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BACKGROUND: The Tampa Scale for Kinesiophobia (TSK) is one of the most frequently employed instruments for assessing maladaptive beliefs about pain, injury, and movement in patients with chronic musculoskeletal pain. However, the measurement properties of this tool have so far not been tested for individuals with migraine. OBJECTIVE: To evaluate the structural, construct, and criterion validity, and the internal consistency for three versions (TSK-11, TSK-13, and TSK-17) of the TSK for patients with migraine. METHODS: A total of 113 individuals aged between 18 and 55 years old with migraine diagnosis were included. All participants completed the TSK with 17 items, the Fear-Avoidance Beliefs Questionnaire, the Headache Impact Test, and the Pain Catastrophizing Scale questionnaires. Confirmatory factor analysis was used to assess the structural validity of the TSK, and Cronbach's α was used to assess internal consistency. For construct and criterion validity, the Spearman's correlation was calculated. RESULTS: The TSK structure with one factor and the 17, 13, or 11 items versions were suitable, with suitable values in all fit indices related to structural validity. The three versions showed acceptable internal consistency (α = 0.75). All TSK versions showed moderate positive correlation with the other questionnaires (rho range= 0.31-0.63), confirming most of the predefined hypothesis for the construct validity. Also, the criterion validity of the 13-item and 11-item versions was confirmed (rho=0.95 and rho=0.94, respectively). CONCLUSION: All versions of the TSK demonstrated good measurement properties in the assessment of maladaptive beliefs about pain, injury, and movement in individuals with migraine.
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Transtornos de Enxaqueca , Humanos , Inquéritos e Questionários , Pessoa de Meia-Idade , Psicometria , Adulto , Catastrofização , Transtornos Fóbicos , Reprodutibilidade dos Testes , Adolescente , CinesiofobiaRESUMO
BACKGROUND: Migraine may be accompanied by several cervical musculoskeletal dysfunctions, for example an altered performance on the Craniocervical Flexion Test (CCFT). However, CCFT measurement properties are still unclear in patients with migraine. OBJECTIVES: To determine intra- and inter-examiner reliability, construct validity, standard measurement error (SEM), and minimal detectable change (MDC) of the CCFT in patients with migraine. METHODS: Women diagnosed with migraine were considered eligible for this study. Participants were assessed by two examiners for the inter-examiner reliability, and with 7-10 days interval for the intra-examiner reliability. Construct validity was assessed considering headache and neck pain frequency and intensity, and self-reported questionnaires, including the Headache Impact Test - 6 items (HIT-6), the 12-item Allodynia Symptom Checklist/Brazil (ASC-12), and the Neck Disability Index (NDI). In addition, participants performed cervical endurance and maximal voluntary isometric contraction of the cervical flexors. RESULTS: A total of 103 women with migraine were recruited. The intra-examiner reliability was rated as good (ICC= 0.81, 95% CI: 0.73, 0.87), while the inter-examiner reliability was rated as moderate (ICC= 0.55, 95% CI: 0.40, 0.67). The intra and inter-examiner SEM were 1.31 and 1.36 mmHg respectively, and MDC were 3.63 and 3.77 mmHg. The HIT-6 and the cervical endurance flexion test were associated with the CCFT in a multiple linear regression model (p = 0.004, R = 0.35). CONCLUSION: The CCFT presents adequate intra- and inter-examiner reliability. Better performance on the CCFT test was associated with better HIT-6 scores and greater cervical endurance time, which was not influenced by the presence of neck pain.
