Liang Zhiqi, Thomas Lucy, Jull Gwendolen, Treleaven Julia
The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, Qld, Australia.
Arch Physiother. 2021 Dec 8;11(1):27. doi: 10.1186/s40945-021-00123-0.
Neck pain is common and disabling amongst individuals with migraine. Cervical musculoskeletal interventions are often sought but there is currently no evidence to support such interventions for this population. Improved understanding of how cervical musculoskeletal impairments present in migraine can elucidate neck pain mechanisms and guide clinicians and researchers in the management of patients with migraine and neck pain.
Migraine hypersensitivity is a major consideration when assessing for cervical impairments as it can aggravate migraine and confound findings. Current evidence of cervical impairments in migraine is limited by disregard for the different underlying causes of neck pain and possible influence of hypersensitivity. Findings of cervical musculoskeletal impairments are mixed within and across studies, indicating that different forms of neck pain are present in migraine. Some migraineurs have neck pain that is part of the migraine symptom complex and therefore exhibit little or no cervical musculoskeletal impairment. Others have a cervical source of neck pain and therefore exhibit a pattern of cervical musculoskeletal impairments akin to that of cervical disorders. The presence of cervical musculoskeletal dysfunction may or may not be related to migraine but knowledge of this is currently lacking which impacts decision making on management. Cervical musculoskeletal interventions may be indicated for migraineurs with identified cervical dysfunction but other factors requiring further clarification include determination of i) patient specific outcomes, ii) impact of co-existing migraine referred neck pain, and iii) potential moderating effects of migraine hypersensitivity on treatment efficacy.
Physiotherapists should seek a combination of cervical impairments through skilful assessment to identify if cervical musculoskeletal dysfunction is present or not in individual patients. The relevance of cervical dysfunction to migraine and influence of co-existing migraine referred neck pain need to be established through detailed evaluation of pain behaviours and further research. Future clinical trials should define expected treatment outcomes and select individuals with cervical musculoskeletal dysfunction when investigating the efficacy of cervical musculoskeletal interventions.
颈部疼痛在偏头痛患者中很常见且会导致功能障碍。人们常常寻求颈部肌肉骨骼方面的干预措施，但目前尚无证据支持对这一人群进行此类干预。更好地了解偏头痛患者颈部肌肉骨骼损伤的表现方式，有助于阐明颈部疼痛的机制，并为临床医生和研究人员管理偏头痛和颈部疼痛患者提供指导。
在评估颈部损伤时，偏头痛超敏反应是一个主要考虑因素，因为它会加重偏头痛并混淆检查结果。目前关于偏头痛患者颈部损伤的证据有限，原因在于忽视了颈部疼痛的不同潜在病因以及超敏反应可能产生的影响。关于颈部肌肉骨骼损伤的研究结果在不同研究之间以及同一研究内部都存在差异，这表明偏头痛患者存在不同形式的颈部疼痛。一些偏头痛患者的颈部疼痛是偏头痛症状复合体的一部分，因此几乎没有或不存在颈部肌肉骨骼损伤。另一些患者的颈部疼痛源自颈椎，因此表现出与颈椎疾病类似的颈部肌肉骨骼损伤模式。颈部肌肉骨骼功能障碍的存在可能与偏头痛有关，也可能无关，但目前对此缺乏了解，这影响了治疗管理的决策。对于已确定存在颈椎功能障碍的偏头痛患者，可能需要进行颈部肌肉骨骼方面的干预，但其他需要进一步明确的因素包括：确定（i）患者特定的治疗结果；（ii）并存的偏头痛性牵涉性颈部疼痛的影响；以及（iii）偏头痛超敏反应对治疗效果的潜在调节作用。
物理治疗师应通过熟练的评估综合判断颈部损伤情况，以确定个体患者是否存在颈部肌肉骨骼功能障碍。需要通过对疼痛行为的详细评估和进一步研究，来确定颈椎功能障碍与偏头痛的相关性以及并存的偏头痛性牵涉性颈部疼痛的影响。未来的临床试验在研究颈部肌肉骨骼干预措施的疗效时，应明确预期的治疗结果，并选择存在颈部肌肉骨骼功能障碍的个体。
