EHMTI-0160. New questionnaire – impact of migraine, tension-type headache and neck pain: a validation study

AabstractBackground and aimMigraine often includes co-existing tension-type headache (TTH) and neck pain (NP). Multiple headache questionnaires assessing headache impact have beendescribed previously; however, none of the existing questionnaires have been designed to cover migraine with co-existing TTH and NP. Therefore a new questionnaire was developed to measure these co-morbidities. The aim was to determine face and content validity of the newly developed questionnaire, “Impact of Migraine, Tension-Type Headache and Neck Pain” (impact M-TTH-NP) and to determine face and content validity of the International Physical Activity Questionnaire (IPAQ short form), Migraine-Specific Quality of Life Questionnaire (MSQ v. 2.1), WHO-Five Well-Being Index (WHO-5), Major Depression Inventory (MDI) and Neck Disability Index (NDI) not yet validated in this target population.Material and methodsThe new multi-dimensional questionnaire “Impact M-TTH-NP” cover pain, triggers, psychosocial, socioeconomic and work related aspects, based on a four-week recall period. The items are rated on an 11-point numeric rating scale with the end points 0 = no impact and 10 = most imaginable impact. Face validity was assessed by migraine patients with co-existing TTH and NP. They were recruited between September 2012 and March 2013 from a tertiary referral headache centre. Nine women with a mean age of 38 years participated in group interviews. The questionnaires were reviewed for relevance and meaningfulness. Content validity was assessed by 13 headache experts. They had worked with headache diseases for an average of 9 (range, 2–38) years. Experts were recruited between August 2012 and October 2012. Nine medical doctors, two physical therapists, one headache nurse and one psychologist (eight women and five men, mean age of 42 years) participated. The experts rated each item of the questionnaires using a four-point Likert scale with the end points 1 = not relevant and 4 = highly relevant. The quantitative measurement of content validity was calculated by the item-level content validity index (I-CVI) and the scale-level content validity average method (S-CVI/Ave). The average deviation (AD) index was used as a measure of interrater agreement.ResultsImpact M-TTH-NP showed acceptable face validity. Of 78 items twelve were revised and one was added based on group interviews and expert review. Seventy-two items (92%) obtained I-CVI≥0.78 (range 0.78–1.00) indicating excellent content validity, 71 items (91%) obtained acceptable AD index. Nine items did not meet either the limit for excellent I-CVI and/or acceptable AD index. The overall S-CVI/Ave was 0.92 indicating an excellent content validity. In addition, four of the five additional questionnaires showed acceptable face validity (MSQ, WHO-5, MDI and NDI) and three showed excellent content validity (WHO-5, MDI and NDI) for patients suffering from migraine and co-existing TTH and NP.Conclusions and implicationsThe impact M-TTH-NP questionnaire showed acceptable face validity and excellent content validity and may be useful when evaluating treatment effect in this target group. The new impact M-TTH-NP questionnaire in combination with the additional questionnaires that together assess pain, triggers, psychosocial and socioeconomic aspects may provide a deeper understanding of the complexity of migraine with co-existing TTH and NP

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The effects of aerobic exercise for persons with migraine and co-existing tension-type headache and neck pain. A randomized, controlled, clinical trial

Cephalalgia ◽

10.1177/0333102417752119 ◽

2018 ◽

Vol 38 (12) ◽

pp. 1805-1816 ◽

Cited By ~ 19

Author(s):

Lotte Skytte Krøll ◽

Catharina Sjödahl Hammarlund ◽

Mattias Linde ◽

Gunvor Gard ◽

Rigmor Højland Jensen

Keyword(s):

Physical Activity ◽

Neck Pain ◽

Physical Fitness ◽

Aerobic Exercise ◽

Pain Intensity ◽

Well Being ◽

Exercise Group ◽

Tension Type Headache ◽

Type Headache ◽

Headache And Neck Pain

Aim To evaluate aerobic exercise in migraine and co-existing tension-type headache and neck pain. Methods Consecutively recruited persons with migraine and co-existing tension-type headache and neck pain were randomized into an exercise group or control group. Aerobic exercise consisted of bike/cross-trainer/brisk walking for 45 minutes, three times/week. Controls continued usual daily activities. Pain frequency, intensity, and duration; physical fitness, level of physical activity, well-being and ability to engage in daily activities were assessed at baseline, after treatment and at follow-up. Results Fifty-two persons completed the study. Significant between-group improvements for the exercise group were found for physical fitness, level of physical activity, migraine burden and the ability to engage in physical activity because of reduced impact of tension-type headache and neck pain. Within the exercise group, significant reduction was found for migraine frequency, pain intensity and duration, neck pain intensity, and burden of migraine; an increase in physical fitness and well-being. Conclusions Exercise significantly reduced the burden of migraine and the ability to engage in physical activity because of reduced impact of tension-type headache and neck pain. Exercise also reduced migraine frequency, pain intensity and duration, although this was not significant compared to controls. These results emphasize the importance of regular aerobic exercise for reduction of migraine burden.

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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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The comparative effects of spinal manipulation, myofascial release and exercise in tension-type headache patients with neck pain: A randomized controlled trial

Complementary Therapies in Clinical Practice ◽

10.1016/j.ctcp.2021.101319 ◽

2021 ◽

Vol 43 ◽

pp. 101319

Author(s):

Mustafa Corum ◽

Tugba Aydin ◽

Cansın Medin Ceylan ◽

Fatma Nur Kesiktas

Keyword(s):

Randomized Controlled Trial ◽

Neck Pain ◽

Spinal Manipulation ◽

Controlled Trial ◽

Tension Type Headache ◽

Myofascial Release ◽

Randomized Controlled ◽

Type Headache ◽

Headache Patients

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Self-reported neck pain is associated with migraine but not with tension-type headache in adolescents

Cephalalgia ◽

10.1177/0333102414523338 ◽

2014 ◽

Vol 34 (11) ◽

pp. 895-903 ◽

Cited By ~ 24

Author(s):

Astrid Blaschek ◽

Siona Decke ◽

Lucia Albers ◽

Andreas Sebastian Schroeder ◽

Steffi Lehmann ◽

...

