Balance alterations are associated with neck pain and neck muscle endurance in migraine

Amanda Rodrigues; Débora Bevilaqua-Grossi; Lidiane Lima Florencio; Carina Ferreira Pinheiro; Fabíola Dach; Marcelo Bigal; Gabriela Ferreira Carvalho

doi:10.1016/j.msksp.2023.102811

Balance alterations are associated with neck pain and neck muscle endurance in migraine

Musculoskelet Sci Pract. 2023 Aug:66:102811. doi: 10.1016/j.msksp.2023.102811. Epub 2023 Jun 20.

Authors

Amanda Rodrigues¹, Débora Bevilaqua-Grossi², Lidiane Lima Florencio³, Carina Ferreira Pinheiro⁴, Fabíola Dach⁵, Marcelo Bigal⁶, Gabriela Ferreira Carvalho⁷

Affiliations

¹ Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil. Electronic address: amanda_rodrigues@usp.br.
² Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil. Electronic address: deborabg@fmrp.usp.br.
³ Department of Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain. Electronic address: lidianelimaflorencio@gmail.com.
⁴ Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil. Electronic address: carinafp@hotmail.com.
⁵ Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil. Electronic address: fabioladach@usp.br.
⁶ Ventus Therapeutics, Montreal, Canada. Electronic address: mbigal@ventustx.com.
⁷ Institut für Gesundheitswissenschaften, Studiengang Physiotherapie, Pain and Exercise Research Luebeck (P.E.R.L), Universität zu Lübeck, Lübeck, Germany. Electronic address: gabriela.fisioterapia@gmail.com.

PMID: 37357054
DOI: 10.1016/j.msksp.2023.102811

Abstract

Background: Migraine patients may present with both cervical and balance dysfunctions. The neck plays an important role in balance by providing substantial proprioceptive input, which is integrated in the central nervous system and influences the balance control systems. Whether balance and neck dysfunctions are associated in patients with migraine is still to be explored.

Objectives: This study aimed to assess the association between the sensory organization test of balance with neck pain features, cervical strength, endurance, and range of motion in patients with migraine.

Methods: Sixty-five patients with migraine underwent the sensory organization test assessed with the Equitest-Neurocom® device. Maximum voluntary isometric contraction, cervical flexion and extension range of motion, and cervical flexor and extensor endurance were assessed. In addition, the features of migraine and neck pain were collected. Patients were dichotomized according to cut-off scores of balance performance and the association between outcomes were explored.

Results: Patients with reduced balance performance presented a higher frequency of migraine (p = 0.035), a higher frequency of aura (p = 0.002), greater neck pain intensity (p = 0.013), and decreased endurance of cervical flexors (p = 0.010) and extensors (p < 0.0001). The total balance score was correlated with age (r = -0.33; p = 0.007), migraine frequency (r = -0.29; p = 0.021), neck pain intensity (r = -0.26; p = 0.038), and endurance of the cervical flexors (r = 0.39; p = 0.001) and extensors (r = 0.36; p = 0.001). Migraine frequency, neck pain intensity, and endurance of the cervical flexors can predict 21% of the sensory organization test variability.

Conclusion: Neck pain features and endurance of the cervical muscles are related to reduced balance performance in patients with migraine. These results shed light to a better understanding of balance alterations in migraine patients.

Keywords: Balance; Headache; Migraine; Neck pain; Sensory organization test.

MeSH terms

Humans
Isometric Contraction / physiology
Migraine Disorders*
Neck Muscles*
Neck Pain
Pain Measurement