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Transtornos de Enxaqueca , Humanos , Transtornos de Enxaqueca/fisiopatologia , Reprodutibilidade dos Testes , Cervicalgia/fisiopatologia , Feminino , Inquéritos e Questionários , Amplitude de Movimento ArticularRESUMO
Knowledge of reference values for cervical muscle strength is a key tool for clinicians to use as a clinical reference measure and to establish goals during rehabilitation. The objective was to establish reference values for the maximal strength of cervical muscles in healthy women using a handheld dynamometer and verify the association of cervical muscle strength with age and anthropometric measurements. A hundred women were classified into four groups (n = 25) according to age: 18-29 years, 30-39 years, 40-49 years, and 50-60 years. Maximal muscle strength of the cervical spine was measured using a Lafayette® handheld dynamometer for flexion, extension, and bilateral lateral flexion. No differences in cervical muscle strength were observed among the groups (p > 0.05). However, the 18-29-year-old group took less time to reach the peak of force for flexion than the 50-60-year-old group. Moderate correlations were observed between cervical flexor strength and weight, body mass index, and neck circumference, and between cervical extensor strength and weight and body mass index (r = 0.43-0.55; p < 0.05). Reference values for cervical muscle strength in healthy women were established using a handheld dynamometer, and the association between muscle strength and anthropometric data was moderate.
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OBJECTIVE: The goal of this study was to reach consensus about the best exercise prescription parameters, the most relevant considerations, and other recommendations that could be useful for prescribing exercise to patients with migraine. METHODS: This was an international study conducted between April 9, 2022 and June 30, 2022. An expert panel of health care and exercise professionals was assembled, and a 3-round Delphi survey was performed. Consensus was reached for each item if an Aiken V Validity Index ≥ 0.7 was obtained. RESULTS: The study included 14 experts who reached consensus on 42 items by the third round. The most approved prescription parameters were 30 to 60 minutes of exercise per session, 3 days per week of moderate-intensity continuous aerobic exercise, and relaxation and breathing exercises for 5 to 20 minutes every day. When considering an exercise prescription, initial exercise supervision should progress to patient self-regulation; catastrophizing, fear-avoidance beliefs, headache-related disability, anxiety, depression, physical activity baseline level, and self-efficacy could influence the patients' exercise participation and efficacy; and gradual exposure to exercise could help improve these psychological variables and increase exercise efficacy. Yoga and concurrent exercise were also included as recommended interventions. CONCLUSION: From the experts in the study, exercise prescriptions should be adapted to patients with migraine considering different exercise modalities, such as moderate-intensity aerobic exercise, relaxation, yoga, and concurrent exercise, based on the patients' preferences and psychological considerations, level of physical activity, and possible adverse effects. IMPACT: The consensus reached by the experts can help prescribe exercise accurately to patients with migraine. Offering various exercise modalities can improve exercise participation in this population. The evaluation of the patients' psychological and physical status can also facilitate the adaptation of the exercise prescription to their abilities and diminish the risk of adverse events.
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Transtornos de Enxaqueca , Yoga , Humanos , Técnica Delphi , Terapia por Exercício , Exercício FísicoRESUMO
BACKGROUND: Migraine has been associated with balance dysfunction, more pronounced in patients with aura and chronic migraine. Also, it has been suggested that balance deficits are progressive through the migraineurs lifetime. OBJECTIVE: To analyze the one-year progression of balance parameters and clinical parameters associated with balance in female patients with and without migraine. DESIGN: Prospective cohort study. METHODS: The participants were distributed in four groups: control (CG; n = 27) migraine with aura (MA; n = 25), migraine without aura (MwA; n = 26), and chronic migraine (CM; n = 27). They performed the Sensory Organization Test, Motor Control Test and Adaptation Test protocols of dynamic posturography tests. Questionnaires about fear of falls, dizziness disability, and kinesiophobia were administered. These assessments were performed twice: baseline and after 1-year (follow-up). No intervention was performed for balance improvement, and the participants maintained their usual migraine treatment prescribed. RESULTS: None of the groups differed in balance tests between baseline and follow-up. We observed a reduction in migraine frequency in MA (-2.2 days, p = 0.01) and CM (-10.8 days, p < 0.001) groups, and in the migraine intensity (-2.3 points, p = 0.001) in CM group. Significant decreases in the scores of fear of falling, dizziness disability, and kinesiophobia were observed in the migraine groups (p < 0.05), but the differences did not exceed the minimal detectable change of the questionaries scores. CONCLUSION: Women with different migraine subtypes did not present balance changes in a one-year interval. The improvements in migraine's clinical features were not accompanied by improvements in balance parameters.
