Influence of Neck Pain in Response to Cervical Spine Manual Palpation on Neck Proprioception and Muscle Endurance of Migraine Patients and Controls

Abstract text (incl. figure legends and references)

The aim of this study was to investigate the cervical joint position sense (JPSE) and the neck muscle endurance among migraineurs and controls following stratification according to pain response over the cervical spine. Thirty-two headache-free subjects and 57 migraineurs were included. The sample was stratified according to the presence of pain during the manual palpation of the upper cervical spine: no neck pain (P0, n=23), local neck pain (P1, n=37) and pain referred to the head (P2, n=29). All subjects were instructed to perform the cervical JPSE for extension, right and left rotation. All subjects also underwent the muscle endurance test of the neck flexors and extensors. A significant effect of neck dysfunction for the JPSE was found (P0 versus P2 mean difference=1.93 cm, F2=4.85, p=0.008). No diagnosis effect was verified for all movement directions (p>0.39), and no neck dysfunction effect was verified for the remaining right (p>0.83) and left (p>0.46) directions. For the muscle endurance test, a significant effect was found for diagnosis (migraine vs no migraine) and neck dysfunction. Compared to migraineurs, controls exhibited greater muscle endurance of neck flexors (mean difference 15 sec, F1=10.54, p=0.001) and extensors (mean difference 48 sec, F1=4.93, p=0.02). According to the stratification, subjects of the P0 group exhibited greater muscle endurance compared to P1 for neck flexors (mean difference 27 sec, F2=16.21, p<0.001) and extensors (mean difference 46 sec, F2=3.20, p=0.04). The P0 group also was different from the P2 group regarding flexion (mean difference 29 sec, F2=16.21, p<0.001) and extension (mean difference 68.4 sec, F2=3.20, p=0.04) endurance. No differences between P1 and P2 groups were found. The presence of neck pain referred to the head is related to a greater JPSE for neck extension. The presence of migraine and/or any neck dysfunction is related to reduced endurance of neck flexor and extensor muscles.