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.

Differences and similarities between COVID-19 related-headache and COVID-19 vaccine related-headache. A case-control study. / Diferencias y similitudes entre la cefalea relacionada con la COVID-19 y la cefalea relacionada con la vacuna de la COVID-19. Un estudio de casos y controles.

INTRODUCTION: Headache is a frequent symptom at the acute phase of coronavirus disease 2019 (COVID-19) and also one of the most frequent adverse effects following vaccination. In both cases, headache pathophysiology seems linked to the host immune response and could have similarities. We aimed to compare the clinical phenotype and the frequency and associated onset symptoms in patients with COVID-19 related-headache and COVID-19 vaccine related-headache. SUBJECTS AND METHODS: A case-control study was conducted. Patients with confirmed COVID-19 infection and COVID-19-vaccine recipients who experienced new-onset headache were included. A standardised questionnaire was administered, including demographic variables, prior history of headaches, associated symptoms and headache-related variables. Both groups were matched for age, sex, and prior history of headache. A multivariate regression analysis was performed. RESULTS: A total of 238 patients fulfilled eligibility criteria (143 patients with COVID-19 related-headache and 95 subjects experiencing COVID-19 vaccine related-headache). Patients with COVID-19 related-headache exhibited a higher frequency of arthralgia, diarrhoea, dyspnoea, chest pain, expectoration, anosmia, myalgia, odynophagia, rhinorrhoea, cough, and dysgeusia. Further, patients with COVID-19 related-headache had a more prolonged daily duration of headache and described the headache as the worst headache ever experienced. Patients with COVID-19 vaccine-related headache, experienced more frequently pain in the parietal region, phonophobia, and worsening of the headache by head movements or eye movements. CONCLUSION: Headache caused by SARS-CoV-2 infection and COVID-19 vaccination related-headache have more similarities than differences, supporting a shared pathophysiology, and the activation of the innate immune response. The main differences were related to associated symptoms.

TITLE: Diferencias y similitudes entre la cefalea relacionada con la COVID-19 y la cefalea relacionada con la vacuna de la COVID-19. Un estudio de casos y controles.Introducción. La cefalea es un síntoma frecuente en la fase aguda de la enfermedad por coronavirus 2019 (COVID-19) y también uno de los efectos adversos más comunes tras la vacunación. En ambos casos, la fisiopatología de la cefalea parece estar relacionada con la respuesta inmunitaria del huésped y podría presentar similitudes. Nuestro objetivo fue comparar el fenotipo clínico y la frecuencia de los síntomas asociados y los síntomas de inicio en pacientes con cefalea relacionada con la COVID-19 y cefalea relacionada con la vacuna de la COVID-19. Sujetos y métodos. Se realizó un estudio de casos y controles. Se incluyó a pacientes con infección confirmada por COVID-19 y receptores de la vacuna de la COVID-19 que experimentaron un nuevo inicio de cefalea. Se administró un cuestionario estandarizado que incluyó variables demográficas, antecedentes previos de cefaleas, síntomas asociados y variables relacionadas con la cefalea. Ambos grupos se emparejaron por edad, sexo y antecedentes previos de cefaleas. Se realizó un análisis de regresión multivariante. Resultados. Un total de 238 pacientes cumplieron con los criterios de elegibilidad (143 pacientes con cefalea relacionada con la COVID-19 y 95 sujetos con cefalea relacionada con la vacuna de la COVID-19). Los pacientes con cefalea relacionada con la COVID-19 presentaron una mayor frecuencia de artralgia, diarrea, disnea, dolor torácico, expectoración, anosmia, mialgia, odinofagia, rinorrea, tos y disgeusia. Además, los pacientes con cefalea relacionada con la COVID-19 experimentaron una duración diaria más prolongada de la cefalea y describieron la cefalea como la peor que habían experimentado. Los pacientes con cefalea relacionada con la vacuna de la COVID-19 experimentaron con más frecuencia dolor en la región parietal, fonofobia y empeoramiento de la cefalea por movimientos de la cabeza o de los ojos. Conclusión. La cefalea causada por la infección por el SARS-CoV-2 y la cefalea relacionada con la vacunación de la COVID-19 presentan más similitudes que diferencias, lo que respalda una fisiopatología compartida y la activación de la respuesta inmunitaria innata. Las principales diferencias estuvieron relacionadas con los síntomas asociados.

