偏头痛的颈椎肌肉骨骼损伤。

IF 2.1 Q1 REHABILITATION
Zhiqi Liang, Lucy Thomas, Gwendolen Jull, Julia Treleaven
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引用次数: 8

摘要

背景:颈部疼痛在偏头痛患者中是常见和致残的。经常寻求颈椎肌肉骨骼干预,但目前没有证据支持这种干预对这一人群。改善对偏头痛中颈椎肌肉骨骼损伤的理解可以阐明颈部疼痛的机制,并指导临床医生和研究人员对偏头痛和颈部疼痛患者的管理。正文:偏头痛过敏是评估颈椎损伤的主要考虑因素,因为它会加重偏头痛并混淆结果。目前偏头痛中颈椎损伤的证据是有限的,因为忽视了颈部疼痛的不同潜在原因和过敏的可能影响。颈椎肌肉骨骼损伤的研究结果在研究内部和研究之间是混合的,表明偏头痛中存在不同形式的颈部疼痛。一些偏头痛患者有颈部疼痛,这是偏头痛症状的一部分,因此很少或没有颈椎肌肉骨骼损伤。另一些人的颈部疼痛来源于颈部,因此表现出类似于颈部疾病的颈部肌肉骨骼损伤模式。颈椎肌肉骨骼功能障碍的存在可能与偏头痛有关,也可能与偏头痛无关,但目前缺乏这方面的知识,这影响了管理决策。颈椎肌肉骨骼干预可能适用于已确定的颈椎功能障碍的偏头痛患者,但其他因素需要进一步澄清,包括确定i)患者特定结果,ii)共存的偏头痛相关颈部疼痛的影响,以及iii)偏头痛超敏反应对治疗效果的潜在调节作用。结论:物理治疗师应该通过熟练的评估来寻找颈椎损伤的组合,以确定个别患者是否存在颈椎肌肉骨骼功能障碍。颈椎功能障碍与偏头痛的相关性以及共存的偏头痛相关颈部疼痛的影响需要通过对疼痛行为的详细评估和进一步的研究来确定。未来的临床试验应明确预期的治疗结果,并在调查颈椎肌肉骨骼干预的疗效时选择患有颈椎肌肉骨骼功能障碍的个体。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Cervical musculoskeletal impairments in migraine.

Cervical musculoskeletal impairments in migraine.

Background: Neck pain is common and disabling amongst individuals with migraine. Cervical musculoskeletal interventions are often sought but there is currently no evidence to support such interventions for this population. Improved understanding of how cervical musculoskeletal impairments present in migraine can elucidate neck pain mechanisms and guide clinicians and researchers in the management of patients with migraine and neck pain.

Main body: Migraine hypersensitivity is a major consideration when assessing for cervical impairments as it can aggravate migraine and confound findings. Current evidence of cervical impairments in migraine is limited by disregard for the different underlying causes of neck pain and possible influence of hypersensitivity. Findings of cervical musculoskeletal impairments are mixed within and across studies, indicating that different forms of neck pain are present in migraine. Some migraineurs have neck pain that is part of the migraine symptom complex and therefore exhibit little or no cervical musculoskeletal impairment. Others have a cervical source of neck pain and therefore exhibit a pattern of cervical musculoskeletal impairments akin to that of cervical disorders. The presence of cervical musculoskeletal dysfunction may or may not be related to migraine but knowledge of this is currently lacking which impacts decision making on management. Cervical musculoskeletal interventions may be indicated for migraineurs with identified cervical dysfunction but other factors requiring further clarification include determination of i) patient specific outcomes, ii) impact of co-existing migraine referred neck pain, and iii) potential moderating effects of migraine hypersensitivity on treatment efficacy.

Conclusions: Physiotherapists should seek a combination of cervical impairments through skilful assessment to identify if cervical musculoskeletal dysfunction is present or not in individual patients. The relevance of cervical dysfunction to migraine and influence of co-existing migraine referred neck pain need to be established through detailed evaluation of pain behaviours and further research. Future clinical trials should define expected treatment outcomes and select individuals with cervical musculoskeletal dysfunction when investigating the efficacy of cervical musculoskeletal interventions.

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CiteScore
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