Impaired Standing Balance in Individuals with Cervicogenic Headache and Migraine

Objective. This systematic review aimed to assess the efficacy of manual therapies for headache relief. Method. A systematic search in MEDLINE, LILACS, Cochrane, CINAHL, Scopus and Web of Science databases was conducted for randomized and quasi-randomized trials, with no restrictions for language or year of publication. The descriptors were ‘Headache’, ‘Headache disorders’ and ‘Musculoskeletal manipulations’, in addition to the keyword ‘Manual therapy’ and its equivalents in Portuguese. We included studies that compared massage, chiropractic manipulation, osteopathic manipulation and other spinal manipulation to groups with no intervention, other physiotherapeutic modalities or to a sham group. Results. Seven of the 567 articles initially screened were selected, including patients with tension type headache, cervicogenic headache or migraine. It was not possible to assess the magnitude of the treatment effect on the findings of this review. The main limitations were the absence of randomization and adequate allocation concealment, the lack of blinded evaluators and intention-to-treat analysis and inadequate statistical analysis. Conclusions. We were unable to determine the size of the treatment effect due to the selective description of findings. Owing to the high risk of bias in the articles included, the available evidence regarding the efficacy of manual therapies for headache relief is insufficient.

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Validation of a clinical examination to differentiate a cervicogenic source of headache: a diagnostic prediction model using controlled diagnostic blocks

BMJ Open ◽

10.1136/bmjopen-2019-035245 ◽

2020 ◽

Vol 10 (5) ◽

pp. e035245 ◽

Cited By ~ 2

Author(s):

Scott L Getsoian ◽

Surendra M Gulati ◽

Ikenna Okpareke ◽

Robert J Nee ◽

Gwendolen A Jull

Keyword(s):

Neck Pain ◽

Clinical Examination ◽

Model Building ◽

Clinical Signs ◽

Cervicogenic Headache ◽

Tension Type Headache ◽

Local Source ◽

Diagnostic Model ◽

Convenience Sample ◽

Headache And Neck Pain

ObjectivesNeck pain commonly accompanies recurrent headaches such as migraine, tension-type and cervicogenic headache. Neck pain may be part of the headache symptom complex or a local source. Patients commonly seek neck treatment to alleviate headache, but this is only indicated when cervical musculoskeletal dysfunction is the source of pain. Clinical presentation of reduced cervical extension, painful cervical joint dysfunction and impaired muscle function collectively has been shown to identify cervicogenic headache among patients with recurrent headaches. The pattern’s validity has not been tested against the ‘gold standard’ of controlled diagnostic blocks. This study assessed the validity of this pattern of cervical musculoskeletal signs to identify a cervical source of headache and neck pain, against controlled diagnostic blocks, in patients with headache and neck pain.DesignProspective concurrent validity study that employed a diagnostic model building approach to analysis.SettingHospital-based multidisciplinary outpatient clinic in Joliet, Illinois.ParticipantsA convenience sample of participants who presented to a headache clinic with recurrent headaches associated with neck pain. Sixty participants were enrolled and thirty were included in the analysis.Outcome measuresParticipants underwent a clinical examination consisting of relevant tests of cervical musculoskeletal dysfunction. Controlled diagnostic blocks of C2/C3–C3/C4 established a cervical source of neck pain. Penalised logistic regression identified clinical signs to be included in a diagnostic model that best predicted participants’ responses to diagnostic blocks.ResultsTen of thirty participants responded to diagnostic blocks. The full pattern of cervical musculoskeletal signs best predicted participants’ responses (expected prediction error = 0.57) and accounted for 65% of the variance in responses.ConclusionsThis study confirmed the validity of the musculoskeletal pattern to identify a cervical source of headache and neck pain. Adopting this criterion pattern may strengthen cervicogenic headache diagnosis and inform differential diagnosis of neck pain accompanying migraine and tension-type headache.

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Post-Drive Standing Balance of Vehicle Passengers Using Wearable Sensors: The Effect of On-Road Driving and Task Performance

Sensors ◽

10.3390/s21154997 ◽

2021 ◽

Vol 21 (15) ◽

pp. 4997

Author(s):

Victor C. Le ◽

Monica L. H. Jones ◽

Kathleen H. Sienko

Keyword(s):

Task Performance ◽

Postural Sway ◽

Wearable Sensors ◽

Standing Balance ◽

Balance Performance ◽

Real Time Traffic ◽

Balance Exercises ◽

Before And After ◽

The Relationship ◽

And Task

Postural sway has been demonstrated to increase following exposure to different types of motion. However, limited prior studies have investigated the relationship between exposure to normative on-road driving conditions and standing balance following the exposure. The purpose of this on-road study was to quantify the effect of vehicle motion and task performance on passengers’ post-drive standing balance performance. In this study, trunk-based kinematic data were captured while participants performed a series of balance exercises before and after an on-road driving session in real-time traffic. Postural sway for all balance exercises increased following the driving session. Performing a series of ecologically relevant visual-based tasks led to increases in most post-drive balance metrics such as sway position and velocity. However, the post-drive changes following the driving session with a task were not significantly different compared to changes observed following the driving session without a task. The post-drive standing balance performance changes observed in this study may increase vulnerable users’ risk of falling. Wearable sensors offer an opportunity to monitor postural sway following in-vehicle exposures.

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