Abstract
Background:
Central and peripheral mechanisms may be involved in migraine and tension-type headache pathogenesis, however the role of muscle disorders in their pathophysiological mechanisms remains unclear.
Objectives:
To assess the association between the presence of migraine or tension-type headache and changes in longus colli muscle dimensions and sternocleidomastoid muscle activity.
Method:
An observational study with 48 women comparing the following groups: migraine (n=21), tension-type headache (n=16), and control (n=11). The cross-sectional area, lateral and anteroposterior dimensions, and shape ratio of the longus colli muscle were measured using ultrasound. The activation of the sternocleidomastoid muscle was assessed by signal amplitude and the decline in median frequency using surface electromyographic analysis.
Results:
The dimensions of the longus colli muscle did not differ between groups (p>0.05). Post-test analysis showed lower sternocleidomastoid muscle activation on both sides, at the onset of contraction, in the group with tension-type headache when compared to the control group {right sternocleidomastoid [tension-type headache: 0.39 (0.30-0.49); control: 0.58 (0.42-0.76); p=0.026] and left sternocleidomastoid [tension-type headache: 0.39 (0.31-0.48); control: 0.60 (0.42-0.79); p=0.039], Tukey's post hoc test}. There was no difference between the three groups in sternocleidomastoid muscle activation, on both sides, at the end of contraction (p>0.05). Intergroup analysis showed no difference in the rate of decline in median frequency (p>0.05).
Conclusion:
The group with tension-type headache exhibited less activation at the onset of sternocleidomastoid muscle contraction. No association was observed between the presence of headache and alterations in longus colli muscle dimensions, median frequency, and sternocleidomastoid muscle activation at the end of contraction.
migraine disorders; tension-type headache; neck muscles; ultrasonography; electromyography; movement
Introduction
Migraine and tension-type headache are the most common source of pain in young
workers and they have also been characterized as significant public health issues,
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44 Fumal A, Schoenen J. Tension-type headache: current research and
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http://dx.doi.org/10.1016/S1474-4422(07)...
. These are primary headaches, and central
and peripheral mechanisms may be involved in their pathogenesis55 Burstein R. Deconstructing migraine headache into peripheral and
central sensitization. Pain. 2001;89(2-3):107-10.
http://dx.doi.org/10.1016/S0304-3959(00)00478-4. PMid:11166465
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,
66 Sohn J-H, Choi H-C, Jun A-Y. Differential patterns of muscle
modification in women with episodic and chronic tension-type headache revealed
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PMid:22947196
http://dx.doi.org/10.1016/j.jelekin.2012...
.
A number of authors66 Sohn J-H, Choi H-C, Jun A-Y. Differential patterns of muscle
modification in women with episodic and chronic tension-type headache revealed
using surface electromyographic analysis. J Electromyogr Kinesiol.
2013;23(1):110-7. http://dx.doi.org/10.1016/j.jelekin.2012.08.001.
PMid:22947196
http://dx.doi.org/10.1016/j.jelekin.2012...
7 Jensen R, Fuglsang-Frederiksen A, Olesen J. Quantitative surface EMG
of pericranial muscles in headache. A population study. Electroencephalogr Clin
Neurophysiol. 1994;93(5):335-44. http://dx.doi.org/10.1016/0168-5597(94)90121-X.
PMid:7525241
http://dx.doi.org/10.1016/0168-5597(94)9...
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2001;41(10):985-9. http://dx.doi.org/10.1046/j.1526-4610.2001.01193.x.
PMid:11903527
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9 Bartsch T. Migraine and the neck: new insights from basic data. Curr
Pain Headache Rep. 2005;9(3):191-6. http://dx.doi.org/10.1007/s11916-005-0061-0.
PMid:15907257
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-
1010 Bartsch T, Goadsby PJ. Increased responses in trigeminocervical
nociceptive neurons to cervical input after stimulation of the dura mater.
Brain. 2003;126(Pt 8):1801-13. http://dx.doi.org/10.1093/brain/awg190.
PMid:12821523
http://dx.doi.org/10.1093/brain/awg190...
have sought to elucidate the involvement
of peripheral nociceptive stimuli in the pathogenesis of migraine and tension-type
headache. However, the role of muscle alterations in the activation of the
physiopathological process of these types of headache remains unclear88 Rollnik JD, Karst M, Fink M, Dengler R. Botulinum toxin type A and
EMG: a key to the understanding of chronic tension-type headaches? Headache.
2001;41(10):985-9. http://dx.doi.org/10.1046/j.1526-4610.2001.01193.x.
PMid:11903527
http://dx.doi.org/10.1046/j.1526-4610.20...
9 Bartsch T. Migraine and the neck: new insights from basic data. Curr
Pain Headache Rep. 2005;9(3):191-6. http://dx.doi.org/10.1007/s11916-005-0061-0.
PMid:15907257
http://dx.doi.org/10.1007/s11916-005-006...
-
1010 Bartsch T, Goadsby PJ. Increased responses in trigeminocervical
nociceptive neurons to cervical input after stimulation of the dura mater.
Brain. 2003;126(Pt 8):1801-13. http://dx.doi.org/10.1093/brain/awg190.
PMid:12821523
http://dx.doi.org/10.1093/brain/awg190...
.
A possible reason for the association between changes in craniocervical muscles in
patients with migraine or tension-type headache is the activation of
trigemino-cervical nucleus during migraine or tension-type headache attacks. In this
nucleus, there is a convergence of cervical and trigeminal nociceptive afferents in
the trigeminocervical complex, releasing vasoactive algogenic substances, which
facilitate pain transmission to the brain and promote awareness of the central
nervous system44 Fumal A, Schoenen J. Tension-type headache: current research and
clinical management. Lancet Neurol. 2008;7(1):70-83.
http://dx.doi.org/10.1016/S1474-4422(07)70325-3. PMid:18093564
http://dx.doi.org/10.1016/S1474-4422(07)...
-
55 Burstein R. Deconstructing migraine headache into peripheral and
central sensitization. Pain. 2001;89(2-3):107-10.
http://dx.doi.org/10.1016/S0304-3959(00)00478-4. PMid:11166465
http://dx.doi.org/10.1016/S0304-3959(00)...
,
1111 Ferreira MC, Bevilaqua-Grossi D, Dach FE, Speciali JG, Gonçalves MC,
Chaves TC. Body posture changes in women with migraine with or without
temporomandibular disorders. Braz J Phys Ther. 2014;18(1):19-29.
http://dx.doi.org/10.1590/S1413-35552012005000137.
PMid:24675909
http://dx.doi.org/10.1590/S1413-35552012...
.
This is supported by other findings suggesting that individuals with migraine or
tension-type headache are more likely to self-report neck pain and to report
cervical muscles disorders, such as limited range of motion1111 Ferreira MC, Bevilaqua-Grossi D, Dach FE, Speciali JG, Gonçalves MC,
Chaves TC. Body posture changes in women with migraine with or without
temporomandibular disorders. Braz J Phys Ther. 2014;18(1):19-29.
http://dx.doi.org/10.1590/S1413-35552012005000137.
PMid:24675909
http://dx.doi.org/10.1590/S1413-35552012...
, changes in head and cervical posture1111 Ferreira MC, Bevilaqua-Grossi D, Dach FE, Speciali JG, Gonçalves MC,
Chaves TC. Body posture changes in women with migraine with or without
temporomandibular disorders. Braz J Phys Ther. 2014;18(1):19-29.
http://dx.doi.org/10.1590/S1413-35552012005000137.
