Unterscheiden sich Patienten mit episodischer Migräne ohne Aura hinsichtlich der zervikalen muskuloskelettalen Funktion von einer symptomfreien Kontrollgruppe ohne Migräne?

Zusammenfassung

Kopfschmerzen stellen für viele Menschen eine große Beeinträchtigung dar. Ziel der Arbeit war es, klinische Tests, die bereits bei Patienten mit Nackenschmerzen oder Whiplash Associated Disorders (WAD) angewandt werden, bei Migränepatienten ohne Aura im Vergleich mit einer symptomfreien Kontrollgruppe durchzuführen.

Im Rahmen einer Querschnittstudie wurden die Ergebnisse aus 2 Fragebögen und 6 klinischen Tests von Patienten mit episodischer Migräne (n = 23) mit den Ergebnissen einer symptomfreien Kontrollgruppe (n = 15) verglichen. Die Ergebnisse zeigten hoch signifikante Unterschiede (p < 0,001) zwischen den Gruppen für die Fragebögen und signifikante Unterschiede bei den Kopf-Auge-Bewegungskontrolltests, dem Joint-Position-Error-Test, Zervikalen Flexions-Rotations-Test, Fukuda-Stepping-Test (Merkmal > 45° Körperrotation) sowie dem Kraniozervikalen Flexionstest. Kein signifikanter Unterschied (p > 0,05) zeigte sich bei dem Fukuda-Stepping-Test (Merkmal > 1 m Vorwärtsgehen) sowie für den Single-Leg-Stance.

Verschiedene sensomotorische, okulomotorische und muskuloskelettale Auffälligkeiten konnten bei Patienten mit episodischer Migräne ohne Aura in dieser Studie aufgezeigt werden. Für therapeutische Prozesse sollten daher die Tests in Untersuchungsabläufe integriert werden. Es bedarf jedoch weiterer Studien, um die Effektivität von Therapien, die auf diese Dysfunktionen Einfluss nehmen, zu bewerten.

Abstract

Headaches are a severe impairment for a great number of people. It was the aim of this study to conduct clinical tests which had already been used for patients with cervical pain or whiplash-associated disorders (WAD) on patients who suffer from migraine without aura compared to a symptom-free control group.

In a cross sectional-study, outcomes from 2 questionnaires and 6 clinical tests of patients with episodic migraine (n = 23) were compared to those of a symptom-free control group (n = 15). The differences in outcome between the groups were highly significant (p < 0.001) for the questionnaires and significant for the head-eye motion control test, the joint position error test, the cervical flexion-rotation test, the Fukuda stepping test (item body rotation > 45°) as well as the craniocervical flexion test. No significant differences in outcome (p > 0.05) were noted for the Fukuda stepping test (item > 1 m forward walking) and the single leg stance.

This study showed several distinctive sensomotoric, oculomotoric and musculoskeletal issues in patients suffering from episodic migraine without aura. Therefore, these tests should be integrated into the therapeutic process at assessment level. However, further studies are needed to evaluate the effectiveness of therapies which address these dysfunctions.

