偏头痛和紧张型头痛中的颈部肌肉骨骼损伤及其与疼痛相关因素的关系：一项更新的系统评价和荟萃分析。

Cervical musculoskeletal impairments in migraine and tension-type headache and relationship to pain related factors: An updated systematic review and meta-analysis.

作者信息

Pensri Chalomjai, Liang Zhiqi, Treleaven Julia, Jull Gwendolen, Thomas Lucy

机构信息

School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia.

出版信息

Musculoskelet Sci Pract. 2025 Apr;76:103251. doi: 10.1016/j.msksp.2024.103251. Epub 2024 Dec 24.

DOI:10.1016/j.msksp.2024.103251

PMID:39756244

Abstract

BACKGROUND

An updated systematic review of cervical musculoskeletal dysfunction in migraine and tension-type headache is needed. Influencing factors (pain hypersensitivity with cervical musculoskeletal testing, active trigger points and tenderness) have not been investigated.

OBJECTIVES

To i) update evidence for cervical musculoskeletal impairments in migraine and tension-type headache ii) report on accompanying pain associated with testing, active trigger points and tenderness in headache; iii) determine relationships between these sensitivity features and cervical musculoskeletal impairments in headache.

METHODS

Five databases were searched for observational studies. Quality of studies was assessed with JBI Critical Appraisal. Meta-analysis was performed using random effect models. Certainty of the evidence was assessed using GRADE.

RESULTS

Seventy-seven studies were included comprising 2551 participants. New findings in migraine were increased forward head posture in standing (MD = -2.51°[-4.94°, -0.09°]), reduced flexion/rotation range (MD = -9.47°[-15.78°, -3.16°]), reduced flexor strength (Std. MD = -0.34[-0.57, -0.10]) and endurance (MD = -14.37[-28.15, -0.58]), and reduced extensor strength (Std. MD = -0.34[-0.60, -0.08]) in migraine. Tension-type headache had reduced extensor strength (Std. MD = -0.45[-0.85, -0.04]). Certainty was very low for all findings due to heterogeneity and small effect size. Active trigger points and tenderness were common, particularly, in chronic headache. A negative relationship between cervical musculoskeletal performance and active trigger points and tenderness was found in 2 from 77 studies (r < - 0.47).

CONCLUSIONS

Several cervical musculoskeletal impairments are present in migraine and tension-type headache with very low certainty. Caution is needed since few studies considered factors that would influence testing.

摘要

背景

需要对偏头痛和紧张型头痛中的颈部肌肉骨骼功能障碍进行更新的系统评价。尚未对影响因素（颈部肌肉骨骼检查时的疼痛超敏反应、活动性触发点和压痛）进行研究。

目的

i）更新偏头痛和紧张型头痛中颈部肌肉骨骼损伤的证据；ii）报告与检查、活动性触发点和头痛压痛相关的伴随疼痛；iii）确定这些敏感性特征与头痛中颈部肌肉骨骼损伤之间的关系。

方法

检索五个数据库以查找观察性研究。使用JBI批判性评价对研究质量进行评估。使用随机效应模型进行荟萃分析。使用GRADE评估证据的确定性。

结果

纳入77项研究，共2551名参与者。偏头痛的新发现包括站立时头部前伸增加（MD = -2.51°[-4.94°，-0.09°]）、屈伸/旋转范围减小（MD = -9.47°[-15.78°，-3.16°]）、屈肌力量降低（标准MD = -0.34[-0.57，-0.10]）和耐力降低（MD = -14.37[-28.15，-0.58]），以及伸肌力量降低（标准MD = -0.34[-0.60，-0.08]）。由于异质性和效应量小，所有发现的确定性都非常低。活动性触发点和压痛很常见，尤其是在慢性头痛中。在77项研究中的2项中发现颈部肌肉骨骼功能与活动性触发点和压痛之间存在负相关（r < -0.47）。