PMid:24675909
http://dx.doi.org/10.1590/S1413-35552012...
, alterations in muscle dimensions1212 Falla DL, Jull GA, Hodges PW. Patients with neck pain demonstrate
reduced electromyographic activity of the deep cervical flexor muscles during
performance of the craniocervical flexion test. Spine. 2004;29(19):2108-14.
http://dx.doi.org/10.1097/01.brs.0000141170.89317.0e.
PMid:15454700
http://dx.doi.org/10.1097/01.brs.0000141...
13 Javanshir K, Rezasoltani A, Mohseni-Bandpei MA, Amiri M,
Ortega-Santiago R, Fernández-de-Las-Peñas C. Ultrasound assessment of bilateral
longus colli muscles in subjects with chronic bilateral neck pain. Am J Phys Med
Rehabil. 2011;90(4):293-301. http://dx.doi.org/10.1097/PHM.0b013e31820173e5.
PMid:21173685
http://dx.doi.org/10.1097/PHM.0b013e3182...
-
1414 Jesus-Moraleida FR, Ferreira PH, Pereira LSM, Vasconcelos CM,
Ferreira ML. Ultrasonographic analysis of the neck flexor muscles in patients
with chronic neck pain and changes after cervical spine mobilization. J
Manipulative Physiol Ther. 2011;34(8):514-24.
http://dx.doi.org/10.1016/j.jmpt.2011.08.006. PMid:21978544
http://dx.doi.org/10.1016/j.jmpt.2011.08...
, and muscle fatigue and activation during
contractions77 Jensen R, Fuglsang-Frederiksen A, Olesen J. Quantitative surface EMG
of pericranial muscles in headache. A population study. Electroencephalogr Clin
Neurophysiol. 1994;93(5):335-44. http://dx.doi.org/10.1016/0168-5597(94)90121-X.
PMid:7525241
http://dx.doi.org/10.1016/0168-5597(94)9...
,
1515 Oksanen A, Pöyhönen T, Metsähonkala L, Anttila P, Hiekkanen H, Laimi
K, et al. Neck flexor muscle fatigue in adolescents with headache: an
electromyographic study. Eur J Pain. 2007;11(7):764-72.
http://dx.doi.org/10.1016/j.ejpain.2006.12.003. PMid:17291797
http://dx.doi.org/10.1016/j.ejpain.2006....
. Several methods have been used to verify
this association, including photogrammetry1111 Ferreira MC, Bevilaqua-Grossi D, Dach FE, Speciali JG, Gonçalves MC,
Chaves TC. Body posture changes in women with migraine with or without
temporomandibular disorders. Braz J Phys Ther. 2014;18(1):19-29.
http://dx.doi.org/10.1590/S1413-35552012005000137.
PMid:24675909
http://dx.doi.org/10.1590/S1413-35552012...
,
electromyography77 Jensen R, Fuglsang-Frederiksen A, Olesen J. Quantitative surface EMG
of pericranial muscles in headache. A population study. Electroencephalogr Clin
Neurophysiol. 1994;93(5):335-44. http://dx.doi.org/10.1016/0168-5597(94)90121-X.
PMid:7525241
http://dx.doi.org/10.1016/0168-5597(94)9...
,
1515 Oksanen A, Pöyhönen T, Metsähonkala L, Anttila P, Hiekkanen H, Laimi
K, et al. Neck flexor muscle fatigue in adolescents with headache: an
electromyographic study. Eur J Pain. 2007;11(7):764-72.
http://dx.doi.org/10.1016/j.ejpain.2006.12.003. PMid:17291797
http://dx.doi.org/10.1016/j.ejpain.2006....
16 Barton PM, Hayes KC. Neck flexor muscle strength, efficiency, and
relaxation times in normal subjects and subjects with unilateral neck pain and
headache. Arch Phys Med Rehabil. 1996;77(7):680-7.
http://dx.doi.org/10.1016/S0003-9993(96)90008-8. PMid:8669995
http://dx.doi.org/10.1016/S0003-9993(96)...
-
1717 Fernández-de-las-Peñas C, Falla D, Arendt-Nielsen L, Farina D.
Cervical muscle co-activation in isometric contractions is enhanced in chronic
tension-type headache patients. Cephalalgia. 2008;28(7):744-51.
http://dx.doi.org/10.1111/j.1468-2982.2008.01584.x.
PMid:18460003
http://dx.doi.org/10.1111/j.1468-2982.20...
, and ultrassonography1212 Falla DL, Jull GA, Hodges PW. Patients with neck pain demonstrate
reduced electromyographic activity of the deep cervical flexor muscles during
performance of the craniocervical flexion test. Spine. 2004;29(19):2108-14.
http://dx.doi.org/10.1097/01.brs.0000141170.89317.0e.
PMid:15454700
http://dx.doi.org/10.1097/01.brs.0000141...
13 Javanshir K, Rezasoltani A, Mohseni-Bandpei MA, Amiri M,
Ortega-Santiago R, Fernández-de-Las-Peñas C. Ultrasound assessment of bilateral
longus colli muscles in subjects with chronic bilateral neck pain. Am J Phys Med
Rehabil. 2011;90(4):293-301. http://dx.doi.org/10.1097/PHM.0b013e31820173e5.
PMid:21173685
http://dx.doi.org/10.1097/PHM.0b013e3182...
-
1414 Jesus-Moraleida FR, Ferreira PH, Pereira LSM, Vasconcelos CM,
Ferreira ML. Ultrasonographic analysis of the neck flexor muscles in patients
with chronic neck pain and changes after cervical spine mobilization. J
Manipulative Physiol Ther. 2011;34(8):514-24.
http://dx.doi.org/10.1016/j.jmpt.2011.08.006. PMid:21978544
http://dx.doi.org/10.1016/j.jmpt.2011.08...
.
Prior studies77 Jensen R, Fuglsang-Frederiksen A, Olesen J. Quantitative surface EMG
of pericranial muscles in headache. A population study. Electroencephalogr Clin
Neurophysiol. 1994;93(5):335-44. http://dx.doi.org/10.1016/0168-5597(94)90121-X.
PMid:7525241
http://dx.doi.org/10.1016/0168-5597(94)9...
,
1515 Oksanen A, Pöyhönen T, Metsähonkala L, Anttila P, Hiekkanen H, Laimi
K, et al. Neck flexor muscle fatigue in adolescents with headache: an
electromyographic study. Eur J Pain. 2007;11(7):764-72.
http://dx.doi.org/10.1016/j.ejpain.2006.12.003. PMid:17291797
http://dx.doi.org/10.1016/j.ejpain.2006....
16 Barton PM, Hayes KC. Neck flexor muscle strength, efficiency, and
relaxation times in normal subjects and subjects with unilateral neck pain and
headache. Arch Phys Med Rehabil. 1996;77(7):680-7.
http://dx.doi.org/10.1016/S0003-9993(96)90008-8. PMid:8669995
http://dx.doi.org/10.1016/S0003-9993(96)...
-
1717 Fernández-de-las-Peñas C, Falla D, Arendt-Nielsen L, Farina D.
Cervical muscle co-activation in isometric contractions is enhanced in chronic
tension-type headache patients. Cephalalgia. 2008;28(7):744-51.
http://dx.doi.org/10.1111/j.1468-2982.2008.01584.x.
