颈部特异性强化锻炼与偏头痛患者安慰剂假超声治疗的随机对照试验。

Neck-specific strengthening exercise compared with placebo sham ultrasound in patients with migraine: a randomized controlled trial.

机构信息

Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.

Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain.

出版信息

BMC Neurol. 2022 Apr 2;22(1):126. doi: 10.1186/s12883-022-02650-0.

DOI:10.1186/s12883-022-02650-0

PMID:35366822

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8976325/

Abstract

BACKGROUND

Migraine patients have musculoskeletal disorders and pain in the cervical. And, despite the pathophysiology demonstrating the relationship between migraine and the cervical spine, the effectiveness of craniocervical exercises in these patients has not been verified. So, the aimed of this study was verify the effectiveness of craniocervical muscle-strengthening exercise (CMSE) in reducing the frequency and intensity of headache in migraine patients. METHODS: A two-armed, parallel-group randomized controlled trial with a 3-month follow-up was performed. For eight weeks, the volunteers in the intervention group (n = 21) performed a protocol of CMSE, while those in the sham ultrasound group (n = 21) received the application of disconnected therapeutic ultrasound in the upper trapezius and guideline for home-stretching. The primary outcomes were the frequency and intensity of the headache. The secondary outcomes were questionnaires about migraine and neck disability, and satisfaction with the treatment, cervical range of motion, the pressure pain threshold, craniocervical flexion test (CCFT), cervical muscle strength and endurance test, and the cervical muscle activity during the physical tests.

RESULTS

No differences were observed for the changes observed in primary outcomes after eight weeks and at the 3-months follow up (p > 0.05). For the secondary outcomes, craniocervical exercises improved the sensitivity of the frontal muscle (p = 0.040) and promoted a reduced amplitude of muscle activity of the anterior scalene and upper trapezius in the last stages of CCFT (p ≤ 0.010). There was also reduced muscle activity of the anterior scalene and splenius capitis in the endurance test (p ≤ 0.045), as evaluated by surface electromyography.

CONCLUSION

CMSE were insufficient in reducing the frequency and intensity of headache, improving the performance of the cervical muscles, or reducing migraine and neck pain-related disabilities. This was found despite a decreased electromyographic activity of the cervical muscles during the last stages of CCFT and increased median frequency during the endurance test.

TRIAL REGISTRATION

Accession code RBR-8gfv5j , registered 28/11/2016 in the Registro Brasileiro de Ensaios Clínicos (ReBEC).

摘要

背景

偏头痛患者存在肌肉骨骼疾病和颈椎疼痛。尽管病理生理学显示偏头痛与颈椎之间存在关系，但颅颈运动锻炼在这些患者中的有效性尚未得到验证。因此，本研究旨在验证颅颈肌肉强化锻炼（CMSE）在降低偏头痛患者头痛发作频率和强度中的有效性。

方法

这是一项为期 3 个月随访的双臂、平行组随机对照试验。在 8 周的时间里，干预组（n=21）的志愿者进行了 CMSE 方案，而假超声组（n=21）则在上斜方肌上接受了断开式治疗超声的应用和家庭伸展指导。主要结局是头痛的频率和强度。次要结局是偏头痛和颈部残疾问卷、对治疗的满意度、颈椎活动度、压痛阈、颅颈屈曲试验（CCFT）、颈肌力量和耐力测试以及在身体测试期间颈肌的活动。

结果

在 8 周后和 3 个月随访时，主要结局的变化无差异（p＞0.05）。对于次要结局，颅颈运动锻炼提高了额肌的敏感性（p=0.040），并在 CCFT 的最后阶段降低了前斜角肌和上斜方肌的肌肉活动幅度（p≤0.010）。在耐力测试中，前斜角肌和头夹肌的肌肉活动也减少（p≤0.045），这是通过表面肌电图评估的。