Gabriela Natália Ferracini

Quality of Life and Health‐Related Disability in Children With Migraine

To determine whether migraine interferes with health‐related quality of life (HRQL) and the degree of disability caused by this condition in the daily life of children of both genders aged 6‐12 years.

Myofascial Trigger Points and Migraine-related Disability in Women with Episodic and Chronic Migraine.

Objective: The aim of this study was to investigate the differences in the presence of head and neck-shoulder trigger points (TrPs) between women with episodic or chronic migraine and their association with migraine-related disability. Materials and Methods: One hundred forty-three women, aged 18 to 60 years, with migraine were recruited to participate in this study. Migraine-related disability was evaluated with the Migraine Disability Assessment Questionnaire. TrPs were explored bilaterally within the masseter, temporalis, suboccipital, sternocleidomastoid, upper trapezius, and splenius capitis muscles. Results: Ninety-eight women exhibited episodic migraine, whereas 45 had chronic migraine. Women with chronic migraine reported a higher related disability than those with episodic migraine (P=0.045). Women with episodic migraine had a similar number of TrPs (total number: 4.3±3.3; active TrPs: 3.0±2.9; and latent TrPs: 1.3±2.1) to those with chronic migraine (total number: 4.8±3.2; active TrPs: 3.4±2.9; and latent TrPs: 1.4±1.9). No linear association was observed between the number of TrPs and migraine-related disability in women with episodic or chronic migraine. Conclusions: Women with episodic and chronic migraine had a similar number of TrPs. TrPs may be considered a trigger factor that can facilitate the onset of migraine or also can potentially be a promoting factor for pain once the migraine attack has started and hence may contribute to related disability. Nevertheless, we observed that the number of TrPs in the head and neck-shoulder muscles in an interictal state was not associated with the degree of migraine-related disability, suggesting a multifactorial nature of self-perceived disability in this population.

Relationship Between Active Trigger Points and Head/Neck Posture in Patients with Migraine.

ObjectiveTo investigate the relationship between the presence of active trigger points (TrPs), craniocervical posture, and clinical features (frequency, intensity, and duration) in patients with migraine. DesignA cross-sectional study. MethodsFifty patients with migraine (90% women; age, 34.1 years) participated. Clinical data regarding migraine (frequency, intensity, and duration) were obtained. Trigger points were bilaterally explored in the following muscles: masseter, suboccipital, temporalis (anterior, medium, and posterior fibers), sternocleidomastoid, upper trapezius, and splenius capitis. Eight measures of head and neck posture were obtained from radiographs using the K-Pacs software. ResultsIndividuals with migraine showed active and latent TrPs in all the muscles, the suboccipital, upper trapezius, sternocleidomastoid, and temporalis muscles being the most affected. The results showed a relationship between the number of active TrPs and several x-ray outcomes, suggesting that the higher number of active TrPs was positively associated with a reduction in cervical lordosis and head extension of the head on the neck. No association between the number of active TrPs and clinical features of migraine was seen. ConclusionOur study supports the hypothesis that active TrPs are associated with reduced cervical lordosis and head extension in individuals with migraine.

A Comparison Pressure Pain Threshold in Pericranial and Extracephalic Regions in Children with Migraine

BACKGROUND There is evidence that the pressure pain threshold (PPT) is reduced in children with migraine and that it varies according to age, sex, and region of the body. However, in view of the lack of consensus in the literature, the objective of the present study was to evaluate the PPT in children with migraine of both genders aged 6-12 years. METHODS Fifty children with migraine without aura and 50 children without headache were studied. The PPT was evaluated using an algometer at nine bilateral anatomical sites. RESULTS Comparison of children with migraine to children without headache did not show differences in PPT, except for the points of insertion of occipital muscles and the anterior aspect of C5-C7, where the values were lower in the children with migraine. Analysis according to gender revealed that both girls and boys had a lower PPT in at least one region evaluated. CONCLUSION Comparison of the PPTs between sites revealed that the pericranial and cervical regions showed a lower PPT than the extracephalic sites in children with migraine.

Active Trigger Points in the Cervical Musculature Determine Altered Activation of Superficial Neck and Extensor Muscles in Women with Migraine.