Schlüsselwörter

Kopfschmerzen - Migräne - Nackenschmerzen - muskuloskelettale Dysfunktion

Key words

headache - migraine - neck pain - musculoskeletal dsyfu

• Literatur

• 1 Jay GW, Barkin RL. Primary Headache Disorders Part I- Migraine and the Trigeminal Autonomic Cephalalgias. Dis Mon 2017; 63: 308-38
• 2 Berg J, Stovner LJ. Cost of migraine and other headaches in Europe. Eur J Neurol 2005; 1: 59-62
• 3 Luedtke K, Boissonnault W, Caspersen N. et al. International consensus on the most useful physical examination tests used by physiotherapists for patients with headache: A Delphi study. Man Ther 2016; 23: 17-24
• 4 Jensen R, Stovner LJ. Epidemiology and comorbidity of headache. Lancet Neurol 2008; 7: 354-61
• 5 Ferracini GN, Florencio LL, Dach F. et al. Musculoskeletal disorders of the upper cervical spine in women with episodic or chronic migraine. Eur J Phys Rehabil Med 2017; 53: 342-50
• 6 GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1211-59
• 7 Steiner TJ, Stovner LJ, Vos T. et al. Migraine is first cause of disability in under 50 s: will health politicians now take notice?. J Headache Pain 2018; 19: 17
• 8 Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3 rd edition. Cephalalgia 2018; 38: 1-211
• 9 Bartsch T. Migraine and the neck: new insights from basic data. Curr Pain Headache Rep 2005; 9: 191-6
• 10 Luedtke K, May A. Stratifying migraine patients based on dynamic pain provocation over the upper cervical spine. J Headache Pain 2017; 18: 97
• 11 Carville S, Padhi S, Reason T. et al. Diagnosis and management of headaches in young people and adults: summary of NICE guidance. BMJ 2012; 345: e5765
• 12 Kernick DP, Goadsby PJ. Royal College of General Practitioners, British Association for the Study of Headache. Guidance for the management of headache in sport on behalf of The Royal College of General Practitioners and The British Association for the Study of Headache. Cephalalgia 2011; 31: 106-11
• 13 Treleaven J, Jull G, Grip H. Head eye co-ordination and gaze stability in subjects with persistent whiplash associated disorders. Man Ther 2011; 16: 252-7
• 14 Watson DH, Drummond PD. Head pain referral during examination of the neck in migraine and tension-type headache. Headache 2012; 52: 1226-35
• 15 Luedtke K, Starke W, May A. Musculoskeletal dysfunction in migraine patients. Cephalalgia 2018; 38: 865-75
• 16 Jull G, Hall T. Cervical musculoskeletal dysfunction in headache: How should it be defined?. Musculoskelet Sci Pract 2018; 38: 148-50
• 17 Jacobson GP, Ramadan NM, Norris L. et al. Headache disability inventory (HDI): short-term test-retest reliability and spouse perceptions. Headache 1995; 35: 534-9
• 18 Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther 1991; 14: 409-15
• 19 Cramer H, Lauche R, Langhorst J. et al. Validation of the German version of the Neck Disability Index (NDI). BMC Musculoskelet Disorders 2014; 15: 91
• 20 Castien R, De Hertogh W. A Neuroscience Perspective of Physical Treatment of Headache and Neck Pain. Front Neurol 2019; 10: 276
• 21 Young IA, Dunning J, Butts R. et al. Psychometric properties of the Numeric Pain Rating Scale and Neck Disability Index in patients with cervicogenic headache. Cephalalgia 2019; 39: 44-51
• 22 Della Casa E, Affolter Helbling J, Meichtry A. et al. Head-eye movement control tests in patients with chronic neck pain; inter-observer reliability and discriminative validity. BMC Musculoskelet Disord 2014; 15: 16
• 23 Revel M, Andre-Deshays C, Minguet M. Cervicocephalic kinesthetic sensibility in patients with cervical pain. Arch Phys Med Rehabil 1991; 72: 288-91
• 24 de Vries J, Ischebeck BK, Voogt LP. et al. Joint position sense error in people with neck pain: A systematic review. Man Ther 2015; 20: 736-44
• 25 Beinert K, Lutz B, Zieglgänsberger W. et al. Seeing the site of treatment improves habitual pain but not cervical joint position sense immediately after manual therapy in chronic neck pain patients. Eur J Pain 2019; 23: 117-23
• 26 Oliveira-Souza AIS, Florencio LL, Carvalho GF. et al. Reduced flexion rotation test in women with chronic and episodic migraine. Braz J Phys Ther 2019; 23: 387-94
• 27 Kristjansson E, Treleaven J. Sensorimotor function and dizziness in neck pain: implications for assessment and management. J Orthop Sports Phys Ther 2009; 39: 364-77
• 28 Silva AG, Cruz AL. Standing balance in patients with whiplash-associated neck pain and idiopathic neck pain when compared with asymptomatic participants: A systematic review. Physiother Theory Pract 2013; 29: 1-18
• 29 Field S, Treleaven J, Jull G. Standing balance: a comparison between idiopathic and whiplash-induced neck pain. Man Ther 2008; 13: 183-91
• 30 Stokell R, Yu A, Williams K. et al. Dynamic and functional balance tasks in subjects with persistent whiplash: a pilot trial. Man Ther 2011; 16: 394-8
• 31 Elsig S, Luomajoki H, Sattelmayer M. et al. Sensorimotor tests, such as movement control and laterality judgment accuracy, in persons with recurrent neck pain and controls. A case-control study. Man Ther 2014; 19: 555-61
• 32 Falla D, Bilenkij G, Jull G. Patients with chronic neck pain demonstrate altered patterns of muscle activation during performance of a functional upper limb task. Spine 2004; 29: 1436-40
• 33 Jull G, Kristjansson E, Dall’Alba P. Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients. Man Ther 2004; 9: 89-94
• 34 Liang Z, Galea O, Thomas L. et al. Cervical musculoskeletal impairments in migraine and tension type headache: A systematic review and meta-analysis. Musculoskelet Sci Pract 2019; 42: 67-83