PMid:18460003
http://dx.doi.org/10.1111/j.1468-2982.20...
have used electromyography to assess the
relationship between headache and alterations in the superficial cervical activity
of the sternocleidomastoid, splenius, and trapezius muscles. The results suggest
that changes in activation77 Jensen R, Fuglsang-Frederiksen A, Olesen J. Quantitative surface EMG
of pericranial muscles in headache. A population study. Electroencephalogr Clin
Neurophysiol. 1994;93(5):335-44. http://dx.doi.org/10.1016/0168-5597(94)90121-X.
PMid:7525241
http://dx.doi.org/10.1016/0168-5597(94)9...
,
1616 Barton PM, Hayes KC. Neck flexor muscle strength, efficiency, and
relaxation times in normal subjects and subjects with unilateral neck pain and
headache. Arch Phys Med Rehabil. 1996;77(7):680-7.
http://dx.doi.org/10.1016/S0003-9993(96)90008-8. PMid:8669995
http://dx.doi.org/10.1016/S0003-9993(96)...
,
1717 Fernández-de-las-Peñas C, Falla D, Arendt-Nielsen L, Farina D.
Cervical muscle co-activation in isometric contractions is enhanced in chronic
tension-type headache patients. Cephalalgia. 2008;28(7):744-51.
http://dx.doi.org/10.1111/j.1468-2982.2008.01584.x.
PMid:18460003
http://dx.doi.org/10.1111/j.1468-2982.20...
and fatigability77 Jensen R, Fuglsang-Frederiksen A, Olesen J. Quantitative surface EMG
of pericranial muscles in headache. A population study. Electroencephalogr Clin
Neurophysiol. 1994;93(5):335-44. http://dx.doi.org/10.1016/0168-5597(94)90121-X.
PMid:7525241
http://dx.doi.org/10.1016/0168-5597(94)9...
,
1515 Oksanen A, Pöyhönen T, Metsähonkala L, Anttila P, Hiekkanen H, Laimi
K, et al. Neck flexor muscle fatigue in adolescents with headache: an
electromyographic study. Eur J Pain. 2007;11(7):764-72.
http://dx.doi.org/10.1016/j.ejpain.2006.12.003. PMid:17291797
http://dx.doi.org/10.1016/j.ejpain.2006....
are more frequent in individuals with
headache. However, previous assessments of neck muscle dimensions only included
patients with chronic neck pain and did not include subjects with migraine.
Patients with chronic neck pain exhibited lower activation in deep neck muscles, such
as the longus capitis and longus colli muscles1212 Falla DL, Jull GA, Hodges PW. Patients with neck pain demonstrate
reduced electromyographic activity of the deep cervical flexor muscles during
performance of the craniocervical flexion test. Spine. 2004;29(19):2108-14.
http://dx.doi.org/10.1097/01.brs.0000141170.89317.0e.
PMid:15454700
http://dx.doi.org/10.1097/01.brs.0000141...
13 Javanshir K, Rezasoltani A, Mohseni-Bandpei MA, Amiri M,
Ortega-Santiago R, Fernández-de-Las-Peñas C. Ultrasound assessment of bilateral
longus colli muscles in subjects with chronic bilateral neck pain. Am J Phys Med
Rehabil. 2011;90(4):293-301. http://dx.doi.org/10.1097/PHM.0b013e31820173e5.
PMid:21173685
http://dx.doi.org/10.1097/PHM.0b013e3182...
-
1414 Jesus-Moraleida FR, Ferreira PH, Pereira LSM, Vasconcelos CM,
Ferreira ML. Ultrasonographic analysis of the neck flexor muscles in patients
with chronic neck pain and changes after cervical spine mobilization. J
Manipulative Physiol Ther. 2011;34(8):514-24.
http://dx.doi.org/10.1016/j.jmpt.2011.08.006. PMid:21978544
http://dx.doi.org/10.1016/j.jmpt.2011.08...
, accompanied by increased
sternocleidomastoid muscle activity1212 Falla DL, Jull GA, Hodges PW. Patients with neck pain demonstrate
reduced electromyographic activity of the deep cervical flexor muscles during
performance of the craniocervical flexion test. Spine. 2004;29(19):2108-14.
http://dx.doi.org/10.1097/01.brs.0000141170.89317.0e.
PMid:15454700
http://dx.doi.org/10.1097/01.brs.0000141...
as a
compensatory mechanism. In two studies1313 Javanshir K, Rezasoltani A, Mohseni-Bandpei MA, Amiri M,
Ortega-Santiago R, Fernández-de-Las-Peñas C. Ultrasound assessment of bilateral
longus colli muscles in subjects with chronic bilateral neck pain. Am J Phys Med
Rehabil. 2011;90(4):293-301. http://dx.doi.org/10.1097/PHM.0b013e31820173e5.
PMid:21173685
http://dx.doi.org/10.1097/PHM.0b013e3182...
,
1414 Jesus-Moraleida FR, Ferreira PH, Pereira LSM, Vasconcelos CM,
Ferreira ML. Ultrasonographic analysis of the neck flexor muscles in patients
with chronic neck pain and changes after cervical spine mobilization. J
Manipulative Physiol Ther. 2011;34(8):514-24.
http://dx.doi.org/10.1016/j.jmpt.2011.08.006. PMid:21978544
http://dx.doi.org/10.1016/j.jmpt.2011.08...
, the ultrasonographic images of these
muscles showed a reduction in thickness1313 Javanshir K, Rezasoltani A, Mohseni-Bandpei MA, Amiri M,
Ortega-Santiago R, Fernández-de-Las-Peñas C. Ultrasound assessment of bilateral
longus colli muscles in subjects with chronic bilateral neck pain. Am J Phys Med
Rehabil. 2011;90(4):293-301. http://dx.doi.org/10.1097/PHM.0b013e31820173e5.
PMid:21173685
http://dx.doi.org/10.1097/PHM.0b013e3182...
,
cross-sectional area1313 Javanshir K, Rezasoltani A, Mohseni-Bandpei MA, Amiri M,
Ortega-Santiago R, Fernández-de-Las-Peñas C. Ultrasound assessment of bilateral
longus colli muscles in subjects with chronic bilateral neck pain. Am J Phys Med
Rehabil. 2011;90(4):293-301. http://dx.doi.org/10.1097/PHM.0b013e31820173e5.
PMid:21173685
http://dx.doi.org/10.1097/PHM.0b013e3182...
, and anteroposterior
dimension in individuals with chronic neck pain. Other findings suggest the presence
of atrophy and alterations in muscle recruitment1414 Jesus-Moraleida FR, Ferreira PH, Pereira LSM, Vasconcelos CM,
Ferreira ML. Ultrasonographic analysis of the neck flexor muscles in patients
with chronic neck pain and changes after cervical spine mobilization. J
Manipulative Physiol Ther. 2011;34(8):514-24.
http://dx.doi.org/10.1016/j.jmpt.2011.08.006. PMid:21978544
http://dx.doi.org/10.1016/j.jmpt.2011.08...
.
In this respect, deep flexor muscles in the cervical region are essential to cervical
spine postural control. Thus, imbalances between these muscles and superficial
cervical muscles make the cervical spine less stable and more vulnerable to other
forces involved in maintaining posture, causing overload in other muscles1818 Mayoux-Benhamou MA, Revel M, Vallée C, Roudier R, Barbet JP, Bargy
F. Longus colli has a postural function on cervical curvature. Surg Radiol Anat.
1994;16(4):367-71. http://dx.doi.org/10.1007/BF01627655.
PMid:7725191
http://dx.doi.org/10.1007/BF01627655...