Pain extent is associated with Central Sensitization Inventory but not widespread pressure pain sensitivity or psychological variables in women with fibromyalgia.

OBJECTIVE: To investigate the relationship between pain extent, as a clinical sign of central sensitization, and clinical, psychological, and pressure sensitivity in women with fibromyalgia syndrome (FMS). METHOD: In this study, 126 females with FMS completed demographic (age, gender, body mass index, height, weight), clinical (pain history, and pain intensity at rest and during daily living activities), psychological (depression and anxiety levels), and neurophysiological [pressure pain threshold (PPT)] assessments. The Central Sensitization Inventory (CSI) was also used to collect self-reported symptoms of sensitization. Pain extent and frequency maps were obtained from pain drawings using customized software. After conducting a multivariable correlation analysis to determine the relationships between variables, a stepwise linear regression model analysis was performed to identify variables associated with pain extent. RESULTS: Pain extent was positively associated with age (r = 0.17), years with pain (r = 0.27), pain during daily life activities (r = 0.27), and CSI (r = 0.42) (all p < 0.05). The stepwise regression analysis revealed that 27.8% of the pain extent was explained by CSI, age, and years with pain. CONCLUSIONS: This study found that larger pain extent was associated with self-reported outcomes, i.e. CSI, but not neurophysiological outcomes, i.e. PPTs, of sensitization in women with FMS. Older age and a longer history with pain symptoms were also associated with larger pain extent.

Evaluación y mejora de la calidad asistencial en fisioterapia a pacientes con cefalea / Evaluation and improvement of healthcare quality in patients with headache attending physical theray

Fundamento: Evaluar el efecto de un ciclo de mejora en la atención a pacientes con cefalea en dos centros de Fisioterapia sobre la calidad asistencial y su asociación con la satisfacción percibida y su mejora clínica. Métodos: Para medir la calidad asistencial se observó el cumplimiento de quince criterios de calidad en las historias clínicas de todos los pacientes con diagnóstico de cefalea tensional, cervicogénica o migraña en dos centros de Fisioterapia entre 2010 y 2014. En 2015, tras introducir en uno de los centros (C1) medidas correctivas, se reevaluó la calidad asistencial en ambos centros, usando el otro como control (C2). Resultados: En la primera evaluación, en ambos centros se observó un número muy elevado de incumplimientos en todos los criterios. Tras el ciclo de mejora, en el C1 hubo un aumento significativo en el cumplimiento de los criterios de calidad, como la entrega de un calendario de cefalea, que pasó del 0% a un 100% de cumplimiento, o el uso de la escala HIT-6, que pasó del 30 a un 100%, Asimismo, hubo una mejor valoración en la calidad percibida por el paciente en el C1 respecto al C2, incluyendo una mejora en el estado de salud. Conclusiones: El uso de la metodología de mejora de la calidad, con iniciativa interna, obtuvo mejoras significativas tanto en la calidad de la atención prestada como en la percepción que tienen los usuarios de los servicios de fisioterapia, así como en la salud de los pacientes

Background: To evaluate the effects on healthcare quality following implementation of a program to improve care for individuals with headache in two physical therapy clinics and its association with outcomes and self-perceived improvement. Methods: We assessed healthcare quality by creating a questionnaire on fulfilment of fifteen quality criteria included in the clinical history of individuals suffering from tension-type, cervicogenic or migraine headaches seeking physical therapy between 2010 and 2014. In 2015, after applying a program to improve care in one center (C1), we reassessed the same fulfilment questionnaire in both centers, using the other center (C2) as control. Results: In the first evaluation there was a huge number of cases of non-compliance of all the criteria in both centers. After implementation of the care improvement program in C1 a significant improvement was observed in some items, as use of a headache diary, which rose from 0 to 100%, or use of the HIT-6 disability questionnaire, which rose from 30 to 100%. In addition, there was a significant improvement in self-perceived health status after implementation of the care program in C1. Conclusions: The implementation of a care improvement program was effective in improving healthcare quality for individuals with headache attending physical therapy services

[Evaluation and improvement of healthcare quality in patients with headache attending physical therapy]. / Evaluación y mejora de la calidad asistencial en fisioterapia a pacientes con cefalea.

