Effectiveness of physiotherapy for seniors with recurrent headaches associated with neck pain and dysfunction: a randomized controlled trial

Background Context A previous study demonstrated that in seniors, the presence of cervical musculoskeletal impairment was not specific to cervicogenic headache but was present in various recurrent headache types. Physiotherapy treatment is indicated in those seniors diagnosed with cervicogenic headache but could also be adjunct treatment for those with cervical musculoskeletal signs who are suspected of having transitional headaches. Purpose This study aimed to determine the effectiveness of a physiotherapy program for seniors with recurrent headaches associated with neck pain and cervical musculoskeletal dysfunction, irrespective of the headache classification. Study Design This is a prospective, stratified, randomized controlled trial with blinded outcome assessment. Patient Sample Sixty-five participants with recurrent headache, aged 50–75 years, were randomly assigned to either a physiotherapy (n=33) or a usual care group (n=32). Outcome Measures The primary outcome was headache frequency. Secondary outcomes were headache intensity and duration, neck pain and disability, cervical range of motion, quality of life, participant satisfaction, and medication intake. Methods Participants in the physiotherapy group received 14 treatment sessions. Participants in the usual care group continued with their usual care. Outcome measures were recorded at baseline, 11 weeks, 6 months, and 9 months. This study was funded by a government research fund of $6,850. No conflict of interest is declared. Results There was no loss to follow-up for the primary outcome measure. Compared with usual care, participants receiving physiotherapy reported significant reductions in headache frequency immediately after treatment (mean difference −1.6 days, 95% confidence interval [CI] −2.5 to −0.6), at 6-month follow-up (−1.7 days, 95% CI −2.6 to −0.8), and at 9-month follow-up (−2.4 days, 95% CI −3.2 to −1.5), and significant improvements in all secondary outcomes immediately posttreatment and at 6- and 9-month follow-ups, (

Immedicate Effects of Core Stabilization Exercise on β-Endorphin and Cortisol Levels Among Patients With Chronic Nonspecific Low Back Pain: A Randomized Crossover Design

Objective: Core stabilization exercise (CSE) is widely prescribed to treat chronic non-specific low back pain (CLBP). However, the neuro-endogenous mechanism behind the pain relieving effect by CSE is still unknown. The main objective of the study was to measure the levels of plasma beta-endorphin (PB) and plasma cortisol (PC) under CSE, placebo and control conditions in CLBP patients. Methods: Twenty-four subjects with CLBP participated in a randomized, placebo-controlled, cross-over design study. There were 3 experimental exercise conditions; control condition (positioning in crook lying and rest), placebo condition (passive cycling in crook lying using automatic cycler), and CSE on a Pilates device tested with 48 hours interval between sessions by concealed randomization. Blood sample was collected before and after the exercise conditions. PB and PC were measured through enzyme-linked immunosorbent assay and electrochemiluminescence in Cobas E411 auto analyzer. Result: PB level showed a significant difference before and after the CSE condition (P<0.05), while no significant differences were noticed in control and placebo exercise conditions. Also, the trend of elevation of PB under the CSE was significantly different when compared to the placebo and control conditions (P<0.01). In contrast, the PC level remains unchanged in all the three conditions. Conclusion: CSE potentially influences PB level but not PC level among CLBP patients. The mechanism of action for pain relieving effect by CSE might be possibly related to an endogenous opioid mechanism as part of its effects, and might not be involved with ‘stress induced analgesia mechanism