.
Despite the importance of deep and superficial cervical flexor muscles in stabilizing
and maintaining cervical lordosis and indications that migraine and tension-type
headache are associated with changes in neck muscles, there is still a lack of
studies77 Jensen R, Fuglsang-Frederiksen A, Olesen J. Quantitative surface EMG
of pericranial muscles in headache. A population study. Electroencephalogr Clin
Neurophysiol. 1994;93(5):335-44. http://dx.doi.org/10.1016/0168-5597(94)90121-X.
PMid:7525241
http://dx.doi.org/10.1016/0168-5597(94)9...
,
1515 Oksanen A, Pöyhönen T, Metsähonkala L, Anttila P, Hiekkanen H, Laimi
K, et al. Neck flexor muscle fatigue in adolescents with headache: an
electromyographic study. Eur J Pain. 2007;11(7):764-72.
http://dx.doi.org/10.1016/j.ejpain.2006.12.003. PMid:17291797
http://dx.doi.org/10.1016/j.ejpain.2006....
16 Barton PM, Hayes KC. Neck flexor muscle strength, efficiency, and
relaxation times in normal subjects and subjects with unilateral neck pain and
headache. Arch Phys Med Rehabil. 1996;77(7):680-7.
http://dx.doi.org/10.1016/S0003-9993(96)90008-8. PMid:8669995
http://dx.doi.org/10.1016/S0003-9993(96)...
-
1717 Fernández-de-las-Peñas C, Falla D, Arendt-Nielsen L, Farina D.
Cervical muscle co-activation in isometric contractions is enhanced in chronic
tension-type headache patients. Cephalalgia. 2008;28(7):744-51.
http://dx.doi.org/10.1111/j.1468-2982.2008.01584.x.
PMid:18460003
http://dx.doi.org/10.1111/j.1468-2982.20...
that use non-invasive techniques to assess
those muscles in individuals with migraine or tension-type headache not related to
chronic neck pain.
Thus, the aim of the present study was to assess the association between the presence of migraine or tension-type headache and changes in the longus colli muscle dimensions and sternocleidomastoid muscle activity, using ultrasonography and surface electromyography.
Method
This is an observational, cross-sectional type study comparing three groups. The sample size was not calculated because this is a pilot study. The study was approved by the Human Research Ethics Committee of the Health Sciences Center of Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil (CAAE 02219412.5.0000.5208). All participants gave their informed consent.
Data were collected from October/2012 to December/2013 in the Physical Therapy Department of UFPE.
Participants
The sample was composed of young adult women, aged between 20 and 30 years, to
avoid biases due to the presence of muscle changes associated with biological
aging. Only nulliparous women were included in order to prevent biases related
to the relationship between hormones and the presence of headache1919 Peres MF, Sanchez del Rio M, Seabra ML, Tufik S, Abucham J,
Cipolla-Neto J, et al. Hypothalamic involvement in chronic migraine. J Neurol
Neurosurg Psychiatry. 2001;71(6):747-51.
http://dx.doi.org/10.1136/jnnp.71.6.747. PMid:11723194
http://dx.doi.org/10.1136/jnnp.71.6.747...
. Clinical diagnosis, established by a
neurologist based on criteria proposed by The International Classification of
Headache Disorders2020 Headache Classification Subcommittee of the International Headache
Society. The international classification of headache disorders. Cephalalgia.
2004;24(1 Suppl 1):9-160. PMid:14979299 ., was used to divide
the sample into migraine, tension-type headache, and control groups.
The migraine group was composed of women diagnosed with episodic migraine (less than 15 days with headache per month), with following characteristics: pure migraine (with aura, without aura or both) or probable migraine (with aura and without aura or both). Participants who had probable migraine associated with tension-type headache or migraine associated with tension-type headache were also allocated to the migraine group2020 Headache Classification Subcommittee of the International Headache Society. The international classification of headache disorders. Cephalalgia. 2004;24(1 Suppl 1):9-160. PMid:14979299 .. The tension-type headache group was formed by women with episodic tension-type headache (less than 15 days with headache per month)2020 Headache Classification Subcommittee of the International Headache Society. The international classification of headache disorders. Cephalalgia. 2004;24(1 Suppl 1):9-160. PMid:14979299 .. The control group was composed of participants who had intermittent headache crises over their lifetime that were not associated with the characteristics of primary headaches and those who did not meet the diagnostic criteria of migraine or tension-type headache2020 Headache Classification Subcommittee of the International Headache Society. The international classification of headache disorders. Cephalalgia. 2004;24(1 Suppl 1):9-160. PMid:14979299 ..
The exclusion criteria were as follows: 1) body mass index ≥30 as obesity can
increase the risk of chronic migraine1919 Peres MF, Sanchez del Rio M, Seabra ML, Tufik S, Abucham J,
Cipolla-Neto J, et al. Hypothalamic involvement in chronic migraine. J Neurol
Neurosurg Psychiatry. 2001;71(6):747-51.
http://dx.doi.org/10.1136/jnnp.71.6.747. PMid:11723194
http://dx.doi.org/10.1136/jnnp.71.6.747...
;
2) chronic migraine, chronic tension-type headache or chronic neck pain due to
the association between muscle alterations and chronification of headache and
neck pain77 Jensen R, Fuglsang-Frederiksen A, Olesen J. Quantitative surface EMG
of pericranial muscles in headache. A population study. Electroencephalogr Clin
Neurophysiol. 1994;93(5):335-44. http://dx.doi.org/10.1016/0168-5597(94)90121-X.
PMid:7525241
http://dx.doi.org/10.1016/0168-5597(94)9...
,
1616 Barton PM, Hayes KC. Neck flexor muscle strength, efficiency, and
relaxation times in normal subjects and subjects with unilateral neck pain and
headache. Arch Phys Med Rehabil. 1996;77(7):680-7.
http://dx.doi.org/10.1016/S0003-9993(96)90008-8. PMid:8669995
http://dx.doi.org/10.1016/S0003-9993(96)...
,
1717 Fernández-de-las-Peñas C, Falla D, Arendt-Nielsen L, Farina D.
Cervical muscle co-activation in isometric contractions is enhanced in chronic
tension-type headache patients. Cephalalgia. 2008;28(7):744-51.
http://dx.doi.org/10.1111/j.1468-2982.2008.01584.x.
PMid:18460003
http://dx.doi.org/10.1111/j.1468-2982.20...
; 3) diseases or dysfunctions such as
myopathies, fibromyalgia, abnormalities, fractures or history of cervical spine
or thoracic surgery, symptomatic spinal disc herniation, rheumatoid arthritis,
and history of spinal tumors; 4) score ≥15 in the neck disability index2121 Cook C, Richardson JK, Braga L, Menezes A, Soler X, Kume P, et al.
Cross-cultural adaptation and validation of the Brazilian Portuguese version of
the Neck Disability Index and Neck Pain and Disability Scale. Spine.
2006;31(14):1621-7. http://dx.doi.org/10.1097/01.brs.0000221989.53069.16.
PMid:16778699
http://dx.doi.org/10.1097/01.brs.0000221...