BACKGROUND: To evaluate the effects on healthcare quality following implementation of a program to improve care for individuals with headache in two physical therapy clinics and its association with outcomes and self-perceived improvement. METHODS: We assessed healthcare quality by creating a questionnaire on fulfilment of fifteen quality criteria included in the clinical history of individuals suffering from tension-type, cervicogenic or migraine headaches seeking physical therapy between 2010 and 2014. In 2015, after applying a program to improve care in one center (C1), we reassessed the same fulfilment questionnaire in both centers, using the other center (C2) as control. RESULTS: In the first evaluation there was a huge number of cases of non-compliance of all the criteria in both centers. After implementation of the care improvement program in C1 a significant improvement was observed in some items, as use of a headache diary, which rose from 0 to 100%, or use of the HIT-6 disability questionnaire, which rose from 30 to 100%. In addition, there was a significant improvement in self-perceived health status after implementation of the care program in C1. CONCLUSIONS: The implementation of a care improvement program was effective in improving healthcare quality for individuals with headache attending physical therapy services.

Assessment of deep dynamic mechanical sensitivity in individuals with tension-type headache: The dynamic pressure algometry.

BACKGROUND: To explore the validity of dynamic pressure algometry for evaluating deep dynamic mechanical sensitivity by assessing its association with headache features and widespread pressure sensitivity in tension-type headache (TTH). METHODS: One hundred and eighty-eight subjects with TTH (70% women) participated. Deep dynamic sensitivity was assessed with a dynamic pressure algometry set (Aalborg University, Denmark© ) consisting of 11 different rollers including fixed levels from 500 g to 5300 g. Each roller was moved at a speed of 0.5 cm/s over a 60-mm horizontal line covering the temporalis muscle. Dynamic pain threshold (DPT-level of the first painful roller) was determined and pain intensity during DPT was rated on a numerical pain rate scale (NPRS, 0-10). Headache clinical features were collected on a headache diary. As gold standard, static pressure pain thresholds (PPT) were assessed over temporalis, C5/C6 joint, second metacarpal, and tibialis anterior muscle. RESULTS: Side-to-side consistency between DPT (r = 0.843, p < 0.001) and pain evoked (r = 0.712; p < 0.001) by dynamic algometer was observed. DPT was moderately associated with widespread PPTs (0.526 > r > 0.656, all p < 0.001). Furthermore, pain during DPT was negatively associated with widespread PPTs (-0.370 < r < -0.162, all p < 0.05). DISCUSSION: Dynamic pressure algometry was a valid tool for assessing deep dynamic mechanical sensitivity in TTH. DPT was associated with widespread pressure sensitivity independently of the frequency of headaches supporting that deep dynamic pressure sensitivity within the trigeminal area is consistent with widespread pressure sensitivity. Assessing deep static and dynamic somatic tissue pain sensitivity may provide new opportunities for differentiated diagnostics and possibly a new tool for assessing treatment effects. SIGNIFICANCE: The current study found that dynamic pressure algometry in the temporalis muscle was associated with widespread pressure pain sensitivity in individuals with tension-type headache. The association was independent of the frequency of headaches. Assessing deep static and dynamic somatic tissue pain sensitivity may provide new opportunities for differentiated diagnostics and possibly a tool for assessing treatment effects.

Effectiveness of manual therapy versus surgery in pain processing due to carpal tunnel syndrome: A randomized clinical trial.

