The relationship between cervical dysfunction and perimenstrual migraines
In this cross-sectional study, forty perimenstrual migraine sufferers and forty-six controls were assessed for dysfunction that may be associated with perimenstrual migraines. A questionnaire assessed for the psychological factors. The blinded physical examination was conducted on the cervical area. This consisted of a posture assessment, muscle length testing, neural tension testing, trigger point examination, segmental cervical assessment, range of motion and muscle strength testing. The difference in most of the psychological risk factors was statistically significant, with higher incidence in the migraine group. These significant factors were: perimenstrual anxiety (p= 0.04), fatigue (p=0.05), perimenstrual fatigue (p > 0.001), perception of neck stiffness (p > 0.001) and perception of neck pain (p > 0.001). Compared to the controls, the migraine group had significantly more cervical dysfunction in muscle length restriction (right trapezius p=0.004, left sternocleidomastoid p=0.05, right occipitals p=0.003), more pain on muscle stretch (right levator scapula p=0.001, left levator scapula p= 0.005, right trapezius p=0.005, left trapezius p=0.006, left sternocleidomastoid p=0.006, right occipitals p=0.003, left occipitals p=0.004), reduced bilateral rotation range (right rotation p=0.04, left rotation p=0.01), worse neural tension (right elbow lag p=0.02, left elbow lag p=0.04), more active trigger points (right trapezius p=0.02, left trapezius p=0.02, right sternocleidomastoid p=0.02, left sternocleidomastoid p=0.004) and higher cervical pain (VAS C4 p=0.01, C5 p=0.04, C6 p=0.002) and stiffness (C5 p=0.02, C7 p=0.02). Therefore it is concluded that both psychological and physical cervical impairment may be associated with the risk of developing perimenstrual migraine, increase migraine intensity and the resultant disability. These factors should thus be managed by physiotherapy and psychological support.
M.Sc. (Physiotherapy), Faculty of Health Sciences, University of the Witwatersrand, 2011