, score ≥36 in the Beck depression
inventory or score ≥30 in the Beck anxiety inventory2222 Stulz N, Crits-Christoph P. Distinguishing anxiety and depression in
self-report: purification of the beck anxiety inventory and beck depression
inventory-II. J Clin Psychol. 2010;66(9):927-40. PMid:20694959
. as neck disability, depression, and anxiety are
disorders often comorbid with chronic migraine1919 Peres MF, Sanchez del Rio M, Seabra ML, Tufik S, Abucham J,
Cipolla-Neto J, et al. Hypothalamic involvement in chronic migraine. J Neurol
Neurosurg Psychiatry. 2001;71(6):747-51.
http://dx.doi.org/10.1136/jnnp.71.6.747. PMid:11723194
http://dx.doi.org/10.1136/jnnp.71.6.747...
,
2020 Headache Classification Subcommittee of the International Headache
Society. The international classification of headache disorders. Cephalalgia.
2004;24(1 Suppl 1):9-160. PMid:14979299 ..
The neck disability index is a questionnaire adapted and validated for the
Brazilian population that provides information about how neck pain affects the
ability to perform activities of daily living. It consists of 10 sections,
scored from 0 to 5 each. Scores ≥15 indicate moderate neck dysfunction2121 Cook C, Richardson JK, Braga L, Menezes A, Soler X, Kume P, et al.
Cross-cultural adaptation and validation of the Brazilian Portuguese version of
the Neck Disability Index and Neck Pain and Disability Scale. Spine.
2006;31(14):1621-7. http://dx.doi.org/10.1097/01.brs.0000221989.53069.16.
PMid:16778699
http://dx.doi.org/10.1097/01.brs.0000221...
.
The Beck depression and anxiety inventories are instruments for research of depressive and anxiety symptoms, translated and validated for the Brazilian population, and consists of 21 items. In the Beck depression inventory, the severity of symptoms varies from 0 to 3, with a maximum score of 63. Scores ≥36 indicate severe depression. In the Beck anxiety inventory, the sum of the items results in a total score that can range from 0 to 63, and scores ≥30 indicate severe anxiety2222 Stulz N, Crits-Christoph P. Distinguishing anxiety and depression in self-report: purification of the beck anxiety inventory and beck depression inventory-II. J Clin Psychol. 2010;66(9):927-40. PMid:20694959 ..
Data collection procedure
An examiner, blinded to the diagnosis of headache, performed an ultrasonographic assessment of the longus colli muscle and surface electromyographic evaluation of the sternocleidomastoid muscle. During data collection, participants could not be menstruating or taking medication such as muscle relaxants, analgesics or anti-inflammatories, in the 48 hours before the examination.
To avoid measurement bias, the examiner was trained to perform the evaluations.
Ultrasonographic assessment of the longus colli muscle
B-mode ultrasonography (Aloka 1500 with 7.5 MHz linear transducer) was used to measure the cross-sectional area (cm2), as well as the lateral (cm), anteroposterior (cm), and shape ratio dimensions of the muscle.
The cross-sectional area was considered the greatest distance between the inner
edges of the margins of the muscle image, without including fascial
contours1313 Javanshir K, Rezasoltani A, Mohseni-Bandpei MA, Amiri M,
Ortega-Santiago R, Fernández-de-Las-Peñas C. Ultrasound assessment of bilateral
longus colli muscles in subjects with chronic bilateral neck pain. Am J Phys Med
Rehabil. 2011;90(4):293-301. http://dx.doi.org/10.1097/PHM.0b013e31820173e5.
PMid:21173685
http://dx.doi.org/10.1097/PHM.0b013e3182...
. The lateral and
anteroposterior dimensions were considered the greatest distance between one
margin and another of the image, in the lateral and anteroposterior direction,
respectively1313 Javanshir K, Rezasoltani A, Mohseni-Bandpei MA, Amiri M,
Ortega-Santiago R, Fernández-de-Las-Peñas C. Ultrasound assessment of bilateral
longus colli muscles in subjects with chronic bilateral neck pain. Am J Phys Med
Rehabil. 2011;90(4):293-301. http://dx.doi.org/10.1097/PHM.0b013e31820173e5.
PMid:21173685
http://dx.doi.org/10.1097/PHM.0b013e3182...
. The shape ratio was
obtained by dividing lateral and anteroposterior dimension values1313 Javanshir K, Rezasoltani A, Mohseni-Bandpei MA, Amiri M,
Ortega-Santiago R, Fernández-de-Las-Peñas C. Ultrasound assessment of bilateral
longus colli muscles in subjects with chronic bilateral neck pain. Am J Phys Med
Rehabil. 2011;90(4):293-301. http://dx.doi.org/10.1097/PHM.0b013e31820173e5.
PMid:21173685
http://dx.doi.org/10.1097/PHM.0b013e3182...
.
Participants were positioned in dorsal decubitus, knees flexed, arms along the
body and head in midline position1414 Jesus-Moraleida FR, Ferreira PH, Pereira LSM, Vasconcelos CM,
Ferreira ML. Ultrasonographic analysis of the neck flexor muscles in patients
with chronic neck pain and changes after cervical spine mobilization. J
Manipulative Physiol Ther. 2011;34(8):514-24.
http://dx.doi.org/10.1016/j.jmpt.2011.08.006. PMid:21978544
http://dx.doi.org/10.1016/j.jmpt.2011.08...
. The
transducer was placed longitudinally in the anterior region of the neck,
parallel to the trachea, approximately five centimeters from the midline at the
level of vertebrae C5 and C6. The longus colli muscle is bordered inferiorly and
medially by the vertebral body, laterally by the carotid artery, and superiorly
by the retropharyngeal space1313 Javanshir K, Rezasoltani A, Mohseni-Bandpei MA, Amiri M,
Ortega-Santiago R, Fernández-de-Las-Peñas C. Ultrasound assessment of bilateral
longus colli muscles in subjects with chronic bilateral neck pain. Am J Phys Med
Rehabil. 2011;90(4):293-301. http://dx.doi.org/10.1097/PHM.0b013e31820173e5.
PMid:21173685
http://dx.doi.org/10.1097/PHM.0b013e3182...
.
Three measurements of the muscle dimensions were taken at rest and during
contraction, with a one-minute interval between them. In contraction, subjects
were instructed to perform a cervical flexion, without removing their head and
shoulders from the table, sustaining it for ten seconds1414 Jesus-Moraleida FR, Ferreira PH, Pereira LSM, Vasconcelos CM,
Ferreira ML. Ultrasonographic analysis of the neck flexor muscles in patients
with chronic neck pain and changes after cervical spine mobilization. J
Manipulative Physiol Ther. 2011;34(8):514-24.
http://dx.doi.org/10.1016/j.jmpt.2011.08.006. PMid:21978544
http://dx.doi.org/10.1016/j.jmpt.2011.08...
. The average of the three results for each measurement
was used to compare intergroup dimensions.
Surface electromyography of the sternocleidomastoid muscle
The EMG device (model 410C, EMG System of Brazil Ltda.) was connected to a portable computer. The equipment has four channels, with pre-amplifiers, sample frequency per channel of 2000 Hz, Butterworth band-pass filter between 20 and 500 Hz, amplified 2000 times (common-mode rejection >120 dB), digitized with a frequency of 2 KHz per channel and amplitude range between -5 and +5 volts. After collection, the signal was digitized, converted to .txt format and analyzed using the software of the device itself.
Signal capture followed ISEK (International Society of Electrophysiology and
Kinesiology) Standards for Reporting EMG Data2323 Merletti R, Di Torino P. Standards for reporting EMG data. J
Electromyogr Kinesiol. 1999;9(1):3-4.. Electromyographic signals were detected using two rectangular
surface electrodes (Ag/AgCl, self-adhesive, bipolar) on the muscle, twenty
millimeters apart2424 Hermens HJ, Freriks B, Disselhorst-Klug C, Rau G. Development of
recommendations for SEMG sensors and sensor placement procedures. J Electromyogr
Kinesiol. 2000;10(5):361-74. http://dx.doi.org/10.1016/S1050-6411(00)00027-4.