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Tontura , Transtornos de Enxaqueca , Humanos , Feminino , Estudos Prospectivos , Acidentes por Quedas , Equilíbrio Postural , Medo , Vertigem/complicaçõesAssuntos
Cefaleia , Cervicalgia , Humanos , Cervicalgia/diagnóstico , Cervicalgia/terapia , Cefaleia/diagnóstico , Cefaleia/terapiaRESUMO
INTRODUCTION: Migraine is a neurological and disabling disease whose peripheral manifestations can be addressed with physiotherapy. These manifestations can include pain and hypersensitivity to muscular and articular palpation in the neck and face region, a higher prevalence of myofascial trigger points, limitation in global cervical motion, especially in the upper segment (C1-C2), and forward head posture with worse muscular performance. Furthermore, patients with migraine can present cervical muscle weakness and greater co-activation of antagonists in maximum and submaximal tasks. In addition to musculoskeletal repercussions, these patients can also present balance impairment and a greater risk of falls, especially when chronicity of migraine frequency is present. The physiotherapist is a relevant player in the interdisciplinary team and can help these patients to control and manage their migraine attacks. PURPOSE: This position paper discusses the most relevant musculoskeletal repercussions of migraine in the craniocervical area under the perspective of sensitization and disease chronification, besides addressing physiotherapy as an important strategy for evaluating and treating these patients. IMPLICATIONS: Physiotherapy as a non-pharmacological treatment option in migraine treatment may potentially reduce musculoskeletal impairments related to neck pain in this population. Disseminating knowledge about the different types of headaches and the diagnostic criteria can support physiotherapists who compose a specialized interdisciplinary team. Furthermore, it is important to acquire competencies in neck pain assessment and treatment approaches according to the current evidence.
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Transtornos de Enxaqueca , Cervicalgia , Humanos , Cervicalgia/etiologia , Cervicalgia/terapia , Amplitude de Movimento Articular , Transtornos de Enxaqueca/terapia , Pescoço , Modalidades de FisioterapiaRESUMO
BACKGROUND: Migraine patients may present with both cervical and balance dysfunctions. The neck plays an important role in balance by providing substantial proprioceptive input, which is integrated in the central nervous system and influences the balance control systems. Whether balance and neck dysfunctions are associated in patients with migraine is still to be explored. OBJECTIVES: This study aimed to assess the association between the sensory organization test of balance with neck pain features, cervical strength, endurance, and range of motion in patients with migraine. METHODS: Sixty-five patients with migraine underwent the sensory organization test assessed with the Equitest-Neurocom® device. Maximum voluntary isometric contraction, cervical flexion and extension range of motion, and cervical flexor and extensor endurance were assessed. In addition, the features of migraine and neck pain were collected. Patients were dichotomized according to cut-off scores of balance performance and the association between outcomes were explored. RESULTS: Patients with reduced balance performance presented a higher frequency of migraine (p = 0.035), a higher frequency of aura (p = 0.002), greater neck pain intensity (p = 0.013), and decreased endurance of cervical flexors (p = 0.010) and extensors (p < 0.0001). The total balance score was correlated with age (r = -0.33; p = 0.007), migraine frequency (r = -0.29; p = 0.021), neck pain intensity (r = -0.26; p = 0.038), and endurance of the cervical flexors (r = 0.39; p = 0.001) and extensors (r = 0.36; p = 0.001). Migraine frequency, neck pain intensity, and endurance of the cervical flexors can predict 21% of the sensory organization test variability. CONCLUSION: Neck pain features and endurance of the cervical muscles are related to reduced balance performance in patients with migraine. These results shed light to a better understanding of balance alterations in migraine patients.
