional improvement in migraine treatment; however, it can increase the cervical pressure pain threshold, anticipate clinically relevant changes, and enhance patient satisfaction.

Patients with chronic, but not episodic, migraine display altered activity of their neck extensor muscles

The current study aimed to investigate differences in activity of neck flexor and extensor muscles in women with migraine considering the chronicity of their condition. Thirty-one subjects with episodic migraine, 21 with chronic migraine and 31 healthy controls participated. Surface electromyography signals were recorded bilaterally from the sternocleidomastoid, anterior scalene, splenius capitis and upper trapezius muscles as subjects performed 5 stages of cranio-cervical flexion (CCF), representing a progressive increase in range of CCF motion. Comparison of normalized root-mean-square among groups was conducted with 3×5 ANCOVA with task level as the within-subject variable, group as the between-subject variable, and the presence of neck pain and disability as co-variates. The group with chronic migraine exhibited increased activity of their extensor muscles compared to the control and episodic migraine groups (splenius capitis: F=3.149, P=0.045; upper trapezius: F=3.369, P=0.041). No significant between-group differences were found for the superficial neck flexors (sternocleidomastoid: F=1.161, P=0.320; anterior scalene: F=0.135, P=0.874). In conclusion, women with chronic migraine exhibit increased activity of their superficial neck extensor muscles when acting as antagonists during low-load isometric CCF contractions in comparison to non-headache subjects.

Cervical Muscle Strength and Muscle Coactivation During Isometric Contractions in Patients With Migraine: A Cross-Sectional Study

This cross‐sectional study investigated potential differences in cervical musculature in groups of migraine headaches vs. non‐headache controls. Differences in cervical muscle strength and antagonist coactivation during maximal isometric voluntary contraction (MIVC) were analyzed between individuals with migraine and non‐headache subjects and relationships between force with migraine and neck pain clinical aspects.

Balance Impairments in Different Subgroups of Patients With Migraine

Patients with migraine often experience balance impairments. However, the relationship between clinical features – like aura and chronicity – and the severity of balance impairments is not well established. The objective of this study was to assess balance impairments in different subgroups of migraine patients.

Reduced thermal threshold in patients with Temporomandibular Disorders.

BACKGROUND Many studies have demonstrated the presence of somatosensory modulation changes at different sites in patients with temporomandibular disorders (TMDs) using different modalities. However, the neck area, a well-know condition related to TMD, remains unexplored. OBJECTIVE To assess the thermal pain threshold in patients with TMD and controls at cephalic and extra-cephalic areas, including the neck. METHODS Twenty female patients with TMDs diagnosed by the Research Diagnostic Criteria for TMD (RDC/TMD) and twenty age-matched controls underwent a first interview about neck pain and disability (NDI questionnaire). A blinded evaluator assessed the thermal pain threshold for cold (CPT) and heat (HPT) stimuli in accordance with an ascending method of limits of the Quantitative Sensory Testing at the following sites: periorbital, masseter, cervical posterior and ventral forearm. The groups were compared using a t-test with α = 5%. RESULTS Patients with TMDs reported pain at higher temperature for cold stimuli in all sites (P < 0·05) and at lower temperature for heat stimuli in the right periorbital site (P < 0·05) than controls. Pain and disability due tothis symptom were reported more often in the TMD group (P < 0·05). CONCLUSION Patients with TMD have pain modulation changes in the neck area as well, especially for cold stimuli, associated with higher disability and a higher report of neck pain than controls. These findings reinforce the evidence regarding the relationship between TMDs and neck pain.