PMid:11018445
http://dx.doi.org/10.1016/S1050-6411(00)...
.
Participants were placed in dorsal decubitus, knees flexed and feet resting on
the table, arms flexed and hands above their head and resting on the table, in
order to reduce the action of trunk and scapular waist muscles2525 Kendall HO, Kendall FP, Wadsworth GE. Músculos, pruebas y funciones.
Barcelona: JIMS; 1974.. The electrodes were placed on the
midpoint of the muscle belly, along the length of the muscle fibers1717 Fernández-de-las-Peñas C, Falla D, Arendt-Nielsen L, Farina D.
Cervical muscle co-activation in isometric contractions is enhanced in chronic
tension-type headache patients. Cephalalgia. 2008;28(7):744-51.
http://dx.doi.org/10.1111/j.1468-2982.2008.01584.x.
PMid:18460003
http://dx.doi.org/10.1111/j.1468-2982.20...
, from a reference line running between
the lower point of the mastoid process and the center of the sternal furcula.
The reference electrode was fixed to the lateral epicondyle of the left
humerus.
In the first five seconds of collection, participants remained at rest with their head at maximum rotation amplitude to the opposite side to that assessed and leaning toward the same side. Cervical flexion was then performed, up to maximum amplitude2525 Kendall HO, Kendall FP, Wadsworth GE. Músculos, pruebas y funciones. Barcelona: JIMS; 1974., maintaining the position in isometric contraction for twenty-five seconds, subjects not raising their shoulders from the table, followed by five seconds of rest. The sternocleidomastoid muscle was assessed unilaterally in order to minimize the cross-talk effect2626 Basmajian JV. Electrofisiología de la acción muscular. Buenos Aires: Medica Panamericana; 1976..
The electrical activities analyzed were median frequency (Hz) and signal amplitude (v), through a time window manually driven by the software of the device itself. One-second samples of the electromyographic recording were analyzed at the start of the rest period (between 2 and 3 seconds), at the onset of contraction (between 6 and 7 seconds), and at the end of contraction (between 28 and 29 seconds).
Median frequency was measured at the start and end of muscle contraction in order
to analyze the rate of decline at the end of contraction1515 Oksanen A, Pöyhönen T, Metsähonkala L, Anttila P, Hiekkanen H, Laimi
K, et al. Neck flexor muscle fatigue in adolescents with headache: an
electromyographic study. Eur J Pain. 2007;11(7):764-72.
http://dx.doi.org/10.1016/j.ejpain.2006.12.003. PMid:17291797
http://dx.doi.org/10.1016/j.ejpain.2006....
. Muscle activation was determined from the amplitude of
the electromyographic signal quantified by root mean square (RMS) values. Data
were normalized by subtracting RMS values at the start and end of contraction
from baseline values2727 Madill SJ, McLean L. Quantification of abdominal and pelvic floor
muscle synergies in response to voluntary pelvic floor muscle contractions. J
Electromyogr Kinesiol. 2008;18(6):955-64.
http://dx.doi.org/10.1016/j.jelekin.2007.05.001. PMid:17646112
http://dx.doi.org/10.1016/j.jelekin.2007...
. The average of
median frequency and normalized RMS values was used for intergroup
comparison.
Processing and data analysis
The data bank was digitized into Microsoft Excel (2007) spreadsheets and exported to SPSS 20.0 for analysis. Data were presented as mean (confidence interval) and percentage. All variables exhibited normal distribution in the Kolmogorov-Smirnov test. To verify the association between variables, paired t-test, one-way ANOVA (for intergroup comparisons separately), repeated measures two-way ANOVA (for intra and intergroup comparisons performed simultaneously) and Tukey's post hoc test were performed. Statistical significance was set at the 95% confidence level (p<0.05).
Results
A total of 52 participants were recruited, 4 of whom refused to take part in the study. Forty-eight women, aged on average 22.67 years (CI: 22.1-23.23), were allocated to the migraine (n=21), tension-type (n=16), and control (n=11) groups.
Of the participants with headache (n=37), 43% (n=16/37) suffered from episodic tension-type headache and 57% (n=21/37) migraine. Considering only the migraine group (n=21), we found the following frequency of subtypes: 67% (n=14/21) had migraine without aura; 14% (n=3/21) migraine without aura associated with episodic tension-type headache; 9% (n=2/21) migraine with aura; 5% (n=1/21) migraine with aura associated with episodic tension-type headache; and 5% (n=1/21) migraine with aura and without aura.
There was no intergroup difference (p>0.05) in age, height, weight or body mass index. The scores for the Neck disability index were statistically significant in the intergroup analysis (p=0.01; one-way ANOVA). Post-test analysis showed higher scores in the migraine group than in the control group (p<0.01); and higher scores in tension-type headache than in the control group (p=0.08). The Beck depression inventory scores and the Beck anxiety inventory scores did not differ between groups (p>0.05; Table 1).
Regarding participants with headache in Table 1, there was no difference between groups in the time with headache (p=0.59) and headache duration (p=0.21). However, headache frequency was higher in the migraine group than in the tension-type headache group (p=0.01).
Ultrasonographic analysis of the left and right longus colli muscle during rest and contraction revealed no intergroup difference in cross-sectional area or lateral, anteroposterior, and shape ratio dimensions (Table 2).
There was a statistically significant intergroup difference in right and left sternocleidomastoid muscle activation at the onset of contraction (p<0.05; repeated measures two-way ANOVA). Post-test analysis showed less sternocleidomastoid muscle activation on both sides at the start of contraction in the group with tension-type headache when compared to the control group {right sternocleidomastoid [tension-type headache: 0.39 (0.30-0.49); control: 0.58 (0.42-0.76); p=0.026] and left sternocleidomastoid [tension-type headache: 0.39 (0.31-0.48); control: 0.60 (0.42-0.79); p=0.039], Tukey's post-hoc test}. There was no difference between the three groups in sternocleidomastoid muscle activation, on either side, at the end of contraction (p>0.05; repeated measures two-way ANOVA; Table 3).
In intragroup analysis, there was a significant difference (p<0.05; repeated measures two-way ANOVA) in median frequency variation between the start and end of sternocleidomastoid muscle contraction, indicating a decline in median frequency at the end of contraction in all groups. However, the difference in the rate of median frequency decline, from the start to the end of sternocleidomastoid muscle contraction, was not significant between groups (p=0.092 on the left side and p=0.97 on the right side; repeated measures two-way ANOVA; Table 4).
Discussion
The hypothesis that women with migraine or tension-type headache have a shorter longus colli muscle and increased sternocleidomastoid muscle activity, when compared to women without headache, was not confirmed. On the other hand, the present study is innovative in that it assesses muscles with important stabilization and postural alignment functions in the cervical region in a young population with migraine or episodic tension-type headache.
Since muscle alterations may be more associated with biological aging and
chronification of headache and neck pain77 Jensen R, Fuglsang-Frederiksen A, Olesen J. Quantitative surface EMG
of pericranial muscles in headache. A population study. Electroencephalogr Clin
Neurophysiol. 1994;93(5):335-44. http://dx.doi.org/10.1016/0168-5597(94)90121-X.