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Transtornos de Enxaqueca , Músculos do Pescoço , Humanos , Cervicalgia , Contração Isométrica/fisiologia , Medição da DorRESUMO
BACKGROUND: Although patients with migraine show cervical muscle impairments previous studies investigating motor performance have not characterized the sample of patients with migraine according to the presence/absence of neck pain complaints. OBJECTIVE: To verify if there are differences in the clinical and muscular performance of the superficial neck flexors and extensors during Craniocervical Flexion Test in women with migraine, considering the presence or absence of concomitant symptoms of neck pain. METHODS: The cranio-cervical flexion test performance was assessed by its clinical stage test and by the surface electromyographic activity of the sternocleidomastoid, anterior scalene muscles upper trapezius and splenius capitis. It was assessed in 25 women with migraine without neck pain, 25 women with migraine and neck pain, 25 women with chronic neck pain and 25 pain-free control women. RESULTS: Poorer performance of the cervical muscles was found during the execution of the cranio-cervical flexion test, in addition to higher muscle activity, especially in the sternocleidomastoid, splenius capitis, and upper trapezius muscles in the neck pain, migraine without neck pain, and migraine with neck pain groups in comparison with the results obtained for healthy women in the control group. No difference was observed between the groups of women experiencing pain. Analysis of the extensor/flexor muscle electromyographic ratio showed that there was no difference between the groups. CONCLUSION: Poor cervical muscle performance was observed in both women with chronic nonspecific neck pain and women with migraine regardless of the presence of neck pain.
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Dor Crônica , Transtornos de Enxaqueca , Humanos , Feminino , Cervicalgia/diagnóstico , Eletromiografia , Pescoço , Exame Físico/métodos , Dor Crônica/diagnóstico , Transtornos de Enxaqueca/diagnósticoRESUMO
BACKGROUND: Migraine is associated with motion sensitivity symptoms such as kinetosis, vestibular symptoms and balance alterations. While focus is given to headache management, addressing these symptoms is often neglected, although they are related to additional migraine burden and increased disability. PURPOSE: Our aim is to disseminate the current understanding of the motion sensitivity symptoms among patients with migraine, with focus on balance impairments. We discuss the susceptibility of migraine to motion sensitivity, its suggested mechanisms, the balance alterations during quiet standing, mobility tasks and reactions to external perturbations. The role of migraine subdiagnosis, implications for clinical practice and future perspectives are also acknowledged. IMPLICATIONS: Balance disorders are one of the signs reflecting a broader and complex spectrum of motion sensitivity, which are present even between attacks. Migraineurs are especially inherent to these symptoms probably due to brain hyperexcitability and to shared pathophysiological mechanisms. Patients, especially with aura and chronic migraine, exhibit balance instability during quiet standing under different surface and visual input conditions. Migraineurs demonstrated reduced limits of stability and lower performance on walk, transposing obstacles and sit to stand tasks. Only patients with aura present impairment of motor control reactions following external perturbations. Balance alterations are associated with falls and are influenced by aura, migraine frequency and psychosocial aspects, but not by vestibular symptoms or vestibular migraine diagnosis. There is a high demand for high quality of evidence regarding the assessment and care of motion sensitivity symptoms in migraineurs, considering approaches to manage not just the pain, but its associated symptoms.
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Epilepsia , Transtornos de Enxaqueca , Humanos , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/terapia , Vertigem/complicações , Vertigem/diagnóstico , Equilíbrio Postural/fisiologia , Cefaleia , Epilepsia/complicaçõesRESUMO
BACKGROUND: Repeated migraine attacks and aura could independently cause structural changes in the central nervous system. Our research aims to study the correlation of migraine type, attack frequency, and other clinical variables with the presence, volume and localization of white matter lesions (WML), in a controlled study. METHODS: Sixty volunteers from a tertiary headache center were selected and divided equally into four groups: episodic migraine without aura (MoA), episodic migraine with aura (MA), chronic migraine (CM) and controls (CG). Voxel-based morphometry techniques were used to analyze WML. RESULTS: There were no differences in WML variables between groups. There was a positive correlation between age and the number and total volume of WMLs, which persisted in the comparison categorized by size and brain lobe. Disease duration was positively correlated with the number and total volume of WML, and when controlled by age, the correlation maintained significance only for the insular lobe. Aura frequency was associated with frontal and temporal lobe WMLs. There was no statistically significant correlation between WML and other clinical variables. CONCLUSION: Migraine overall is not a risk factor for WML. Aura frequency is, however, associated with temporal WML. Disease duration, in adjusted analyses that account for age, is associated with insular WML.
