Cervical muscle parameters and allodynia in migraine and cervical pain-A controlled study.

BACKGROUND: Neck pain is common among individuals with migraine, but there is a lack of information of how this comorbidity can be associated with cervical muscle function. This controlled cross-sectional study aimed to compare cervical muscle function, activity, and sensitization in women with migraine, neck pain, both, and neither. METHODS: This study included women, between 18 and 55 years old, with either episodic migraine with or without aura, without any concomitant headache diagnosis; chronic neck pain, with at least moderate intensity and mild disability; or neither headache nor neck pain. Pain pressure threshold, allodynia, muscle strength, and endurance and cervical muscles activity were evaluated. RESULTS: One hundred subjects, with mean age of 30.4 years old, were stratified by diagnosis (n = 25 per group) and by self-reported pain during tests. Lower endurance during flexion was observed for migraine and neck pain (34s) relative to neck pain alone (45s), migraine (40s), and controls (58s) (p = 0.04). For extensor endurance, means were 142s, 166s, 215s, and 270s, respectively (p < 0.001). Endurance times were impacted by the presence of test-induced pain decreasing about 40%-53% of the performance. Diagnostic groups did not differ significantly in strength (p > 0.05), but all pain groups presented significantly higher proportion of test-induced pain, lower muscle activity during the maximal isometric voluntary contractions, and lower pressure pain thresholds. CONCLUSION: Patients with migraine, chronic neck pain, and the association of both present altered cervical muscle function and activity. Also, test-induced pain impacts significantly on neck muscles endurance. SIGNIFICANCE: The diagnosis of migraine and chronic neck pain is associated with altered function and activity of the cervical muscles. However, the test-induced pain had an important contribution to worse cervical muscle endurance. This suggests that the therapeutic approach should focus on de-sensitization of the trigeminal-cervical complex when dealing with the comorbidity of migraine and cervical pain.

Do patients with migraine experience an increased prevalence of falls and fear of falling? A cross-sectional study.

OBJECTIVE: To assess the prevalence of falls and fear of falling in patients with migraine compared with controls. DESIGN: Cross-sectional. SETTING: Tertiary headache clinic. PARTICIPANTS: This study consisted of 105 controls and 105 consecutive patients diagnosed with migraine with aura (MA, n=35), migraine without aura (MO, n=35) and chronic migraine (CM, n=35). MAIN OUTCOME MEASURES: Patients were interviewed using a questionnaire containing questions about the history of falls and impairment in balance, and completed the International Falls Efficacy Scale (FES-I). Groups were contrasted using Student's t-test and analysis of variance, and prevalence ratios were estimated. RESULTS: Falls and self-reported impairment in balance are more prevalent in patients with migraine (54% and 69%, respectively) than in controls (2% and 2%, respectively). In particular, patients with CM and MA reported a greater mean number of falls during the previous year {CM 1.4 [standard deviation (SD) 2.2]; MA 2.2 (SD 2.3)} compared with patients with MO [0.5 (SD 1.0); P <0.04] and controls [0.05 (SD 0.2); P <0.002]. The prevalence ratio of falls was greater in patients with MA (7.2; P <0.002) and CM (4.5; P <0.002) compared with controls. Patients with migraine experienced a high level of concern about falls during their daily activities compared with controls (29.8 vs 20.1 points in the FES-I questionnaire; P<0.0001). CONCLUSIONS: The balance impairment of patients with migraine may have a functional impact. Migraine is associated with risk of falling, and patients exhibit a higher prevalence of impairment in balance, falls and fear of falling.

Reduced thermal threshold in patients with Temporomandibular Disorders.

BACKGROUND: Many studies have demonstrated the presence of somatosensory modulation changes at different sites in patients with temporomandibular disorders (TMDs) using different modalities. However, the neck area, a well-know condition related to TMD, remains unexplored. OBJECTIVE: To assess the thermal pain threshold in patients with TMD and controls at cephalic and extra-cephalic areas, including the neck. METHODS: Twenty female patients with TMDs diagnosed by the Research Diagnostic Criteria for TMD (RDC/TMD) and twenty age-matched controls underwent a first interview about neck pain and disability (NDI questionnaire). A blinded evaluator assessed the thermal pain threshold for cold (CPT) and heat (HPT) stimuli in accordance with an ascending method of limits of the Quantitative Sensory Testing at the following sites: periorbital, masseter, cervical posterior and ventral forearm. The groups were compared using a t-test with α = 5%. RESULTS: Patients with TMDs reported pain at higher temperature for cold stimuli in all sites (P < 0·05) and at lower temperature for heat stimuli in the right periorbital site (P < 0·05) than controls. Pain and disability due tothis symptom were reported more often in the TMD group (P < 0·05). CONCLUSION: Patients with TMD have pain modulation changes in the neck area as well, especially for cold stimuli, associated with higher disability and a higher report of neck pain than controls. These findings reinforce the evidence regarding the relationship between TMDs and neck pain.