BACKGROUND: People with carpal tunnel syndrome (CTS) exhibit widespread pressure pain and thermal pain hypersensitivity as a manifestation of central sensitization. The aim of our study was to compare the effectiveness of manual therapy versus surgery for improving pain and nociceptive gain processing in people with CTS. METHODS: The trial was conducted at a local regional Hospital in Madrid, Spain from August 2014 to February 2015. In this randomized parallel-group, blinded, clinical trial, 100 women with CTS were randomly allocated to either manual therapy (n = 50), who received three sessions (once/week) of manual therapies including desensitization manoeuvres of the central nervous system, or surgical intervention (n = 50) group. Outcomes including pressure pain thresholds (PPT), thermal pain thresholds (HPT or CPT), and pain intensity which were assessed at baseline, and 3, 6, 9 and 12 months after the intervention by an assessor unaware of group assignment. Analysis was by intention to treat with mixed ANCOVAs adjusted for baseline scores. RESULTS: At 12 months, 95 women completed the follow-up. Patients receiving manual therapy exhibited higher increases in PPT over the carpal tunnel at 3, 6 and 9 months (all, p < 0.01) and higher decrease of pain intensity at 3 month follow-up (p < 0.001) than those receiving surgery. No significant differences were observed between groups for the remaining outcomes. CONCLUSIONS: Manual therapy and surgery have similar effects on decreasing widespread pressure pain sensitivity and pain intensity in women with CTS. Neither manual therapy nor surgery resulted in changes in thermal pain sensitivity. SIGNIFICANCE: The current study found that manual therapy and surgery exhibited similar effects on decreasing widespread pressure pain sensitivity and pain intensity in women with carpal tunnel syndrome at medium- and long-term follow-ups investigating changes in nociceptive gain processing after treatment in carpal tunnel syndrome.

The use of unsafe abbreviations in discharge report and medical prescription: Observational and retrospective study / El uso de abreviaturas no recomendadas en el informe de alta y prescripción médica: Estudio observacional retrospectivo.

Background. The medical record represents the transcript of the pathologic narrative of a patient. Our aims were: to identify the most common abbreviations present in medical records; to identify discouraged abbreviations; to identify polysemic abbreviations; and to show the distribution of the abbreviations according to the type of ward (medical-surgical). Methods. An observational, descriptive and retrospective study by auditing the digital clinical records of patients discharged from FuenlabradaUniversityHospital in 2013 was conducted. Abbreviations in discharge reports and medical order prescriptions present in 78 medical records, corresponding to 39 men and 39 women of different services, were reviewed. Results. All medical records showed abbreviations. The mean of abbreviations in each medical record was 38.9±17.7. Medical records showed 688 different abbreviations, which were repeated up to a total of 3,038 times. The most frequent abbreviations were HTA (n=98; 3.23%), AP (n=89; 2.93%). Twenty-eight abbreviations considered unsafe appeared and were repeated 646 times. The most frequent included SC (n=63; 9.75%), ui (n=49; 7.59%), > (n=38; 5.88%), mcg (n=36; 5.57%). Twenty-three polysemic abbreviations were also identified, the most frequent being H (n=117; 12.81%), MC (n= 109; 11.94%), MP (n=99; 10.84%). Finally, medical wards had 1,866 abbreviations and surgical 1,172 (P <0.001). Conclusions. All medical records revised included unsafe abbreviations. The use of unsafe abbreviations was common among medical services.

El uso de abreviaturas no recomendadas en el informe de alta y prescripción médica: estudio observacional retrospectivo / The use of unsafe abbreviations in discharge report and medical prescription: observational and retrospective study

