Throbbing Pain is Related to Queckenstedt's Test Effect in Migraine Patients

The Queckenstedt's (Q)-est can aggravate headache intensity during migraine attacks (Q-test effect). The objective of this study was to delineate the Q-test effect in patients experiencing migraine attacks. We performed a 30-s Q- and a sham test on 39 patients with acute migraine attacks in both supine and sitting positions. Headache intensities during and 30 s after the Q- or sham tests were recorded on a 0–10 verbal scale. Brushing allodynia (BA) was recorded after using a gauze-brushing test over the patient's face and forearms. The Q- but not the sham test aggravated headache intensity in both sitting and supine positions. The presence of throbbing pain and higher pain intensities was associated with the Q-test effect in the supine position. However, the presence or absence of BA was not correlated. We concluded that the Q-test effect is likely to be related to peripheral sensitization of the meninges but not central sensitization. The Q-test effect may be used as an objective marker for peripheral sensitization.

The spinal manometric examination (Queckenstedt's test)

✓ Queckenstedt's dynamic manometry has been studied in a model constructed of clinical manometers, spinal needles, and commonly available items. Experiments with the model were made with the system unblocked, partially blocked, and totally blocked in ways to simulate clinical conditions. In clinical manometry what one observes is flow of fluid and its actual pressure. Poiseuille's law is predictive. Impedance to flow is governed by that segment of the system having the smallest cross section, whether it is the pathological block or the spinal needle chosen. If a blocking lesion contains fluid which the rising cerebrospinal fluid pressure can displace (as venous blood), a block may exist on myelography but not on manometry. When, in the presence of partial block, the manometer indication does not fall to the initial pressure but holds up at a new resting pressure, this new pressure probably represents the pressure of the lesion upon the cord and dura. When fluid cannot be displaced from a blocking lesion, as when it is totally solid, no amount of CSF pressure rise produced by jugular compression will overcome the block.