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OBJECTIVE: The purpose of this study was to assess the correlation, concurrent validity, and agreement between the isometric cervical force measurements obtained with fixed and portable dynamometers in asymptomatic individuals. METHODS: Fifty asymptomatic individuals performed 3 maximal isometric contractions for flexion, extension, and lateral flexion of the cervical spine using fixed and portable dynamometers. The correlation and concurrent validity for the measurements of the portable and fixed dynamometers were analyzed using Spearman's correlation coefficient and the intraclass correlation coefficient (ICC), respectively. The agreement between the force values of the portable and fixed dynamometers was measured using the Bland-Altman method. RESULTS: Isometric cervical force measurements obtained with the fixed dynamometer and portable dynamometer showed a moderately to highly significant correlation for flexion (rs = 0.74), extension (rs = 0.82), right lateral flexion (rs = 0.74), and left lateral flexion (rs = 0.68). The concurrent validity was moderate to good for all measurements (ICC2,3 = 0.67-0.80). The fixed and portable dynamometers did not agree, with a significant mean difference between the methods of 2.8 kgf (95% confidence interval [CI], 2.1-3.4 kgf) for cervical flexion, 5.3 kgf (95% CI, 4.2-6.4 kgf) for extension, and 9.1 kgf (95% CI, 0.4-2.1 kgf) for left lateral flexion. The limits of agreement were broad for all movements, with errors that varied between 61% and 77% of the mean force obtained with the fixed dynamometer. CONCLUSION: The neck strength measurements obtained with the fixed and portable dynamometers demonstrated high to moderate correlation and had moderate to good comparability for asymptomatic participants. However, they did not agree in that the 2 methods did not provide equivalent measurements, and, therefore, based on these findings, the same equipment should always be used when reassessing an individual.
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Força Muscular , Pescoço , Humanos , Dinamômetro de Força Muscular , Reprodutibilidade dos Testes , Vértebras Cervicais , Contração IsométricaRESUMO
OBJECTIVE: To assess the balance sensory organization among patients with migraine, considering the influence of migraine subdiagnosis, otoneurological function, falls, and psychosocial factors. BACKGROUND: Migraine has been associated with vestibular symptoms and balance dysfunction; however, neither comprehensive balance assessment nor associated factors for greater impairment have been addressed thus far. METHODS: Patients from a tertiary headache clinic with a diagnosis of episodic migraine with aura (MWA), without aura (MWoA), and chronic migraine (CM) were included for this cross-sectional study (30 patients per group). Thirty headache-free controls (CG) were recruited. Participants underwent a comprehensive evaluation protocol, including the Sensory Organization Test (SOT) and otoneurological examination. Questionnaires about fear of falls, dizziness disability, and kinesiophobia were administered. RESULTS: All migraine groups presented lower composite SOT scores than controls (CG: 82.4 [95% confidence interval (CI): 79.5-85.3], MWoA: 76.5 [95% CI: 73.6-79.3], MWA: 66.5 [95% CI: 63.6-69.3], CM: 69.1 [95% CI: 66.3-72.0]; p < 0.0001). Compared to controls and to MWoA, MWA and CM groups exhibited greater vestibular (CG: 75.9 [95% CI: 71.3-80.4], MWoA: 67.3 [95% CI: 62.7-71.8], MWA: 55.7 [95% CI: 51.2-60.3], CM: 58.4 [95% CI: 53.8-63.0]; p < 0.0001) and visual functional impairment (CG: 89.6 [95% CI: 84.2-94.9], MWoA: 83.2 [95% CI: 77.9-88.6], MWA: 68.6 [95% CI: 63.3-74.0], CM: 71.9 [95% CI: 66.5-77.2], p < 0.0001). Fall events during the assessment were documented more often among patients with migraine (CG: 0.0, interquartile range [IQR], 0.0, 0.0); MWoA: 1.0 [IQR: 1.0, 1.0], MWA: 2.0 [IQR: 1.8, 4.3], CM: 1.0 [IQR: 1.0, 2.0]; p = 0.001). The SOT scores correlated with fear of falls (r = -0.44), dizziness disability (r = -0.37), kinesiophobia (r = -0.38), and migraine frequency (r = -0.38). There was no significant influence of the vestibular migraine diagnosis in the study outcomes when used as a covariate in the analysis (composite score [F = 3.33, p = 0.070], visual score [F = 2.11, p = 0.149], vestibular score [F = 1.88, p = 0.172], somatosensory score [F = 0.00, p = 0.993]). CONCLUSIONS: Aura and greater migraine frequency were related to falls and balance impairment with sensory input manipulation, although no otoneurological alterations were detected. The diagnosis of vestibular migraine does not influence the balance performance. The vestibular/visual systems should be considered in the clinical examination and treatment of patients with migraine.