Fundamento: La historia clínica es la transcripción del relato patográfico del paciente. Los objetivos de este trabajo fueron: identificar las abreviaturas más frecuentes presentes en la historia clínica, identificar las abreviaturas desaconsejadas, identificar abreviaturas polisémicas, y describir su distribución según servicio (médico-quirúrgico). Material y métodos: Estudio observacional, descriptivo y retrospectivo mediante auditoría de historia clínica digitalizada de pacientes dados de alta del hospital Universitario Fuenlabrada en el año 2013. Se revisaron las abreviaturas de los informes de alta y las órdenes de prescripción en 78 historias clínicas (39 hombres y 39 mujeres) de diferentes servicios. Resultados: El 100% de las historias revisadas presentaron abreviaturas (media: 38,95; DS 17,7). Se encontraron 688 abreviaturas diferentes, que se repetían hasta llegar a un total de 3.038. Las más frecuentes fueron: HTA (n=98; 3,23%), AP (n=89; 2,93%), SC (n=63; 2,07%). Se identificaron 28 abreviaturas desaconsejadas, repitiéndose 646 veces. Las más frecuentes fueron: SC (n=63; 9,75%), ui (n=49; 7,59%), > (n=38; 5,88%), mcg (n=36; 5,57%). Se identificaron 23 abreviaturas polisémicas, siendo las más frecuentes: H (n=117; 12,81%), MC (n= 109; 11,94%), MP (n=99; 10,84%). Finalmente, los servicios médicos presentaron 1.866 abreviaturas y los quirúrgicos 1.172 (p<0,001). Conclusiones: Todas las historias clínicas presentaron abreviaturas de riesgo, y el uso de abreviaturas desaconsejadas fue habitual en los servicios de medicina (AU)

Background: The medical record represents the transcript of the pathologic narrative of a patient. Our aims were: to identify the most common abbreviations present in medical records; to identify discouraged abbreviations; to identify polysemic abbreviations; and to show the distribution of the abbreviations according to the type of ward (medical-surgical). Methods: An observational, descriptive and retrospective study by auditing the digital clinical records of patients discharged from Fuenlabrada University Hospital in 2013 was conducted. Abbreviations in discharge reports and medical order prescriptions present in 78 medical records, corresponding to 39 men and 39 women of different services, were reviewed. Results: All medical records showed abbreviations. The mean of abbreviations in each medical record was 38.9±17.7. Medical records showed 688 different abbreviations, which were repeated up to a total of 3,038 times. The most frequent abbreviations were HTA (n=98; 3.23%), AP (n=89; 2.93%). Twenty-eight abbreviations considered unsafe appeared and were repeated 646 times. The most frequent included SC (n=63; 9.75%), ui (n=49; 7.59%), > (n=38; 5.88%), mcg (n=36; 5.57%). Twenty-three polysemic abbreviations were also identified, the most frequent being H (n=117; 12.81%), MC (n= 109; 11.94%), MP (n=99; 10.84%). Finally, medical wards had 1,866 abbreviations and surgical 1,172 (P <0.001). Conclusions: All medical records revised included unsafe abbreviations. The use of unsafe abbreviations was common among medical services (AU)

Myogenic temporomandibular disorders: Clinical systemic comorbidities in a female population sample.

BACKGROUND: Myogenic temporomandibular disorders (MTMD) frequently coexist with other clinical conditions in the same individual. In the last decades, several authors have analyzed these comorbidities looking for the origin of this overlapping. Objetives: The aim of this study was to perform a comparative anaylisis between a group of patients with MTMD and a control group of dental patients without dysfunctional pathology to assess whether there are significant differences in the presence of systemic medical comorbidities between the two groups. MATERIAL AND METHODS: Restrospective epidemiological analysis, based on medical questionnaires in a group of 31 patients, women, aged from 24 to 58 (average 39.96 years), diagnosed with MTMD (Masticatory Myofascial Pain), with a control group with the same number of individuals, gender and age range to evaluate if there is a significant statistical difference in the presence of medical comorbidities in this group of patients with MTMD and if they are in a higher risk of suffering different pathological conditions. RESULTS: It was found that the group affected by MTMD presented many more associated medical conditions than the control group: health changes during the last year, medical evaluations and treatments, presence of pain, sinus disease, tinnitus, headache, joint pain, ocular disorders, fatigue, dizziness, genitourinary disorders and xerostomia among others; and they were also in a higher risk to suffer other pathological entities as headaches and articular pain. CONCLUSIONS: These results reinforce our hypothesis that MTMD belong to a group of medical conditions triggered by a loss of equilibrium of the individual's Psycho-Neuro-Endocrine-Immune (PNEI) Axis that produces alterations in the response against external stimuli in some genetically predisposed individuals. It is, therefore, necessary to change the way of diagnosing and managing these individual's medical conditions, being mandatory to look from a more multidisciplinary perspective than the one we are currently offering.

