• Gabriela N Ferracini, Lidiane L Florencio, Fabíola Dach, Bevilaqua Grossi Débora D Departament of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation, Faculty of Medicine of Ribeirão Preto, University of São Paulo, FM, María Palacios-Ceña, Carlos Ordás-Bandera, Thais C Chaves, José G Speciali, and César Fernández-de-Las-Peñas.
• Department of Neurosciences and Behavioral Sciences, Faculty of Medicine of Ribeirão Preto, University of São Paulo, FMRP-USP, Ribeirão Preto, São Paulo, Brazil.
• Eur J Phys Rehabil Med. 2017 Jun 1; 53 (3): 342-350.

BackgroundThe role of musculoskeletal disorders of the cervical spine in migraine is under debate.AimTo investigate differences in musculoskeletal impairments of the neck including active global and upper cervical spine mobility, the presence of symptomatic upper cervical spine joints, cervicocephalic kinesthesia and head/neck posture between women with episodic migraine, chronic migraine, and controls.DesignA cross-sectional study.SettingTertiary university-based hospital.PopulationFifty-five women with episodic migraine, 16 with chronic migraine, and 22 matched healthy women.MethodsActive cervical range of motion, upper cervical spine mobility (i.e., flexion-rotation test), referred pain from upper cervical joints, cervicocephalic kinesthesia (joint position sense error test, JPSE), and head/neck posture (i.e. the cranio-vertebral and cervical lordosis angles) were assessed by an assessor blinded to the subject's condition.ResultsWomen with migraine showed reduced cervical rotation than healthy women (P=0.012). No differences between episodic and chronic migraine were found in cervical mobility. Significant differences for flexion-rotation test were also reported, suggesting that upper cervical spine mobility was restricted in both migraine groups (P<0.001). Referred pain elicited on manual examination of the upper cervical spine mimicking pain symptoms was present in 50% of migraineurs. No differences were observed on the frequency of symptomatic upper cervical joints between episodic and chronic migraine. No differences on JPSE or posture were found among groups (P>0.121).ConclusionsWomen with migraine exhibit musculoskeletal impairments of the upper cervical spine expressed as restricted cervical rotation, decreased upper cervical rotation, and the presence of symptomatic upper cervical joints. No differences were found between episodic or chronic migraine.Clinical Rehabilitation ImpactIdentification treatment of the musculoskeletal impairments of the cervical spine may help to clinician for better management of patients with migraine.

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