Three physical examination tests may be useful in confirming the presence of cervical musculoskeletal impairments in patients with migraine, according to a systematic review and meta-analysis results published in Physical Therapy.

To identify differences in cervical musculoskeletal impairment between patients with migraine and healthy individuals, researchers conducted a systematic review and meta-analysis of controlled studies in which the use of physical examination procedures with potential for use in physical therapy for patients with migraine were examined.

The 35 studies considered in a qualitative synthesis included a total of 1371 participants with migraine and 1033 control participants. The 18 studies considered for the meta-analysis included a total of 603 patients with migraine and 544 control individuals. All studies but 1 were deemed to have a low or moderate risk for bias.

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A total of 20 different examinations were examined, 3 of which (cervical range of motion, forward head posture in a standing position, and pressure pain thresholds) yielded strong evidence of being useful detectors of musculoskeletal impairment.

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Meta-analyses revealed that mean combined range of motion (extension and rotation) was significantly reduced in patients with migraine vs healthy participants. In addition, patients with migraine could be distinguished from healthy controls using the flexion-rotation test, pressure pain thresholds for the temporalis muscle and the sternocleidomastoid muscle below the mastoid process, and a forward head posture in a standing position.

Study limitations include a heterogeneous reporting across included studies.

“Whether these musculoskeletal findings are the consequence of repeated migraine attacks or whether untreated musculoskeletal findings might contribute to a higher frequency of attacks or even trigger attacks as suggested in previous publications cannot be concluded from this review,” noted the study authors.

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Szikszay TM, Hoenick S, von Korn K, et al. Which examination tests detect differences in cervical musculoskeletal impairments in people with migraine? A systematic review and meta-analysis [published online January 28, 2019]. Phys Ther. doi: 10.1093/ptj/pzz007