Neck Solutions Blog

The Prevalence of Neck Pain in Migraine

From: Headache. 2010 Jan 20. [Epub ahead of print]

To determine the prevalence of neck pain at the time of migraine treatment relative to the prevalence of nausea, a defining associated symptom of migraine. This is a prospective, observational cross-sectional study of 113 migraineurs, ranging in attack frequency from episodic to chronic migraine. Subjects were examined by headache medicine specialists to confirm the diagnosis of migraine and exclude both cervicogenic headache and fibromyalgia. Details of all migraines were recorded over the course of at least 1 month and until 6 qualifying migraines had been treated. For each attack, subjects recorded the presence or absence of nausea as well as the intensity of headache and neck pain (graded as none, mild, moderate, or severe).

Subjects recorded 2411 headache days, 786 of which were migraines. The majority of migraines were treated in the moderate pain stage. Regardless of the intensity of headache pain at time of treatment, neck pain was a more frequent accompaniment of migraine than was nausea. Prevalence of neck pain correlated with chronicity of headache as attacks moved from episodic to chronic daily headache.

In this representative cross-section of migraineurs, neck pain was more commonly associated with migraine than was nausea, a defining characteristic of the disorder. Awareness of neck pain as a common associated feature of migraine may improve diagnostic accuracy and have a beneficial impact on time to treatment.

Performance in the cranio-cervical flexion test is altered in elderly subjects

From: Man Ther. 2009 Oct;14(5):475-9

The cranio-cervical flexion test tests the coordination of the deep and superficial cervical flexor muscles during a cranio-cervical flexion task. The test has revealed impairments in muscle function in younger/middle aged patients with various neck pain disorders. Neck pain and headache are common in elders but it is unknown if age alone affects performance in the cranio-cervical flexion test. This study compared performance in the cranio-cervical flexion test between healthy asymptomatic elderly and younger subjects. Electromyographic (EMG) amplitude in the sternocleidomastoid, angle of cranio-cervical flexion and ability to target the pressure levels of each test stage were examined in 44 elderly and 39 young participants.

The results indicated that the elderly group had higher measures of normalized EMG signal amplitude in the sternocleidomastoid during the test, greater shortfalls from the target pressures of all stages of the test, except for the 22 mm Hg stage, and larger variability of the cranio-cervical flexion range of motion for the five successive stages of the test (particularly at 26, 28 and 30 mm Hg stages) compared to young subjects. Clinicians must be aware of this occurrence when assessing performance in the cranio-cervical flexion test in elders with neck pain.

Cervical musculoskeletal impairment is common in elders with headache

From: Man Ther. 2009 Feb 10. [Epub ahead of print]

There is an opinion that with increasing cervical degenerative joint disease with ageing, cervicogenic headaches become more frequent. This study aimed to determine if cervical musculoskeletal dysfunction was specific to headache classifiable as cervicogenic or was more generic to headache in elders. Subjects (n=118), aged 60-75 years with recurrent headache and 44 controls were recruited. Neck function measures included range of motion (ROM), cervical joint dysfunction, cranio-cervical flexor muscle function, joint position sense (JPS) and cervical muscle strength. A questionnaire documented the characteristics of headaches for classification. A cluster analysis based on three musculoskeletal variables aligned previously with cervicogenic headache, divided headache subjects into two groups; cluster 1 (n=57), cluster 2 (n=50). Dysfunctions were greater in cluster 1 than in 2 for extension range and C1-2 joint dysfunction. Most cervicogenic headaches were grouped in cluster 1, but musculoskeletal dysfunction was also found in headaches classifiable as migraine or tension type headache. Neck dysfunction is not uniquely confined to cervicogenic headache in elders. Further research such as headache responsiveness to management of the neck disorder is required to better understand about the neck’s causative or contributing role to elders’ headache.

Immediate effects of inhibitive distraction on active range of cervical flexion in patients with neck pain

From: J Man Manip Ther. 2007;15(2):82-92

Neck pain as well as headaches with a proposed neck related etiology or contribution are highly prevalent disorders. Doug lass and Bope reported a point-prevalence for neck pain in the general population of 9%. They further noted a 1 month, 6 month, and lifetime prevalence of 10%, 54%, and 66%, respectively. In a cross-sectional population survey, investigators found an 18% prevalence for chronic neck pain greater than months’ duration. Headache types associated with cervical spine dysfunction include tension type and cervicogenic headache, occipital neuralgia, and to a lesser extent migraine headaches. Tension type headache affects two-thirds of men and over 80% of women in developed countries. For the general population, the prevalence of cervicogenic headache varies between 0.4% and 2.5%; in those with chronic headaches, prevalence may be as high as 15% to 20%.

Neck pain and headache are not only highly prevalent but also frequent reasons for patients to seek medical or physical therapy care. In the United States, neck pain accounts for almost 1% of all primary care physician visits, and cervical spine diagnoses were the reason for referral in 16% of 1,258 outpatient physical therapy patients, second only to lumbar spine related diagnoses, which accounted for 19% of referrals. No data are available on the prevalence of headache as a cause for physical therapy management; however, an investigator reported headache as co-morbidity in 22% of 2,433 patients presenting for outpatient physical and occupational therapy, and headaches are reportedly the leading cause for visits to a neurologist.

Physical therapists place a diagnostic emphasis on identifying impairments that may be amenable to management with interventions within their scope of practice. In this context, impairments are defined as any loss or abnormality of body structure or of a physiological or psychological function. Studies have shown a strong correlation between neck pain and restricted cervical flexion-extension mobility, and limited motion may be the most relevant impairment associated with neck pain and headache of a proposed cervical etiology. An investigator attributed cervical hypomobility to either a voluntary or reflexogenic muscular restraint caused by pain or a purely mechanical restraint caused by degeneration of the joint surfaces and ligaments. Corresponding to said degenerative process, investigators described a fibrotic process in connective tissue, whereby it shrinks progressively, caused by arthrokinematic dysfunction, poor posture, overuse, habit patterns, or structural or movement imbalances. They further suggested that in many cases the surrounding musculature maintains a hypertonic recruitment pattern long after the inducing injury has healed, potentially immobilizing joints by the surrounding muscle hypertonicity.

(more…)

The effect of TENS on selected symptoms in the management of patients with chronic tension type headache: a preliminary study

From: Nig Q J Hosp Med. 2008 Jan-Mar;18(1):25-9.

Headache is one of the most frequent causes of consultation in both general medical practice and neurological clinics. It is the most common of all medical conditions causing pain and disability. Headache is experienced by 90% of the general population at some point in life, as a consequence of febrile illness. However, primary headache occur in some people on chronic basis such as tension headache, and require long-term relief.

This study was aimed at investigating the efficacy of Transcutaneous Electrical Nerve Stimulation (TENS) on Pain, Functional Disability and Cervical Range of Motion in patients with Chronic Tension Type Headache.

Eight subjects aged 20-50 years with diagnosis of Chronic Tension Type Headache participated in the study. The subjects were treated thrice weekly for ten weeks with a TENS unit, at a pulse rate of 4Hz and pulse width of 200micros. Pain level, Functional Disability and Cervical Range of Motion were determined using the Visual Analogue Scale, Headache Disability Index and Universal Goniometer respectively. Data was analyzed using the Wilcoxon Signed Ranks Test for pain and functional disability while unpaired t-test was used to analyze cervical range of motion.

The result showed a significant reduction in pain and functional disability with a significant improvement of cervical range of motion within the studied subjects. Based on the findings of this study, it was therefore concluded that a TENS unit application should be considered in the long-term management of patients with chronic tension type headache.