Florencio L1,2, Oliveira I2, Lodovichi S2, Bragato M2, Benatto M2, Dach F2, Fernández-de-las-Peñas C1, Bevilaqua-Grossi D2
1Universidad Rey Juan Carlos, Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Madrid, Spain, 2University of São Paulo, Health Sciences, Ribeirão Preto, Brazil
Background: Although an association between migraine and cervical dysfunction have been demonstrated, some aspects of the cervical musculoskeletal impairment is still on debate.
Purpose: To assess neck flexor and extensor muscle endurance of patients with migraine and non-headache subjects.
Methods: Clinical test of neck flexor and extensor endurance were applied in a total of 52 subjects, 26 with migraine and 26 without headache history. Migraine group was composed by 24 women and 2 men, with mean age of 28.9 (7.3), BMI 24.5 (4.2), reporting an average of 15.0 (7.6) years with migraine, with 10.0 (8.1) days with headache per month, a duration of 26.9 (23.3) hours and headache intensity of 8.9 (1.1). Control group was also composed by 24 women and 2 men, with mean age of 28.0 (4.1) and BMI 22.4 (3.3). Neck pain was reported by 69% (n=18) of migraineurs and 12% (n=3) of control group (P 0.001). Migraine group that reported neck pain lived an average of 4.2 (3.8) years with neck pain, 10.6 (6.3) days per moth and an intensity of 4.8 (1.6); while those from control group lived with neck pain by 1.6 years, with a mean frequency of 10.0 (4.4) and an intensity of 6.0(2.0). Tests were performed based on the protocol proposed by Edmonston et al (2008). For neck extensor test, subject was lying in prone and a 2kg weight was fixed to a Velcro band and attached to their head. The extensor test was terminated when the subject was no longer able to hold the neutral position, determined by a head position change of more than 5° from the starting position guided by a cervical range of motion device. For neck flexors endurance, subjects were lying in supine position with the head and neck in slight flexion, around 5 cm. Flexors test was terminated if the head touches the hand of the examiner, positioned on the plinth under the participant's head, or if the subject cannot sustain the position due to pain. Holding time (s) and report of head or neck pain during test performance were registered for each test. Groups were compared regarding holding time in both tests using Student's t test for independent samples and prevalence of pain reported in the neck was contrasted by the Chi Square. All statistical tests were performed adopting a level of significance of 0.05.
Results: Lower holding time could be observed both tests in migraine group (p 0.05).
Mean holding time at neck flexor endurance of migraine group was 41s while headache-free subjects hold it for 71s (P=0.005). Holding time of neck extensor endurance was 207s for migraine group and 309s for controls (P=0.02). Both groups experiences similarly prevalence of neck pain during the endurance test (P=0.55), but only migraine reported pain referral to the head.
Conclusion(s): Patients with migraine present worse neck flexor and extensor endurance than controls.
Implications: Musculoskeletal capacity deterioration may act as a aggravation, perpetuating and chronification factor for neck pain and headache attacks in patients with migraine.
Keywords: Neck muscles, headache, cervical spine
Funding acknowledgements: We acknowledge FAPESP for the financial support (process number 2017/07410-0)
Purpose: To assess neck flexor and extensor muscle endurance of patients with migraine and non-headache subjects.
Methods: Clinical test of neck flexor and extensor endurance were applied in a total of 52 subjects, 26 with migraine and 26 without headache history. Migraine group was composed by 24 women and 2 men, with mean age of 28.9 (7.3), BMI 24.5 (4.2), reporting an average of 15.0 (7.6) years with migraine, with 10.0 (8.1) days with headache per month, a duration of 26.9 (23.3) hours and headache intensity of 8.9 (1.1). Control group was also composed by 24 women and 2 men, with mean age of 28.0 (4.1) and BMI 22.4 (3.3). Neck pain was reported by 69% (n=18) of migraineurs and 12% (n=3) of control group (P 0.001). Migraine group that reported neck pain lived an average of 4.2 (3.8) years with neck pain, 10.6 (6.3) days per moth and an intensity of 4.8 (1.6); while those from control group lived with neck pain by 1.6 years, with a mean frequency of 10.0 (4.4) and an intensity of 6.0(2.0). Tests were performed based on the protocol proposed by Edmonston et al (2008). For neck extensor test, subject was lying in prone and a 2kg weight was fixed to a Velcro band and attached to their head. The extensor test was terminated when the subject was no longer able to hold the neutral position, determined by a head position change of more than 5° from the starting position guided by a cervical range of motion device. For neck flexors endurance, subjects were lying in supine position with the head and neck in slight flexion, around 5 cm. Flexors test was terminated if the head touches the hand of the examiner, positioned on the plinth under the participant's head, or if the subject cannot sustain the position due to pain. Holding time (s) and report of head or neck pain during test performance were registered for each test. Groups were compared regarding holding time in both tests using Student's t test for independent samples and prevalence of pain reported in the neck was contrasted by the Chi Square. All statistical tests were performed adopting a level of significance of 0.05.
Results: Lower holding time could be observed both tests in migraine group (p 0.05).
Mean holding time at neck flexor endurance of migraine group was 41s while headache-free subjects hold it for 71s (P=0.005). Holding time of neck extensor endurance was 207s for migraine group and 309s for controls (P=0.02). Both groups experiences similarly prevalence of neck pain during the endurance test (P=0.55), but only migraine reported pain referral to the head.
Conclusion(s): Patients with migraine present worse neck flexor and extensor endurance than controls.
Implications: Musculoskeletal capacity deterioration may act as a aggravation, perpetuating and chronification factor for neck pain and headache attacks in patients with migraine.
Keywords: Neck muscles, headache, cervical spine
Funding acknowledgements: We acknowledge FAPESP for the financial support (process number 2017/07410-0)
Topic: Musculoskeletal: spine; Musculoskeletal; Pain & pain management
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: 1100/2017
All authors, affiliations and abstracts have been published as submitted.