HEADACHE IN THE ELDERLY: CERVICAL MUSCULOSKELETAL, SENSORY AND PSYCHOLOGICAL FEATURES

Background: Headache is common in the elderly. Cervical degenerative changes are universal with ageing and cervicogenic headache is proposed (albeit without evidence) as a frequent cause of headache in this age group. Previous research identified a pattern of cervical musculoskeletal impairment which differentiated cervicogenic headache from other frequent headaches but this study was undertaken on younger/middle aged individuals. The value of this diagnostic pattern could be questioned for an older population with concomitant age related changes in the musculoskeletal system. The first and foremost aim of this research was to determine if cervical musculoskeletal impairment was specific to headaches classifiable as cervicogenic or was more generic to headache in elders. Participants with headache were sub-grouped on the basis of the pattern of cervical musculoskeletal impairment and the relationship between this grouping and headache classification was investigated. The presence of sensory hypersensitivity and psychological distress are features of headache that can provide information on the underlying mechanisms and provide management directives for headache. There is little knowledge of whether or not these features are influenced by a factor of age. Thus the second and third aims of this research were to investigate sensory features and psychological and quality of life features in the elderly with headache. Methods: One hundred and eighteen subjects, aged 60 to 75 years with recurrent headache and 44 controls were studied. Ninety-three reported a single headache and 25, two or more headache types. All subjects completed the Neck Disability Index (NDI), Geriatric Depression Scale-short form (GDS-S) and SF-36 questionnaires. Subjects with headache also completed a headache questionnaire and the Survey of Pain Attitudes (SOPA-35). Neck function measures included range of motion, manual examination of cervical segments, cranio-cervical flexor muscle function, joint position sense, cervical muscle strength, cross-sectional area of selected cervical extensors and posture. Sensory measures included pressure pain thresholds (PPTs) and thermal pain thresholds (TPTs). PPTs were measured over the forehead, upper neck and at a remote site (tibialis anterior). TPTs were measured over the upper neck. Results: Cluster analysis, based on the three musculoskeletal variables aligned previously with cervicogenic headache, divided headache subjects into two groups; cluster 1 (n = 57), cluster 2 (n = 50). There was significantly reduced cervical extension, axial rotation, rotation in neck flexion and lateral flexion in the headache clusters than the control group, and in the frequency of symptomatic joint dysfunction (C0-1 – C7-T1) (all p 0.05). Heat pain thresholds were significantly lower in the headache groups compared to controls (all p 0.05). There were no strong relationships between any headache variable and pain thresholds. Elders with headache scored lower on most SF-36 domains, higher on the GDS-S (p 0.05) compared to the control group. The GDS score was below the threshold value for depression. Differences in these measures were not dependent on the headache types but rather, headache frequency. Subjects with headaches ≥ 15 days/month scored lowest on SF-36 domains and highest on GDS-S questionnaire compared to those with headache < 15 days/month and controls (all p < 0.05). The mean NDI score in the subjects with headache indicated the presence of mild to moderate neck pain and disability. No strong relationships were found between well-being and headache frequency, intensity and length of headache history. The NDI score had the greatest influence on physical well-being and GDS-S score on mental well-being (p < 0.001). Conclusions: Several aspects of cervical musculoskeletal function, heat thresholds, general well being and quality of life were altered in elders with headache. Neck dysfunction was not uniquely confined to cervicogenic headache but was a generic feature of headache in the elderly. No generalized changes in pain sensitivity were present in elders with headache. Headache had a significant impact on elders’ quality of life but was not associated with depression. Neck pain was an important factor influencing function and well-being. Conservative management such as physiotherapy may be a safe and appropriate option for elders with headache, given its frequent association with cervical musculoskeletal impairment. Further research is required for a better understanding of the neck’s role in elders’ headache

Impaired standing balance in individuals with cervicogenic headache and migraine

Aims: To determine whether a difference in standing balance exists among individuals with cervicogenic headache, those with migraine, and asymptomatic controls. Methods: A total of 24 participants with cervicogenic headache, 24 with migraine, and 24 asymptomatic controls of similar age, gender, and body mass index were included. Standing balance was assessed with a swaymeter under the conditions of eyes open and closed; on firm and soft surfaces; and in comfortable and narrow stances (for a total of eight testing conditions). Each condition was tested for 30 seconds. The outcome measures were sway area and displacement. Multivariate analysis of variance with Bonferroni post hoc test were used to analyze between-group differences in the postural sway variables. Results: Both headache groups had significantly larger sway areas than the control group during comfortable stance with eyes open and with eyes closed on a soft surface (P < .05) and during narrow stance with eyes closed on firm and soft surfaces (P < .05). The overall results demonstrated significantly greater sway in the anterior-posterior direction and less sway in the medial-lateral direction in selected tests in the cervicogenic headache group compared to the migraine group. Conclusion: Individuals with cervicogenic headache and those with migraine have impaired balance during standing, but possibly to a different extent and pattern. Assessment of balance in patients with cervicogenic headache and migraine should be considered in clinical practice