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Epilepsia , Transtornos de Enxaqueca , Enxaqueca com Aura , Estudos Transversais , Tontura/diagnóstico , Tontura/etiologia , Epilepsia/complicações , Humanos , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/diagnóstico , Equilíbrio Postural , Vertigem/complicações , Vertigem/diagnósticoRESUMO
This cross-sectional study aimed to describe and compare kinetic and kinematic variables of the knee joint during stair descent, single-leg step down, and single-leg squat tasks. It also aimed to investigate potential sex difference during the tasks. Thirty young asymptomatic individuals (15 males, 15 females) were assessed during the performance of single-leg weight-bearing tasks. The kinetic and kinematic data from the knee were evaluated at the peak knee moment and at peak knee flexion. Single-leg squat presented a higher peak knee moment (2.37 Nm/kg) and the greatest knee moment (1.91 Nm/kg) at knee peak angle in the frontal plane, but the lowest knee flexion (67°) than the other two tasks (p < 0.05). Additionally, the single-leg step down task presented a higher varus knee angle (5.70°) when compared to stair descent (3.71°) (p < 0.001). No substantial sex difference could be observed. In conclusion, in asymptomatic young individuals, single-leg squats presented the greatest demand in the frontal and sagittal planes. Single-leg step down demanded a greater angular displacement than stair descent in the frontal plane. We did not identify a significant difference among the sex and studied variables.
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Articulação do Joelho , Perna (Membro) , Fenômenos Biomecânicos , Estudos Transversais , Feminino , Humanos , Cinética , Masculino , Suporte de CargaRESUMO
BACKGROUND: Migraine patients have musculoskeletal disorders and pain in the cervical. And, despite the pathophysiology demonstrating the relationship between migraine and the cervical spine, the effectiveness of craniocervical exercises in these patients has not been verified. So, the aimed of this study was verify the effectiveness of craniocervical muscle-strengthening exercise (CMSE) in reducing the frequency and intensity of headache in migraine patients. METHODS: A two-armed, parallel-group randomized controlled trial with a 3-month follow-up was performed. For eight weeks, the volunteers in the intervention group (n = 21) performed a protocol of CMSE, while those in the sham ultrasound group (n = 21) received the application of disconnected therapeutic ultrasound in the upper trapezius and guideline for home-stretching. The primary outcomes were the frequency and intensity of the headache. The secondary outcomes were questionnaires about migraine and neck disability, and satisfaction with the treatment, cervical range of motion, the pressure pain threshold, craniocervical flexion test (CCFT), cervical muscle strength and endurance test, and the cervical muscle activity during the physical tests. RESULTS: No differences were observed for the changes observed in primary outcomes after eight weeks and at the 3-months follow up (p > 0.05). For the secondary outcomes, craniocervical exercises improved the sensitivity of the frontal muscle (p = 0.040) and promoted a reduced amplitude of muscle activity of the anterior scalene and upper trapezius in the last stages of CCFT (p ≤ 0.010). There was also reduced muscle activity of the anterior scalene and splenius capitis in the endurance test (p ≤ 0.045), as evaluated by surface electromyography. CONCLUSION: CMSE were insufficient in reducing the frequency and intensity of headache, improving the performance of the cervical muscles, or reducing migraine and neck pain-related disabilities. This was found despite a decreased electromyographic activity of the cervical muscles during the last stages of CCFT and increased median frequency during the endurance test. TRIAL REGISTRATION: Accession code RBR-8gfv5j , registered 28/11/2016 in the Registro Brasileiro de Ensaios Clínicos (ReBEC).