PMid:7525241
http://dx.doi.org/10.1016/0168-5597(94)9...
,
1616 Barton PM, Hayes KC. Neck flexor muscle strength, efficiency, and
relaxation times in normal subjects and subjects with unilateral neck pain and
headache. Arch Phys Med Rehabil. 1996;77(7):680-7.
http://dx.doi.org/10.1016/S0003-9993(96)90008-8. PMid:8669995
http://dx.doi.org/10.1016/S0003-9993(96)...
,
1717 Fernández-de-las-Peñas C, Falla D, Arendt-Nielsen L, Farina D.
Cervical muscle co-activation in isometric contractions is enhanced in chronic
tension-type headache patients. Cephalalgia. 2008;28(7):744-51.
http://dx.doi.org/10.1111/j.1468-2982.2008.01584.x.
PMid:18460003
http://dx.doi.org/10.1111/j.1468-2982.20...
than with episodic headache in a younger
population (15 to 24 years), the present study avoided a confusion factor in the
association between muscle modifications and the emergence of headaches. Therefore,
differences between our results and those reported in the literature77 Jensen R, Fuglsang-Frederiksen A, Olesen J. Quantitative surface EMG
of pericranial muscles in headache. A population study. Electroencephalogr Clin
Neurophysiol. 1994;93(5):335-44. http://dx.doi.org/10.1016/0168-5597(94)90121-X.
PMid:7525241
http://dx.doi.org/10.1016/0168-5597(94)9...
,
1616 Barton PM, Hayes KC. Neck flexor muscle strength, efficiency, and
relaxation times in normal subjects and subjects with unilateral neck pain and
headache. Arch Phys Med Rehabil. 1996;77(7):680-7.
http://dx.doi.org/10.1016/S0003-9993(96)90008-8. PMid:8669995
http://dx.doi.org/10.1016/S0003-9993(96)...
,
1717 Fernández-de-las-Peñas C, Falla D, Arendt-Nielsen L, Farina D.
Cervical muscle co-activation in isometric contractions is enhanced in chronic
tension-type headache patients. Cephalalgia. 2008;28(7):744-51.
http://dx.doi.org/10.1111/j.1468-2982.2008.01584.x.
PMid:18460003
http://dx.doi.org/10.1111/j.1468-2982.20...
may be due to the different
characteristics and age groups of the populations analyzed.
In this study, there was less activation at the onset of sternocleidomastoid muscle
contraction in the group with tension-type headache, when compared to participants
without headache. Corroborating our findings, other authors have also observed less
activation and more prolonged sternocleidomastoid muscle relaxation in participants
with chronic neck pain associated with headache1616 Barton PM, Hayes KC. Neck flexor muscle strength, efficiency, and
relaxation times in normal subjects and subjects with unilateral neck pain and
headache. Arch Phys Med Rehabil. 1996;77(7):680-7.
http://dx.doi.org/10.1016/S0003-9993(96)90008-8. PMid:8669995
http://dx.doi.org/10.1016/S0003-9993(96)...
.
On the other hand, studies that showed greater activation and fatigability in
cervical muscles, such as the sternocleidomastoid, splenius1717 Fernández-de-las-Peñas C, Falla D, Arendt-Nielsen L, Farina D.
Cervical muscle co-activation in isometric contractions is enhanced in chronic
tension-type headache patients. Cephalalgia. 2008;28(7):744-51.
http://dx.doi.org/10.1111/j.1468-2982.2008.01584.x.
PMid:18460003
http://dx.doi.org/10.1111/j.1468-2982.20...
, frontal and temporal77 Jensen R, Fuglsang-Frederiksen A, Olesen J. Quantitative surface EMG
of pericranial muscles in headache. A population study. Electroencephalogr Clin
Neurophysiol. 1994;93(5):335-44. http://dx.doi.org/10.1016/0168-5597(94)90121-X.
PMid:7525241
http://dx.doi.org/10.1016/0168-5597(94)9...
, assessed participants with chronic tension-type headache77 Jensen R, Fuglsang-Frederiksen A, Olesen J. Quantitative surface EMG
of pericranial muscles in headache. A population study. Electroencephalogr Clin
Neurophysiol. 1994;93(5):335-44. http://dx.doi.org/10.1016/0168-5597(94)90121-X.
PMid:7525241
http://dx.doi.org/10.1016/0168-5597(94)9...
,
1717 Fernández-de-las-Peñas C, Falla D, Arendt-Nielsen L, Farina D.
Cervical muscle co-activation in isometric contractions is enhanced in chronic
tension-type headache patients. Cephalalgia. 2008;28(7):744-51.
http://dx.doi.org/10.1111/j.1468-2982.2008.01584.x.
PMid:18460003
http://dx.doi.org/10.1111/j.1468-2982.20...
. Thus, the increase in muscle activation
and fatigability may be a consequence of the motor control reorganization strategy
in subjects with chronic headache1717 Fernández-de-las-Peñas C, Falla D, Arendt-Nielsen L, Farina D.
Cervical muscle co-activation in isometric contractions is enhanced in chronic
tension-type headache patients. Cephalalgia. 2008;28(7):744-51.
http://dx.doi.org/10.1111/j.1468-2982.2008.01584.x.
PMid:18460003
http://dx.doi.org/10.1111/j.1468-2982.20...
,
generating muscle overload and fatigue, increased nociception1717 Fernández-de-las-Peñas C, Falla D, Arendt-Nielsen L, Farina D.
Cervical muscle co-activation in isometric contractions is enhanced in chronic
tension-type headache patients. Cephalalgia. 2008;28(7):744-51.
http://dx.doi.org/10.1111/j.1468-2982.2008.01584.x.
PMid:18460003
http://dx.doi.org/10.1111/j.1468-2982.20...
, and changes in the type of muscle fiber77 Jensen R, Fuglsang-Frederiksen A, Olesen J. Quantitative surface EMG
of pericranial muscles in headache. A population study. Electroencephalogr Clin
Neurophysiol. 1994;93(5):335-44. http://dx.doi.org/10.1016/0168-5597(94)90121-X.
PMid:7525241
http://dx.doi.org/10.1016/0168-5597(94)9...
.
Therefore, the reduced muscle activation values observed in the group with
tension-type headache may be related to the increased basal tonus in the
sternocleidomastoid muscle and smaller amount of fast fibers. The reduction in type
II fibers can be associated with lower speed of contraction, reducing the muscle
activation in the tension-type group77 Jensen R, Fuglsang-Frederiksen A, Olesen J. Quantitative surface EMG
of pericranial muscles in headache. A population study. Electroencephalogr Clin
Neurophysiol. 1994;93(5):335-44. http://dx.doi.org/10.1016/0168-5597(94)90121-X.
PMid:7525241
http://dx.doi.org/10.1016/0168-5597(94)9...
.
Similarly, the absence of a difference in sternocleidomastoid muscle activation in
the group with migraine suggests that these individuals may have another type of
muscle fiber.
The neck disability index scores were higher in the migraine and tension-type
headache groups than in the control group, suggesting that neck pain adds
significantly to the overall disability of individuals with migraine or tension-type
headache. Neck pain-related disability can be associated with changes in body
posture2828 Gonçalves MC, Florencio LL, Chaves TC, Speciali JG, Bigal ME,
Bevilaqua-Grossi D. Do women with migraine have higher prevalence of
temporomandibular disorders? Braz J Phys Ther. 2013;17(1):64-8.
http://dx.doi.org/10.1590/S1413-35552012005000054.
