Meise Ruth, Lüdtke Kerstin, Probst Annette, Stude Philipp, Schöttker-Königer Thomas
Hochschule für Gesundheit, Bochum, Deutschland.
Institut für systemische Neurowissenschaften, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland.
Schmerz. 2019 Jun;33(3):204-211. doi: 10.1007/s00482-019-0369-z.
Chronic migraine (CM) is a primary headache type associated with a severe reduction in the quality of life. The association of sensorimotor dysfunction in the neck, measured with the joint position error test (JPE), and CM is largely unknown, even though up to 60% of migraine patients report neck pain accompanying the migraine.
This manuscript reports a systematic review of the literature on JPE in patients with headache as well as data on an observational study. To determine the JPE of migraine patients, 37 subjects with CM were tested and compared with a control group (CG; n = 22). In an additional analysis, CM patients were divided into two subgroups based on the medical treatment approach. The measurements were taken in the three movement dimensions with five repetitions in each direction using a laser pointer fixed to the head.
The mean JPE in the sagittal plane was 3.7° (SD ± 1.4°) and 3.1° (SD ± 1.1°) for CM (n = 37) and CG, respectively. In the transverse plane it was measured as 3.7° (SD ± 1.5°) for CM and 3.2° (SD ± 1°) for the CG, while it was 3.6° (SD ± 1.2°; CM) and 3.3° (SD ± 1.1°; CG) in the frontal plane. The between group difference was not significant for all movement planes. When groups according to the treatment regimen, both groups showed similar migraine and neck pain features but the JPE was significantly larger in the CM + BTh group compared to the CM without BTh group and the CG. In the sagittal plane, the JPE was 4.21° (SD ± 1.8°) for the CM + BTh compared to 2.99° (SD ± 1.2°) in CM without BTh and 3.21° (SD ± 1.2°) in the CG (p = 0.0053). The difference between CM + BTh and CM without BTh was 1.52° (p = 0.016) after propensity score matching in the sagittal plane.
Only patients in the CM + BTh group showed a statistically increased JPE. The influence of neck pain does not explain the between group difference. A possible factor is the degree of chronification. This study indicates that the JPE might discriminate a subgroup of migraine patients.
慢性偏头痛（CM）是一种与生活质量严重下降相关的原发性头痛类型。尽管高达60%的偏头痛患者报告偏头痛伴有颈部疼痛，但通过关节位置误差测试（JPE）测量的颈部感觉运动功能障碍与CM之间的关联在很大程度上尚不清楚。
本手稿报告了关于头痛患者JPE的文献系统综述以及一项观察性研究的数据。为了确定偏头痛患者的JPE，对37名CM患者进行了测试，并与对照组（CG；n = 22）进行比较。在另一项分析中，根据治疗方法将CM患者分为两个亚组。使用固定在头部的激光指针，在三个运动维度上进行测量，每个方向重复五次。
CM组（n = 37）和CG组在矢状面的平均JPE分别为3.7°（标准差±1.4°）和3.1°（标准差±1.1°）。在横断面中，CM组为3.7°（标准差±1.5°），CG组为3.2°（标准差±1°）；在额面中，CM组为3.6°（标准差±1.2°），CG组为3.3°（标准差±1.1°）。所有运动平面的组间差异均无统计学意义。根据治疗方案分组时，两组的偏头痛和颈部疼痛特征相似，但CM + BTh组的JPE显著大于无BTh的CM组和CG组。在矢状面，CM + BTh组的JPE为4.21°（标准差±1.8°），无BTh的CM组为2.99°（标准差±1.2°），CG组为3.21°（标准差±1.2°）（p = 0.0053）。在矢状面进行倾向得分匹配后，CM + BTh组与无BTh的CM组之间的差异为1.52°（p = 0.016）。
仅CM + BTh组患者的JPE在统计学上有所增加。颈部疼痛的影响并不能解释组间差异。一个可能的因素是慢性化程度。本研究表明，JPE可能区分出偏头痛患者的一个亚组。