Eficacia de la terapia manual en el tratamiento de la cefalea tensional. Una revisión sistemática desde el año 2000 hasta el 2013 / Efficacy of manual therapy in the treatment of tension-type headache. A systematic review from 2000-2013

Objetivos: Estudiar la eficacia de la terapia manual en el tratamiento de la cefalea tensional (CT) valorando los estudios controlados aleatorizados (ECA) publicados desde el año 2000 hasta abril del 2013. Métodos: Se realizó la búsqueda en las bases de datos MEDLINE, EBSCO, CINAHL, SCOPUS, PEDRO y OVID. Se incluyeron ECA que analizasen a pacientes con CT tratados con terapia manual y que recogiesen como variable de resultado la intensidad, frecuencia, duración del dolor de cabeza. La calidad metodológica fue valorada por 2 revisores independientes mediante la escala Jadad. Los datos de los ECA fueron extraídos por 2 revisores. Resultados: Se seleccionaron 14 ECA. Doce de ellos se consideraron de calidad aceptable (Jadad ≥ 3) y 2 de baja (Jadad = 2). Los estudios mostraron resultados positivos obteniendo disminución de la intensidad y/o frecuencia de cefaleas, reducción del consumo de medicamentos y mejora de la calidad de vida en pacientes con CT. Conclusiones: Debido a la heterogeneidad en diseños, instrumentos de medida y tratamientos de los estudios, no es posible obtener conclusiones definitivas sobre la eficacia de la terapia manual en pacientes con CT aunque se aprecien efectos beneficiosos. No obstante, el análisis de los estudios indica que, al recibir tratamiento con terapia manual, los pacientes con CT evolucionaron de forma más favorable respecto a aquellos que recibieron tratamiento habitual o un tratamiento placebo. Se requiere un mayor número de estudios con mayor calidad metodológica, así como mayor homogeneidad de los tratamientos y de los métodos de valoración de los resultados, para determinar la eficacia de la terapia manual en la CT

Objectives: To study the efficacy of manual therapy in the treatment of tension-type headache (TTH) by assessing the quality of randomized control trials (RCTs) published from the year 2000 to April 2013. Methods: A search was performed in the following databases: MEDLINE, EBSCO, CINAHL, SCOPUS, PEDRO and OVID. An analysis was made of RCT including patients with TTH receiving any manual therapy, and assessing outcome measures including the intensity, and frequency or duration of the headache. Two independent referees reviewed the methodological quality of RCTs using the Jadad scale. Data from the studies were extracted by two different reviewers. Results: A total of fourteen RCTs were selected. Twelve studies showed acceptable quality (Jadad scale ≥3), and the remaining 2 had low quality (Jadad = 2). The studies showed positive results, including reduction in headache intensity and/or frequency, reduction of medication consumption, and improvement in quality of life. Conclusions: The effectiveness of manual therapy for TTH cannot be completely assessed due to the heterogeneity in study design, outcome measures, and different treatments. Nevertheless, the results suggest patients with TTH receiving manual therapies showed better progress than those receiving conventional treatment or placebo. Further studies of high quality using manual therapy protocols, and also including standardized outcome measures, are now needed to clarify the efficacy of manual therapy in the management of TTH

International consensus on the most useful physical examination tests used by physiotherapists for patients with headache: A Delphi study.

BACKGROUND: A wide range of physical tests have been published for use in the assessment of musculoskeletal dysfunction in patients with headache. Which tests are used depends on a physiotherapist's clinical and scientific background as there is little guidance on the most clinically useful tests. OBJECTIVES: To identify which physical examination tests international experts in physiotherapy consider the most clinically useful for the assessment of patients with headache. DESIGN/METHODS: Delphi survey with pre-specified procedures based on a systematic search of the literature for physical examination tests proposed for the assessment of musculoskeletal dysfunction in patients with headache. RESULTS: Seventeen experts completed all three rounds of the survey. Fifteen tests were included in round one with eleven additional tests suggested by the experts. Finally eleven physical examination tests were considered clinically useful: manual joint palpation, the cranio-cervical flexion test, the cervical flexion-rotation test, active range of cervical movement, head forward position, trigger point palpation, muscle tests of the shoulder girdle, passive physiological intervertebral movements, reproduction and resolution of headache symptoms, screening of the thoracic spine, and combined movement tests. CONCLUSIONS: Eleven tests are suggested as a minimum standard for the physical examination of musculoskeletal dysfunctions in patients with headache.