PMid:23117652
http://dx.doi.org/10.1590/S1413-35552012...
and seems to increase as the
frequency of migraine attacks increases2929 Florencio LL, Chaves TC, Carvalho GF, Gonçalves MC, Casimiro EC,
Dach F, et al. Neck pain disability is related to the frequency of migraine
attacks: a cross-sectional study. Headache. 2014;54(7):1203-10.
http://dx.doi.org/10.1111/head.12393. PMid:24863346
http://dx.doi.org/10.1111/head.12393...
.
Furthermore, this disability may be a functional consequence of changes in
craniocervical posture in migraine patients2929 Florencio LL, Chaves TC, Carvalho GF, Gonçalves MC, Casimiro EC,
Dach F, et al. Neck pain disability is related to the frequency of migraine
attacks: a cross-sectional study. Headache. 2014;54(7):1203-10.
http://dx.doi.org/10.1111/head.12393. PMid:24863346
http://dx.doi.org/10.1111/head.12393...
.
With respect to the analysis of deep cervical muscles, one study1010 Bartsch T, Goadsby PJ. Increased responses in trigeminocervical
nociceptive neurons to cervical input after stimulation of the dura mater.
Brain. 2003;126(Pt 8):1801-13. http://dx.doi.org/10.1093/brain/awg190.
PMid:12821523
http://dx.doi.org/10.1093/brain/awg190...
showed that people with chronic neck pain exhibited
imbalance between deep and superficial cervical flexor muscles, such as the longus
colli and sternocleidomastoid muscles. In our study, similar results were expected
in groups with migraine or tension-type headache. However, given that they are deep
muscles in the cervical region, alterations in this structure may only be perceived
when there is prolonged accumulation of nociceptive stimuli, as in chronic neck
pain1212 Falla DL, Jull GA, Hodges PW. Patients with neck pain demonstrate
reduced electromyographic activity of the deep cervical flexor muscles during
performance of the craniocervical flexion test. Spine. 2004;29(19):2108-14.
http://dx.doi.org/10.1097/01.brs.0000141170.89317.0e.
PMid:15454700
http://dx.doi.org/10.1097/01.brs.0000141...
,
1414 Jesus-Moraleida FR, Ferreira PH, Pereira LSM, Vasconcelos CM,
Ferreira ML. Ultrasonographic analysis of the neck flexor muscles in patients
with chronic neck pain and changes after cervical spine mobilization. J
Manipulative Physiol Ther. 2011;34(8):514-24.
http://dx.doi.org/10.1016/j.jmpt.2011.08.006. PMid:21978544
http://dx.doi.org/10.1016/j.jmpt.2011.08...
.
Moreover, there are also reports of reduced thickness1414 Jesus-Moraleida FR, Ferreira PH, Pereira LSM, Vasconcelos CM,
Ferreira ML. Ultrasonographic analysis of the neck flexor muscles in patients
with chronic neck pain and changes after cervical spine mobilization. J
Manipulative Physiol Ther. 2011;34(8):514-24.
http://dx.doi.org/10.1016/j.jmpt.2011.08.006. PMid:21978544
http://dx.doi.org/10.1016/j.jmpt.2011.08...
, cross-sectional area, and anteroposterior dimension1313 Javanshir K, Rezasoltani A, Mohseni-Bandpei MA, Amiri M,
Ortega-Santiago R, Fernández-de-Las-Peñas C. Ultrasound assessment of bilateral
longus colli muscles in subjects with chronic bilateral neck pain. Am J Phys Med
Rehabil. 2011;90(4):293-301. http://dx.doi.org/10.1097/PHM.0b013e31820173e5.
PMid:21173685
http://dx.doi.org/10.1097/PHM.0b013e3182...
in the longus colli muscle of individuals
with chronic neck pain. However, it is important to underscore that chronic neck
pain may be linked to muscle atrophy and alterations in muscle dimension and
recruitment1414 Jesus-Moraleida FR, Ferreira PH, Pereira LSM, Vasconcelos CM,
Ferreira ML. Ultrasonographic analysis of the neck flexor muscles in patients
with chronic neck pain and changes after cervical spine mobilization. J
Manipulative Physiol Ther. 2011;34(8):514-24.
http://dx.doi.org/10.1016/j.jmpt.2011.08.006. PMid:21978544
http://dx.doi.org/10.1016/j.jmpt.2011.08...
, justifying the
discrepancies in the findings of the present study. Thus, alterations in cervical
muscles are most likely correlated to pain chronification, as occurs in the aging
process or in conditions such as chronic migraine, cervicogenic headache and chronic
neck pain, than to the pathogenesis of headache77 Jensen R, Fuglsang-Frederiksen A, Olesen J. Quantitative surface EMG
of pericranial muscles in headache. A population study. Electroencephalogr Clin
Neurophysiol. 1994;93(5):335-44. http://dx.doi.org/10.1016/0168-5597(94)90121-X.
PMid:7525241
http://dx.doi.org/10.1016/0168-5597(94)9...
,
1616 Barton PM, Hayes KC. Neck flexor muscle strength, efficiency, and
relaxation times in normal subjects and subjects with unilateral neck pain and
headache. Arch Phys Med Rehabil. 1996;77(7):680-7.
http://dx.doi.org/10.1016/S0003-9993(96)90008-8. PMid:8669995
http://dx.doi.org/10.1016/S0003-9993(96)...
,
1717 Fernández-de-las-Peñas C, Falla D, Arendt-Nielsen L, Farina D.
Cervical muscle co-activation in isometric contractions is enhanced in chronic
tension-type headache patients. Cephalalgia. 2008;28(7):744-51.
http://dx.doi.org/10.1111/j.1468-2982.2008.01584.x.
PMid:18460003
http://dx.doi.org/10.1111/j.1468-2982.20...
,
1919 Peres MF, Sanchez del Rio M, Seabra ML, Tufik S, Abucham J,
Cipolla-Neto J, et al. Hypothalamic involvement in chronic migraine. J Neurol
Neurosurg Psychiatry. 2001;71(6):747-51.
http://dx.doi.org/10.1136/jnnp.71.6.747. PMid:11723194
http://dx.doi.org/10.1136/jnnp.71.6.747...
.
One of the limitations of the present study was that it is not a longitudinal study and does not involve a long-term follow-up of participants to establish a more accurate association between alterations in cervical muscles and the presence of headache. Additionally, the need to control some factors that possibly trigger the headache and the higher prevalence of migraine compared with tension-type headache and women without primary headache limited our ability to obtain a larger sample, especially for the control group.
The clinical importance of our study is that the knowledge of changes in muscle function will be important to guide physical therapy treatment in patients with headache. The decreased activation in the sternocleidomastoid muscle at the onset of contraction in the tension-type headache group suggests the importance of more muscle assessments in patients with headache. Furthermore, patients with headache benefited from the Neck disability index evaluation, because in our study they were more likely to report neck disability than the control group, suggesting that the prevalence of neck pain is higher in patients with headache.
Conclusion
In the present study, the group with tension-type headache showed less sternocleidomastoid muscle activation at the onset of contraction. No association was observed between the presence of headache and alterations in the dimensions of the longus colli muscle, median frequency, and sternocleidomastoid muscle activation at the end of contraction.
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Publication Dates
-
Publication in this collection
12 June 2015 -
Date of issue
May-Jun 2015
History
-
Received
26 Aug 2014 -
Reviewed
16 Nov 2014 -
Accepted
16 Dec 2014