Individual endogenous pain modulation profiles within a multidimensional context of people with cervicogenic headache - A retrospective exploratory study

Sarah Mingels; Marita Granitzer; Annina B Schmid; Wim Dankaerts

doi:10.1016/j.msksp.2023.102855

Individual endogenous pain modulation profiles within a multidimensional context of people with cervicogenic headache - A retrospective exploratory study

Musculoskelet Sci Pract. 2023 Oct:67:102855. doi: 10.1016/j.msksp.2023.102855. Epub 2023 Sep 2.

Authors

Sarah Mingels¹, Marita Granitzer², Annina B Schmid³, Wim Dankaerts⁴

Affiliations

¹ Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Leuven University, Leuven, Belgium; REVAL Rehabilitation Research Centre, Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium. Electronic address: sarah.mingels@kuleuven.be.
² REVAL Rehabilitation Research Centre, Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.
³ Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom. Electronic address: https://twitter.com/AnninaBSchmid.
⁴ Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Leuven University, Leuven, Belgium. Electronic address: https://twitter.com/WimDankaerts.

Abstract

Background: One in four individuals with cervicogenic headache (CeH) are unresponsive to therapy. Such therapy involves predominantly biomedical interventions targeting the upper-cervical spine. A recurring theme within musculoskeletal practice is the multidimensional nature and substantial heterogeneity of the condition. Such heterogeneity might be a reason for failure of a biomedical approach. Therefore, future studies investigating efficacy of managing CeH should ideally be based on identification, and better understanding of the heterogeneity of this population based on a comprehensive evaluation of clinically relevant contributing factors.

Objectives: The objective was to map profiles of individuals with CeH based on pain modulation within a multidimensional context.

Design: Pain Modulation Profiles (PMPs) of 18 adults (29-51 years) with CeH were mapped retrospectively.

Method: The PMPs consisted of a Pain-Profile (bilateral suboccipital, erector spinae, anterior tibialis pressure pain thresholds), a Psycho-Social-Lifestyle-Profile (Depression, Anxiety, Stress Scale, Headache Impact test, Pittsburgh Sleep Quality Index), or a combination of both. Individual results were compared to normative data. Two Pain-Profiles were defined: normal or altered. Psycho-Social-Lifestyle-Profiles were categorized based on the number of altered psycho-social-lifestyle factors (range 0-5).

Results: Mapping PMPs in individuals with CeH resulted in 50% presenting with a dominant altered Pain-Profile, 16.7% with a dominant altered Psycho-Social-Lifestyle-Profile, and 5.6% with dominant alterations in both Pain-Profile and Psycho-Social-Lifestyle-Profile.

Conclusion: Our results indicate heterogeneity of PMPs within the CeH population. Replication of these results is needed through dynamic assessment of the Pain-Profile before evaluating if these profiles can help patient-stratification.

Keywords: Headache disorder; Multidimensional profiling; Pain modulation.