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Transtornos de Enxaqueca , Músculos do Pescoço , Humanos , Transtornos de Enxaqueca/diagnóstico por imagem , Transtornos de Enxaqueca/terapia , Força Muscular/fisiologia , Músculos do Pescoço/diagnóstico por imagem , Cervicalgia/diagnóstico por imagem , Cervicalgia/terapia , UltrassonografiaRESUMO
OBJECTIVE: The objective of this study was to measure the intra- and inter-rater reliability of the quantitative sensory testing for measuring the thermal pain threshold on myofascial trigger points in the upper trapezius muscle of individuals with chronic neck pain. METHODS: Thirty female participants were included, aged between 18 and 45 years and with bilateral myofascial trigger points, active and centrally located in the upper trapezius muscle. Two measurements with quantitative sensory testing were performed by each examiner at an interval of 1 week between them. RESULTS: We observed substantial reliability for the intra-rater analysis (intraclass correlation coefficient ranging between 0.876 and 0.896) and excellent reliability for the inter-rater analysis (intraclass correlation coefficient ranging between 0.917 and 0.954). CONCLUSION: The measurement of the thermal pain threshold on myofascial trigger points in individuals with chronic neck pain has acceptable reliability values, supporting the use of the quantitative sensory testing in the research setting and the clinical environment.
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Síndromes da Dor Miofascial , Cervicalgia , Músculos Superficiais do Dorso , Pontos-Gatilho , Adolescente , Adulto , Dor Crônica , Feminino , Humanos , Pessoa de Meia-Idade , Síndromes da Dor Miofascial/diagnóstico , Síndromes da Dor Miofascial/fisiopatologia , Cervicalgia/epidemiologia , Reprodutibilidade dos Testes , Músculos Superficiais do Dorso/fisiopatologia , Pontos-Gatilho/fisiopatologia , Adulto JovemRESUMO
This cross-sectional study aimed to compare the waveform morphology through noninvasive intracranial pressure (ICP-NI) measurement between patients with migraine and controls, and to analyze the association with clinical variables. Twenty-nine women with migraine, age 32.4 (11.2) years and headache frequency of 12.6 (7.5) days per month and twenty-nine women without headache, age 32.1 (9.0) years, were evaluated. Pain intensity, migraine disability, allodynia, pain catastrophizing, central sensitization and depression were evaluated. The ICP-NI monitoring was performed by a valid method consisting of an extracranial deformation sensor positioned in the patients' scalp, which allowed registration of intracranial pressure waveforms. Heart rate and blood pressure measurements were simultaneously recorded during 20 min in the supine position. The analyzed parameter was the P2/P1 ratio based on mean pulse per minute which P1 represents the percussion wave related to the arterial blood pression maximum and P2 the tidal wave, middle point between the P1 maximum and the dicrotic notch. There was no between-groups difference in the P2/P1 ratio (mean difference: 0.04, IC95%: -0.07 to 0.16, p = 0.352, F (1,1) = 0.881) adjusted by body mass index covariable. The Multiple Linear Regression showed non-statistical significance [F (5,44) = 1.104; p = 0.372; R2 = 0.11)] between the P2/P1 ratio and body mass index, presence of migraine, central sensitization, pain catastrophizing and depression. We found no correlation (p > 0.05) between P2/P1 ratio and migraine frequency, migraine onset, pain intensity, pain intensity at day of examination, disability, allodynia. Migraine patients did not present alterations in the waveform morphology through ICP-NI compared to women without headache and no association with clinical variables was found.