Objective: Previous studies have demonstrated the presence of active trigger points (TrPs) in women with migraine reproducing their headache attacks. No study has investigated whether these TrPs can alter cervical muscle function in migraine. Our objective was to analyze differences in the activation of superficial neck flexor and extensor muscles in women with migraine considering the presence of active TrPs in the splenius capitis (SC), the upper trapezius (UT), and the sternocleidomastoid (SCM) muscles. Methods: Surface electromyography (EMG) was recorded from the superficial flexors (SCM and anterior scalene) and the extensor (SC, UT) muscles bilaterally as participants performed a staged task of cranio-cervical flexion (CCF; 5 contractions representing a progressive increase in CCF range of motion) in 70 women with migraine. They were stratified according to the presence or the absence of active TrPs in the SCM, the SC, or the UT musculature. A comparison of EMG normalized root mean square (RMS) values was conducted with a 2×5 analysis of covariance with the task level as the within-subject variable, group stratified by active TrPs as the between-subjects variable and the presence of neck pain as a covariable. Results: All patients exhibited active TrPs in their cervical muscles, which reproduced their migraine. Women with migraine exhibiting active TrPs in the SCM (P<0.01), the UT (P<0.05), or the SC (P<0.05) muscles had lower normalized RMS values of their superficial neck flexors than those without active TrPs in the same muscles. In addition, individuals exhibiting active TrPs in the SC and the UT (both, P<0.05) muscles had higher normalized RMS values in the SC muscle than those without active TrPs in the same muscles. Conclusions: The presence of active TrPs in the cervical musculature determines an altered activation of superficial neck and extensor muscles during low-load, isometric CCF contractions in women with migraine.

Cervico-occipital Posture in Women With Migraine: A Case-Control Study

STUDY DESIGN Case-control study. BACKGROUND Previous studies have assessed forward head posture in patients with migraine using photographs. To date, no study has compared postural differences using both radiographs and photographs. OBJECTIVE To determine the differences in head extension posture between women with migraine and healthy women assessed with radiographic and photographic measures. METHODS Thirty-three women (mean ± SD age, 32 ± 11.3 years) with migraine and 33 matched controls (age, 33 ± 12.6 years) participated. Radiographs were used to measure the high cervical angle (HCA), the angle between the most inferior line from the occipital surface to the posterior portion of C1 and the posterior surface of the odontoid process of C2, and the vertical distance between C0 and C1 (C0-C1). Photographs and commercially available software were used to assess the craniovertebral angle (CVA). RESULTS None of the outcomes differed significantly between women with migraine and control participants. Outcomes for women with migraine were HCA, 66.1° (95% confidence interval [CI]: 64.2°, 68.1°); CVA, 46.1° (95% CI: 45.0°, 47.1°); and C0-C1, 8.5 mm (95% CI: 7.7, 9.2). Outcomes for the control group were HCA, 67.9° (95% CI: 66.5°, 69.3°); CVA, 44.5° (95% CI: 43.2°, 45.7°); and C0-C1, 8.7 mm (95% CI: 7.9, 9.4). Relationships between the frequency (r = -0.42, P = .01, R (2) = 10%) of migraine and the HCA were found. CONCLUSION This study demonstrated that women with migraine did not exhibit forward head posture compared to women with no history of headache in either radiographic or photographic postural analysis. However, there was a weak association of the frequency of migraine attacks with a variation in the HCA as assessed by radiographs. LEVEL OF EVIDENCE Differential diagnosis/symptom prevalence, level 4.

The Number of Active But Not Latent Trigger Points Associated with Widespread Pressure Pain Hypersensitivity in Women with Episodic Migraines

Objective Previous studies suggest that trigger points (TrPs) contribute to migraine pain, but no data is available on the effects of TrPs on pressure pain sensitivity. Our objective was to investigate the association between the number of TrPs and widespread pressure hypersensitivity in women with episodic migraines. Methods Ninety-five women with episodic migraines participated. Clinical features of migraines, that is, intensity, duration, frequency, and onset, were collected. Active and latent TrPs were bilaterally explored in the temporalis, masseter, suboccipital, sternocleidomastoid, upper trapezius, and splenius capitis musculature. Pressure pain thresholds (PPTs) were assessed over the trigeminal area (i.e., temporalis muscle), extratrigeminal (i.e., C5/C6 zygapophyseal joint), and a distant pain-free point (i.e., tibialis anterior muscle). Results Active TrPs in the temporalis and upper trapezius muscles were the most prevalent. The number of active but not latent TrPs was significantly and negatively associated with PPTs: the higher the number of active TrPs, the lower the widespread PPT and the more generalized sensitization. Conclusions This study found that the number of active but not latent TrPs in head and neck and shoulder muscles was associated with widespread pressure hypersensitivity in women with episodic migraines, suggesting a potential contribution of active TrPs as contributors for sensitization processes in migraines.

