Lodovichi S1, Florencio L1,2, Benatto M1, Bragatto M1, Oliveira I1, Dach F1, Bevilaqua-Grossi D1
1University of São Paulo, Health Sciences, Ribeirão Preto, Brazil, 2Universidad Rey Juan Carlos, Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Madri, Spain
Background: Cervical dysfunctions are frequent in migraine and may contribute to trigger or perpetuate a migraine attack. However, it is not established whether a specific neck muscle exercise protocol can influence strength and decrease the disability of migraine.
Purpose: To investigate the effects of an exercise protocol for flexors and cervical extensors on muscle strength, time to produce peak force and disability of migraine.
Methods: Twenty-three women with migraine, diagnosed by a neurologist according to the 3rd edition of the International Classification of Headache, underwent to an eight-week protocol of cervical muscle training. Individuals had a mean age of 32 years (SD: 8.86); 10.9 days of headache / month (SD: 8.20) and 18.26 (SD: 9.47) years with headache. Initial evaluation was composed by the measurement of muscle strength and peak time during maximal voluntary isometric contraction using a hand-held dynamometer (Lafayette Instrument Company®) and the assessment of the migraine related disability using the Migraine Disability Assessment (MIDAS). After initial evaluation, individuals initiated the protocol, which consisted of 2 stages. Stage 1, with duration of 6 weeks, consisted of low-load exercises, emphasizing the deep neck flexors and extensors muscles. Stage 2: This stage consisted of high-load exercises for a duration of 2 weeks, using the head weight as a load. Revaluation was performed at the ninth week. Statistical analysis was performed adopting a significance level of 0.05. Pre and post flexors and extensors' force, which were normalized by the body mass, were compared using the paired Student´s t-tests, Wilcoxon´s sign rank test for comparison of both mean time to produce the peak force and MIDAS score.
Results: An increase in cervical extensors strength was observed (pre: 0.92 N, SD: 0.42 N / post: 1.24 N, SD: 0.44, p = 0.001) but not for flexors (pre: 0.82 N: SD: 0.25 / post: 0.84 N, SD: 0.23, p = 0.76). Moreover there was a decrease in the disability generated by the migraine measured by the MIDAS (pre: 43,09, SD: 30.08 / post: 27, SD: 17.62, p = 0.015). However, the intervention does not seem to have influenced the time to reach the peak force for the flexors (pre: 2.30s, SD: 0.54 / post: 2.30s, SD: 0.54, p = 0.84) and extensors (pre: 2.61s, SD: 0.41 / post: 2.62, SD: 0.64, p = 0.83).
Conclusion(s): A specific neck muscle exercise protocol increases muscle strength of cervical extensors and decreases migraine related disability. However, it seems that no effect would be expected at flexors extensors' strength and at the time to produce the peak force.
Implications: individuals with migraine may benefit from a exercise programme targeted for neck muscles.
Keywords: physical therapy, migraine, neck pain
Funding acknowledgements: None
Purpose: To investigate the effects of an exercise protocol for flexors and cervical extensors on muscle strength, time to produce peak force and disability of migraine.
Methods: Twenty-three women with migraine, diagnosed by a neurologist according to the 3rd edition of the International Classification of Headache, underwent to an eight-week protocol of cervical muscle training. Individuals had a mean age of 32 years (SD: 8.86); 10.9 days of headache / month (SD: 8.20) and 18.26 (SD: 9.47) years with headache. Initial evaluation was composed by the measurement of muscle strength and peak time during maximal voluntary isometric contraction using a hand-held dynamometer (Lafayette Instrument Company®) and the assessment of the migraine related disability using the Migraine Disability Assessment (MIDAS). After initial evaluation, individuals initiated the protocol, which consisted of 2 stages. Stage 1, with duration of 6 weeks, consisted of low-load exercises, emphasizing the deep neck flexors and extensors muscles. Stage 2: This stage consisted of high-load exercises for a duration of 2 weeks, using the head weight as a load. Revaluation was performed at the ninth week. Statistical analysis was performed adopting a significance level of 0.05. Pre and post flexors and extensors' force, which were normalized by the body mass, were compared using the paired Student´s t-tests, Wilcoxon´s sign rank test for comparison of both mean time to produce the peak force and MIDAS score.
Results: An increase in cervical extensors strength was observed (pre: 0.92 N, SD: 0.42 N / post: 1.24 N, SD: 0.44, p = 0.001) but not for flexors (pre: 0.82 N: SD: 0.25 / post: 0.84 N, SD: 0.23, p = 0.76). Moreover there was a decrease in the disability generated by the migraine measured by the MIDAS (pre: 43,09, SD: 30.08 / post: 27, SD: 17.62, p = 0.015). However, the intervention does not seem to have influenced the time to reach the peak force for the flexors (pre: 2.30s, SD: 0.54 / post: 2.30s, SD: 0.54, p = 0.84) and extensors (pre: 2.61s, SD: 0.41 / post: 2.62, SD: 0.64, p = 0.83).
Conclusion(s): A specific neck muscle exercise protocol increases muscle strength of cervical extensors and decreases migraine related disability. However, it seems that no effect would be expected at flexors extensors' strength and at the time to produce the peak force.
Implications: individuals with migraine may benefit from a exercise programme targeted for neck muscles.
Keywords: physical therapy, migraine, neck pain
Funding acknowledgements: None
Topic: Musculoskeletal: spine; Musculoskeletal; Disability & rehabilitation
Ethics approval required: Yes
Institution: Ribeirão Preto Medical School - University of São Paulo
Ethics committee: Research Ethics Commitee of the Ribeirão Preto Medical School
Ethics number: 6146/2016
All authors, affiliations and abstracts have been published as submitted.