Topographical pressure pain sensitivity maps of the shoulder region in individuals with subacromial pain syndrome.

BACKGROUND: Topographical pain maps (TPM) are useful tools to assess deep tissue sensitivity in musculoskeletal pain conditions. There is evidence suggesting bilateral sensitivity in subacromial pain syndrome (SAPS), although it is not widely accepted. No previous study has investigated TPM of the shoulder in SAPS. OBJECTIVE: To investigate whether differences for TPM of the shoulder are evident among patients with unilateral SAPS and controls. METHODS: Pressure pain thresholds (PPTs) were assessed 3 times at each point and there was a 20 s rest period between each one. The TPM were calculated using 29 pre-determined points on both shoulders in all groups by inverse distance weighted interpolation of PPT data. Multivariate Analysis of Covariance was applied to detect differences in PPTs between groups, sides, points (gender as covariate). RESULTS: The results revealed significant differences between points and genders (both, P < 0.001), but not between groups (P = 0.243) and sides (P = 0.812). Heterogeneous distribution of mechanical pain sensitivity was found in both groups as the PPTs were lower on the root spine of the scapula and the posterior border of the acromion (points 5-8, P < 0.05), glenohumeral joint (points 17-20, P < 0.01) and the anterior deltoid muscle (points 21-25, P < 0.001) compared to the average of the other sites on the shoulder. Women exhibited bilateral lower PPTs in all points than men in both groups (all, P < 0.01). CONCLUSIONS: This study revealed no differences for mechanical pain sensitivity in patients with SAPS experiencing lower levels of pain compared with matched controls, but showed heterogeneous distribution of PPTs in the shoulder.

Efficacy of manual therapy in the treatment of tension-type headache. A systematic review from 2000-2013. / Eficacia de la terapia manual en el tratamiento de la cefalea tensional. Una revisión sistemática desde el año 2000 hasta el 2013.

OBJECTIVES: To study the efficacy of manual therapy in the treatment of tension-type headache (TTH) by assessing the quality of randomized control trials (RCTs) published from the year 2000 to April 2013. METHODS: A search was performed in the following databases: MEDLINE, EBSCO, CINAHL, SCOPUS, PEDRO and OVID. An analysis was made of RCT including patients with TTH receiving any manual therapy, and assessing outcome measures including the intensity, and frequency or duration of the headache. Two independent referees reviewed the methodological quality of RCTs using the Jadad scale. Data from the studies were extracted by two different reviewers. RESULTS: A total of fourteen RCTs were selected. Twelve studies showed acceptable quality (Jadad scale ≥3), and the remaining 2 had low quality (Jadad=2). The studies showed positive results, including reduction in headache intensity and/or frequency, reduction of medication consumption, and improvement in quality of life. CONCLUSIONS: The effectiveness of manual therapy for TTH cannot be completely assessed due to the heterogeneity in study design, outcome measures, and different treatments. Nevertheless, the results suggest patients with TTH receiving manual therapies showed better progress than those receiving conventional treatment or placebo. Further studies of high quality using manual therapy protocols, and also including standardized outcome measures, are now needed to clarify the efficacy of manual therapy in the management of TTH.

[Association between the frequency and duration, but not the intensity, of headache with mechanical hypersensitivity and the health of patients with tension-type headache]. / Asociacion de la frecuencia y duracion, pero no la intensidad, de la cefalea con la hipersensibilidad mecanica y la salud en pacientes con cefalea de tension.

