School of Health and Rehabilitation Sciences, The University of Queensland, Therapies Annexe 84A, St Lucia, QLD, 4072, Australia.
Musculoskelet Sci Pract. 2019 Jul;42:67-83. doi: 10.1016/j.msksp.2019.04.007. Epub 2019 Apr 25.
Neck pain is common in migraine and tension type headache (TTH). This review aimed to examine the evidence for cervical musculoskeletal impairments in these headaches.
Databases PubMed (Medline), EMBASE, CINAHL, SCOPUS, and Web of Science were searched from inception to December 2018. Observational studies using a comparator group were included. Risk of bias was assessed using the Appraisal tool for Cross-Sectional Studies. Results were pooled using random effects meta-analysis. Level of evidence for each outcome was assigned based on risk of bias, consistency of results and magnitude of difference between participants with headache and controls. (PROSPERO registration: CRD42018083683).
Of 48 studies included, the majority were rated moderate risk of bias due to possible confounding influences. In total, 17 cervical outcomes were assessed, with confidence in findings ranging from very low to moderate levels. Compared to controls, participants with TTH had greater forward head posture (FHP) (MD = -6.18°, 95% CI [-8.18°, -4.18°]) and less cervical range of motion (ROM) (greatest difference transverse plane MD = -15.0°, 95% CI [-27.7°, -2.3°]. Participants with migraine demonstrated minimally reduced cervical ROM (greatest difference sagittal plane MD = -5.4°, 95% CI [-9.9°, -0.9°]. No differences presented in head posture, strength, craniocervical flexion test performance or joint position error between migraineurs and controls.
TTH presented with more findings of cervical musculoskeletal impairments than migraine however levels of confidence in findings were low. Future studies should differentiate episodic from chronic headache, identify coexisting musculoskeletal cervical disorders, and describe neck pain behaviour in headache.
偏头痛和紧张型头痛（TTH）常伴有颈部疼痛。本综述旨在研究这些头痛中颈椎肌肉骨骼损伤的证据。
从数据库 PubMed（Medline）、EMBASE、CINAHL、SCOPUS 和 Web of Science 中检索了从创建到 2018 年 12 月的文献。纳入了使用对照组的观察性研究。使用横断面研究评估工具评估了偏倚风险。使用随机效应荟萃分析汇总结果。根据偏倚风险、结果一致性和头痛参与者与对照组之间差异的大小，为每个结果分配证据级别。（PROSPERO 注册：CRD42018083683）。
共纳入 48 项研究，其中大多数由于可能存在混杂影响而被评为中度偏倚风险。总共评估了 17 项颈椎结果，发现的可信度从极低到中等水平。与对照组相比，TTH 参与者的前伸头位（FHP）更大（MD=-6.18°，95%CI[-8.18°，-4.18°]），颈椎活动范围（ROM）更小（最大差异平面 MD=-15.0°，95%CI[-27.7°，-2.3°]）。偏头痛患者的颈椎 ROM 略有减少（最大差异矢状面 MD=-5.4°，95%CI[-9.9°，-0.9°]）。偏头痛患者和对照组之间的头位、力量、颅颈屈曲试验表现或关节位置误差无差异。
TTH 比偏头痛表现出更多的颈椎肌肉骨骼损伤发现，但发现的置信度较低。未来的研究应区分发作性头痛和慢性头痛，确定同时存在的颈椎肌肉骨骼疾病，并描述头痛中的颈部疼痛行为。