Limiar de dor à pressão em crianças com cefaleia

SUMMARY BACKGROUND AND OBJECTIVES: Headache is one of the most common pains during childhood and children have higher sensitivity to pain in body surfaces, which can be evaluated by algometry. This study aimed at reviewing in the literature studies evaluating pressure pain threshold (PPT) in children with and without headache. CONTENTS: Bibliographic databases were searched, including Pubmed (National Library of Medicine), LILACS (Latin-American and the Caribbean Literature on Health Sciences) and ADOLEC (Health during Adolescence) to identify relevant scientific studies. Four studies met all inclusion criteria with a total of 492 children and adolescents, aged from 5 to 15.8 years. From them, 75 had migraine, 61 had tension headache and 356 had no headache history. CONCLUSION: There is no consensus about headache influence on PPT in children. Due to the scarcity of stu dies, one could not conclude that pressure pain threshold is lower in children with headache as compared to healthy children.

Brazilian Portuguese Version of the Craniofacial Pain and Disability Inventory: Cross-Cultural Reliability, Internal Consistency, and Construct and Structural Validity

AIMS To culturally adapt the Craniofacial Pain and Disability Inventory (CF-PDI) for a Brazilian population and to assess its psychometric properties, including internal consistency, reliability, and construct and structural validity. METHODS A total of 100 female and male TMD patients with temporomandibular disorders (TMD), with or without headaches, were included. Participants were assessed based on the Research Diagnostic Criteria for TMD and the International Headache Society criteria. For statistical analyses, intraclass correlation coefficient (ICC) was used for assessing reliability (test-retest), Cronbachs alpha for internal consistency, Pearson rank correlation for construct validity, and confirmatory factor analysis (CFA) for structural validity. RESULTS The CFA provided the following three factors/domains for the Brazilian CF-PDI (CF-PDI/Br): (1) functional and psychosocial limitation; (2) pain; and (3) frequency of comorbidities. Scores for test-retest reliability and internal consistency in each domain were acceptable (ICC > 0.9; Cronbachs α > 0.77). Correlations between CF-PDI scores and jaw functional limitation, pain-related disability, pain catastrophizing, depression, neck pain-related disability, and kinesiophobia scores were confirmed in 89% (50/56) of the comparisons. CONCLUSION The CF-PDI/Br with three factors had sound psychometric properties. Therefore, the Brazilian Portuguese version can be used in clinical settings and for research purposes.

Analysis of the cranio-cervical curvatures in subjects with migraine with and without neck pain

OBJECTIVE To investigate the differences in head and cervical spine alignment between subjects with migraine and healthy people. DESIGN A cross-sectional, observational study. PARTICIPANTS Fifty subjects with migraine and 50 matched healthy controls. MAIN OUTCOMES MEASURES The presence of neck pain and neck pain-related disability was assessed. Four angles (high cervical angle, low cervical angle, atlas plane angle and cervical lordosis Cobb angle) as well as four distances (anterior translation distance, C0 to C1 distance, C2 to C7 posterior translation and hyoid triangle) were calculated using digitalised radiographs and analysed using K-Pacs® software. RESULTS Subjects with migraine reported a longer history of neck pain symptoms, and higher pain intensity and neck-pain-related disability than controls (P<0.01). Patients exhibited a smaller anterior translation distance (mean difference: 4.9mm, 95% confidence interval 1.8 to 8.8; P<0.001) and hyoid triangle (difference: 3.0mm, 95% confidence interval 1.0 to 5.0; P=0.02) than healthy controls. When the presence or the absence of neck pain was included in the analysis, the differences did not change. Differences in anterior translation and hyoid triangle distances were considered clinically relevant for subjects with migraine suffering from neck pain. CONCLUSION Subjects with migraine exhibited straightening of cervical lordosis curvature. The presence of neck pain did not influence head posture in subjects with and without migraine.