Is Postural dysfunction associated with MIGRAINE?

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The following study sought to determine whether or not mechanical dysfunction is consistently present in patients suffering from frequent episodic or chronic migraine.  As stated by the authors, “(t)he International Headache Society (IHS) considers neck stiffness or neck pain a SYMPTOM rather than a CAUSE of migraine attacks. Albeit clinically more often present than nausea or vomiting, symptoms such as neck pain are not part of the diagnostic criteria and are not sufficiently supported with evidence to influence the discussion regarding the PATHOGENESIS OF MIGRAINE, which is currently centered around central versus vascular origin.”

Out of 11  physical therapy tests included, only 6 were shown to reach statistical significance for differentiating those with migraine from the pain-free control subjects:

  1. Craniocervical Flexion Test [CCFT]
  2. Trigger points
  3. Flexion-Rotation Test [FRT]
  4. Passive-Accessory Intervertebral Movements [PAIVM’s]
  5. Thoracic Screening
  6. Reproduction and resolution of symptoms
“These dysfunctions support a RECIPROCAL INTERACTION between the trigeminal and the cervical systems as a trait symptom in migraine.”

Musculoskeletal dysfunction in migraine patients.

 2018 Apr;38(5):865-875.
Luedtke K1, Starke W1, May A1.

Abstract

Objective: The aim of this project was to evaluate the prevalence and pattern of musculoskeletal dysfunctions in migraine patients using a rigorous methodological approach and validating an international consensus cluster of headache assessment tests.

Methods: A physiotherapist, blinded towards the diagnosis, examined 138 migraine patients (frequent episodic and chronic), recruited at a specialized headache clinic, and 73 age and gender matched healthy controls following a standardised protocol. Eleven tests, previously identified in an international consensus procedure, were used to evaluate cervical and thoracic musculoskeletal dysfunctions.

Results: Primary analyses indicated statistically significant differences across groups for the total number of trigger points, flexion-rotation test, thoracic screening, manual joint testing of the upper cervical spine, cranio-cervical flexion test, and reproduction and resolution. Ninety three percent of the assessed patients had at least three musculoskeletal dysfunctions. Post-hoc tests showed significant differences between episodic or chronic migraine patients and healthy controls, but not between migraine groups.

Conclusions: A standardized set of six physical examination tests showed a high prevalence of musculoskeletal dysfunctions in migraine patients. These dysfunctions support a reciprocal interaction between the trigeminal and the cervical systems as a trait symptom in migraine.

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