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Pressão Intracraniana , Transtornos de Enxaqueca/fisiopatologia , Monitorização Fisiológica/métodos , Adulto , Índice de Massa Corporal , Catastrofização , Estudos Transversais , Humanos , Hiperalgesia , Transtornos de Enxaqueca/etiologia , Transtornos de Enxaqueca/psicologia , Resultados Negativos , Medição da Dor , Decúbito Dorsal/fisiologia , Adulto JovemRESUMO
SUMMARY OBJECTIVE: The objective of this study was to measure the intra- and inter-rater reliability of the quantitative sensory testing for measuring the thermal pain threshold on myofascial trigger points in the upper trapezius muscle of individuals with chronic neck pain. METHODS: Thirty female participants were included, aged between 18 and 45 years and with bilateral myofascial trigger points, active and centrally located in the upper trapezius muscle. Two measurements with quantitative sensory testing were performed by each examiner at an interval of 1 week between them. RESULTS: We observed substantial reliability for the intra-rater analysis (intraclass correlation coefficient ranging between 0.876 and 0.896) and excellent reliability for the inter-rater analysis (intraclass correlation coefficient ranging between 0.917 and 0.954). CONCLUSION: The measurement of the thermal pain threshold on myofascial trigger points in individuals with chronic neck pain has acceptable reliability values, supporting the use of the quantitative sensory testing in the research setting and the clinical environment.
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Humanos , Feminino , Adolescente , Adulto , Adulto Jovem , Cervicalgia/epidemiologia , Pontos-Gatilho/fisiopatologia , Músculos Superficiais do Dorso/fisiopatologia , Síndromes da Dor Miofascial/diagnóstico , Síndromes da Dor Miofascial/fisiopatologia , Reprodutibilidade dos Testes , Dor Crônica , Pessoa de Meia-IdadeRESUMO
Autonomic dysfunction, such as reduced vagally mediated heart rate variability, has been suggested in headache patients but is still uncertain when considering primary headache disorders. This study aims to compare the heart rate and blood pressure variability and baroreflex sensitivity between women with migraine and controls. A migraine (n = 20) and a control group (n = 20) of age-matched women without headache were evaluated. Heart rate variability was analyzed through frequency-domain using spectral analysis presenting variance, low-frequency (LF; 0.04-0.15 Hz) and high-frequency (HF; 0.15-0.4 Hz) bands and by time domain (root mean square of successive R-R interval differences, RMSSD). Blood pressure variability was analyzed with spectral analysis and baroreflex sensitivity with the sequence method. Migraine group had lower heart rate variability characterized by a reduction in total variance, LF oscillations (sympathetic/vagal modulation) and HF oscillations (vagal modulation), and a reduction in SD and RMSSD compared to control group. No difference was found in the blood pressure variability analysis. Regarding baroreflex sensitivity, migraine group had decreased values of total gain, gain down and up compared to control group. Women with migraine exhibited autonomic modulation alterations, expressed by decreased values of heart rate variability and baroreflex sensitivity, but not by differences in blood pressure variability.
Assuntos
Sistema Nervoso Autônomo , Transtornos de Enxaqueca , Humanos , Feminino , Pressão Sanguínea/fisiologia , Coração , Barorreflexo/fisiologia , Frequência Cardíaca/fisiologia , CefaleiaRESUMO
INTRODUCTION: Kinesiophobia is a common symptom associated with high disability, and has been observed in patients with migraine. However, the association between kinesiophobia and clinical factors in this population is unknown. OBJECTIVE: To assess the fear of falling, dizziness disability, and migraine disability in patients with migraine, considering the presence of kinesiophobia. METHODS: Eighty patients with migraine completed the Tampa Scale for Kinesiophobia and were divided into two groups according to the questionnaire cutoff point: migraine without kinesiophobia (MoK, n = 39) and migraine with kinesiophobia (MK, n = 41). Fear of falling, dizziness disability, and migraine disability were assessed in both groups using validated questionnaires. RESULTS: The MK group presented higher scores on dizziness disability, fear of falling, and migraine disability compared to the MoK (p < .05). Kinesiophobia can explain 29% of the variance in dizziness disability and 18% of migraine disability. Both kinesiophobia and the presence of dizziness can explain 14% of fear of falling variability. Also, kinesiophobia is associated with the risk of presenting fear of falling (Prevalence Ratio = 2.4, p = .012), and migraine disability (Prevalence Ratio = 2.6, p = .01). CONCLUSION: The presence of kinesiophobia should be considered in clinical practice when evaluating migraine, as it is associated with increased levels of fear of falling, dizziness disability, and migraine disability.