INTRODUCTION: The association between headache clinical parameters and other health-related and neuro-physiological outcomes is controversial. AIM: To investigate the association between headache frequency, duration and intensity with cranio-cervical pressure sensitivity considering the interaction of health-related and physical outcomes. PATIENTS AND METHODS: Seventy-two individuals with tension type headache were included. A 1-month diary was used to assess headache frequency, duration and intensity. Pressure pain thresholds (PPT) and peri-cranial tenderness to palpation, health-related quality of life (Short Form-36), disability, depression, and cervical range of motion were the outcomes. All outcomes were introduced into hierarchic logistic regression models to assess potential associations. RESULTS: Several associations between headache frequency and duration, but not intensity, with the remaining variables were found. Regression analysis showed that PPT over the temporalis muscle, bodily pain, age and physical role explained the 22.3% of the headache frequency, whereas general health, PPT over the upper trapezius and headache frequency explained 20% of headache duration (p < 0.001). CONCLUSIONS: This study found that headache frequency and duration, but not headache intensity, were associated with neurophysiological outcomes, e.g., cranio-cervical pressure sensitivity, and bodily pain in tension type headache. Other variables including age, physical role and general health were also associated with headache frequency and duration.

TITLE: Asociacion de la frecuencia y duracion, pero no la intensidad, de la cefalea con la hipersensibilidad mecanica y la salud en pacientes con cefalea de tension.Introduccion. La asociacion entre las variables clinicas de la cefalea y otras variables neurofisiologicas o de salud es controvertida. Objetivo. Determinar la asociacion de la frecuencia, duracion e intensidad del dolor con la sensibilidad mecanica craneocervical, considerando el efecto de otras variables de salud y fisicas. Pacientes y metodos. Se incluyeron 72 pacientes con cefalea de tension. Se mantuvo un diario mensual para determinar la frecuencia, duracion e intensidad del dolor. Se calcularon los umbrales de dolor a la presion (UDP) y la sensibilidad a la palpacion sobre la region craneocervical, calidad de vida (Short Form-36), discapacidad, depresion y movilidad cervical. Se introdujeron todas las variables en modelos de regresion logistica jerarquica para determinar las interacciones. Resultados. Se encontraron correlaciones entre la frecuencia y duracion de la cefalea, pero no la intensidad, con el resto de variables. El analisis de regresion mostro que la combinacion del UDP sobre el temporal, dolor corporal, edad y rol fisico explicaba el 22,3% de la varianza de la frecuencia, mientras que la combinacion de salud general, UDP sobre el trapecio superior y frecuencia del dolor explicaba el 20% de la varianza de la duracion (p < 0,001). Conclusiones. Este estudio ha encontrado que la frecuencia y la duracion de la cefalea, pero no la intensidad, se encuentran asociadas con variables neurofisiologicas, como el UDP sobre el cuello/cabeza o la percepcion de dolor generalizado en la cefalea tensional. Otras variables, como la edad, el rol fisico y la salud general tambien mostraron una asociacion con la frecuencia y la duracion de la cefalea.

Disability, quality of life, personality, cognitive and psychological variables associated with fatigue in patients with multiple sclerosis.

OBJECTIVE: To examine the associations between function, quality of life, personality, cognitive and psychological outcomes with fatigue in patients with MS. METHODS: One hundred and eight patients (54% women) with definite MS participated. MS-related fatigue was assessed with the Fatigue Impact Scale (FIS). Demographic and clinical data (weight, height, medication and history of pain), specific disease outcomes (Functional Assessment of Multiple Sclerosis/FAMS), general disease outcomes (Beck Depression Inventory/BDI-II, and Short-Form Health Survey 36/SF-36) and personality (NEO Five-Factor Inventory/NEOFFI) were assessed. Correlation and regression analyses were performed to determine associations between variables. RESULTS: A significant positive correlation existed between the FIS and EDSS (r=0.190; P<0.05). Significant negative correlations between the FIS with specific disease (FAMS mobility: r=-0.333, P<0.01; FAMS symptoms: r=-0.443, P<0.01; FAMS emotional well-being: r=-0.412, P<0.01; FAMS general contentment: r=-0.325, P<. 01; and, FAMS thinking/fatigue: r=-0.706, P<0.01); general disease (all domains SF36: -0.508