The influence of neck pain on sensorimotor function in the elderly

Greater disturbances in sensorimotor control have been demonstrated in younger to middle aged groups. However, it is unknown whether or not the impairments documented in these populations can be extrapolated to elders with neck pain. The aim of this study was to investigate the influence of neck pain on sensorimotor function in elders. Twenty elders with neck pain (12 women and 8 men) and 20 healthy elder controls (14 women and 6 men) aged 65 years and over were recruited from the general community. Tests for sensorimotor function included; cervical joint position sense (JPS); computerised rod-and-frame test (RFT); smooth pursuit neck torsion test (SPNT); standing balance (under conditions of eyes open, eyes closed on firm and soft surfaces in comfortable stance); step test and ten-meter walk test with and without head movement. Elders with neck pain had greater deficits in the majority of sensorimotor function tests after controlling for effects of age and comorbidities. Significant differences were found in the SPNT (p < 0.01), error in the RFT (frame angled at 10 degrees and 15 degrees anticlockwise) (p < 0.05), standing balance (amplitude of sway) - eyes open on a firm surface in the medio-lateral (ML) direction (p = 0.03), and total number of steps on the step test, both left and right sides (p < 0.01). Elders with neck pain have greater sensorimotor disturbances than elders without neck pain, supporting a contribution of altered afferent information originating from the cervical spine to such disturbances. The findings may inform falls prevention and management programs. (C) 2012 Elsevier Ireland Ltd. All rights reserved

Neck muscle vibration produces diverse responses in balance and gait speed between individuals with and without neck pain

Neck muscle vibration can influence cervical proprioception and sensorimotor function. It is hypothesized to affect motor performance differently in persons with and without neck pain.Cross-sectional study.To clarify the extent to which vibration-induced motor responses of neck muscles affect static standing balance and gait speed in persons with and without neck pain.Thirty participants with chronic neck pain and 30 healthy controls were recruited. Balance and gait were measured before and after 30 s of suboccipital neck muscle vibration. Balance was measured in a confortable stance with eyes closed using a swaymeter and gait using the timed 10 m walk test.At baseline, neck pain participants had greater postural sway, particularly in the anterior-posterior direction and slower gait speed than healthy controls (p

Effects of tandem walk and cognitive and motor dual- tasks on gait speed in individuals with chronic idiopathic neck pain: a preliminary study

Introduction: Gait impairment has been associated with neck pain. It is relevant to understand the possible influence of narrow-based walk and an attention-demanding secondary task on gait performance in neck pain. Purpose: To investigate the effects of tandem walk and cognitive and motor dual-tasks on gait speed in persons with chronic idiopathic neck pain (CINP) compared with controls. Methods: A cross-sectional study. Thirty participants with CINP and 30 asymptomatic controls participated in the study. Gait speed was assessed using a timed 10-m walk test at a comfortable pace under four conditions: (1) comfortable walk (as reference); (2) tandem walk (single task); (3) cognitive dual-task walking; and (4) motor dual-task walking. Dual-task interference was calculated. Results: There was no difference in comfortable gait speed between groups (p= 0.40). The CINP group had slower gait speed during the tandem walk than controls (p= 0.02). The dual-task interference on gait speed was not different between groups (p = 0.67 for cognitive, p = 0.93 for motor). Conclusion: Participants with CINP had impaired gait stability during tandem walk. An attention-demanding secondary task did not influence gait speed in individuals with CINP compared to controls. The study suggests that tandem walk could be considered as an assessment tool and part of rehabilitation for neck pain

Intrarater Reliability of Pain Intensity, Tissue Blood Flow, Thermal Pain Threshold, Pressure Pain Threshold and Lumbo-Pelvic Stability Tests in Subjects with Low Back Pain

International audienceCour administrative d'appel de Lyon, 23 février 2016, n° 14LY0112