Cervical musculoskeletal impairments in migraine.
Zhiqi Liang, Lucy Thomas, Gwendolen Jull and 1 others
PMID 34876218WHAT IT FOUND
Migraineurs with neck pain are not a uniform group.
Some have true cervical dysfunction, while others have pain referred from migraine sensitisation. Treating the neck helps only the former. Assess carefully for combined impairments and avoid tests that aggravate hypersensitivity.
Key findings
01Migraineurs with neck pain can be separated into two distinct groups: those with cervical musculoskeletal dysfunction similar to idiopathic neck pain, and those with good cervical function similar to healthy controls.
02Physical assessments of the cervical spine can provoke pain or alter muscle activity due to migraine sensitisation, meaning positive findings may not indicate actual structural dysfunction.
03There is currently no evidence that cervical interventions benefit the general migraine population, so treatment should be targeted only to those proven to have cervical musculoskeletal dysfunction.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
This is a narrative review and expert opinion, not a systematic review or meta-analysis, so it lacks the rigour of a comprehensive evidence synthesis. The authors' own recent study is cited as key evidence, which may introduce bias. There is no clear diagnostic algorithm provided to reliably distinguish between migraine-referred neck pain and cervical dysfunction in clinical practice. The efficacy of cervical interventions for the subgroup with dysfunction remains unproven.
Declared interests
No specific conflicts of interest or funding sources are declared in the provided text.
The easy way to misread this
Do not treat all migraineurs with neck pain using cervical manual therapy or exercises. This paper states that many have pain referred from migraine sensitisation, not cervical dysfunction, and previous trials of cervical interventions have failed to show benefit for the general migraine population.