Keyword(s):

Neck Pain ◽

Neck Region ◽

Cross Sectional Study ◽

Lifestyle Factors ◽

Tension Type Headache ◽

Descending Inhibition ◽

School Students ◽

Sensory Afferents ◽

Cross Sectional ◽

Type Headache

Aim The aim of the present analysis is to confirm or refute the association of neck pain to migraine or tension-type headache and to assess whether this association is independent of other risk factors for headache. Methods Secondary school students were invited to complete a questionnaire on headache and lifestyle factors in a cross-sectional study. Neck pain was assessed via (a) a screening question concerning neck pain and (b) denoting affected areas in schematic drawings of the human body. Results Absolute increment in prevalence of headache with pain in the shoulder-neck region was between 7.5% and 9.6%. Gender, grade, stress and lifestyle factors were assessed as potential confounding factors. Nearly all factors were associated with shoulder-neck pain and most with headache. After adjustment for confounders, the association of neck pain with headache was almost completely confined to migraine (OR 2.39; 95% CI 1.48–3.85) and migraine + tension-type headache (OR 2.12; 95% CI 1.50–2.99), whereas the association with isolated tension-type headache was negligible (OR 1.22, 95% CI 0.87–1.69). Conclusion Neck pain is associated with migraine but not with tension-type headache. A possible link between migraine and neck pain may be the cervico-trigeminal convergence of neck and meningeal sensory afferents or a disturbed descending inhibition in migraine.

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Ictal neck pain investigated in the interictal state – a search for the origin of pain

Cephalalgia ◽

10.1177/0333102419896369 ◽

2019 ◽

Vol 40 (6) ◽

pp. 614-624 ◽

Cited By ~ 1

Author(s):

Jeppe Hvedstrup ◽

Lærke Tørring Kolding ◽

Samaira Younis ◽

Messoud Ashina ◽

Henrik Winther Schytz

Keyword(s):

Neck Pain ◽

Migraine Attack ◽

Structured Interview ◽

Tension Type Headache ◽

Prospective Data ◽

Muscle Tenderness ◽

Local Tenderness ◽

Treatment Responses ◽

Type Headache ◽

Interictal State

Background Neck pain is reported in more than 50% of migraine patients during migraine attacks and may be an important source to migraine pain. Objectives To investigate phenotypical differences between migraine patients with and without ictal neck pain in the interictal phase. Additionally, to prospectively examine the association between pericranial muscle tenderness and the impending migraine attack. Methods Migraine patients (n = 100) and controls (n = 46) underwent a semi-structured interview and sensory testing interictally. Pericranial muscle tenderness was determined using total tenderness score and local tenderness score. The occurrence of migraine attacks was then prospectively recorded for the following seven days. Results Patients with ictal neck pain had increased tenderness of pericranial neck muscles compared to migraine patients without ( p = 0.023). Ictal neck pain was not associated with migraine localization, tension-type headache, or markers of central sensitization. Prospective data of 84 patients showed that tenderness of trigeminal sensory innervated muscles increased the migraine attack rate ( p = 0.035). Conclusion The distinction of migraine patients based on the occurrence of ictal neck pain could indicate migraine subtypes and possible involvement of peripheral tissue in the pathophysiology. Whether treatment responses differ among these groups would be fascinating. Additionally, we found that cephalic muscle tenderness is a risk factor for an impending migraine attack.

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Prevalence of neck pain in migraine and tension-type headache: A population study

Cephalalgia ◽

10.1177/0333102414535110 ◽

2014 ◽

Vol 35 (3) ◽

pp. 211-219 ◽

Cited By ~ 112

Author(s):

Sait Ashina ◽

Lars Bendtsen ◽

Ann C Lyngberg ◽

Richard B Lipton ◽

Nazrin Hajiyeva ◽

...

Keyword(s):

Neck Pain ◽

Primary Headache ◽

Cross Sectional Study ◽

Tension Type Headache ◽

Primary Headaches ◽

Cross Sectional ◽

Type Headache ◽

One Year ◽

The One ◽

Reported Data

Background We assessed the prevalence of neck pain in the population in relation to headache. Methods In a cross-sectional study, a total of 797 individuals completed a headache interview and provided self-reported data on neck pain. We identified migraine, TTH or both migraine and TTH (M+TTH) groups. Pericranial tenderness was recorded in 496 individuals. A total tenderness score (TTS) was calculated as the sum of local scores with a maximum score of 48. Results The one-year prevalence of neck pain was 68.4% and higher in those with vs. without primary headache (85.7% vs. 56.7%; adjusted OR 3.0, 95% CI 2.0–4.4, p < 0.001). Adjusting for age, gender, education and poor self-rated health, in comparison with those without headaches, the prevalence of neck pain (56.7%) was significantly higher in those with M+TTH (89.3%), pure TTH (88.4%) and pure migraine (76.2%) ( p < 0.05 for all three group comparisons). Individuals with neck pain had higher TTS than individuals without neck pain (15.1 ± 10.5 vs. 8.4 ± 8.0, p < 0.001). Conclusions Neck pain is highly prevalent in the general population and even more prevalent in individuals with primary headaches. Prevalence is highest in coexistent M+TTH, followed by pure TTH and migraine. Myofascial tenderness is significantly increased in individuals with neck pain.

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