Influence of neck disfunction on joint position sense, dizziness and balance of patients with migraine

Abstract

Migraine is frequently associated to balance changes, vestibular symptoms and neck disfunction. It is especulated that balance and vestibular symptoms in migraineurs are due central origin, and not pheripheric, in the nervous system. However, it is well known that neck dysfuncion is related to proprioceptive changes, imbalance and dizziness. Objective: To investigate the influence of neck dysfunction on the cervicocephalic kinesthesia, self-report of imbalance, falls, agility and vestibular symptoms among migraineurs.Methods: Consecutive patients from a university-based hospital headache clinic will be included, if elegible according to incluision and exclusion criteria. Patients will be distributed according to the presence of pain during the manual pressure of upper cervical spine as follows: a) neck pain free group (PFG), b) local neck tenderness group (LTG) and, c) reffered pain to the head group (RPG). A blinded examiner will give to the patient a questionnarie with questions regarding migraine, neck pain, vestibular symptoms, falls and imbalance. The Neck Disability Index (NDI-G) and the Dizziness Handicap Inventory (DHI) will be also admininstered. Subsequently, patients will perform the cervical joint position sense error test (JPSE). They will be instructed to realocate the head to a neutral posture, without use of vision, after active movements of extension, right and left rotations. The error between the initial and final position, expressed in cm and degrees will be considered, after three trials of each movement. The timed up and go test (TUG) will be also performed and the time in seconds will be considered. The patient will get up from a chair, walk three meters and return to the seated position as fast as he/she can. The three groups will be compared for all outcomes with a significance level of 5%.Expected results: The results of this project will elucidate the role of the pheripherical afferences on joint position sense, balance and vestibular symptoms. The verification if there is or not differences at the clinical presentation of migraine according to the neck dysfunction would contribute to the proper assessment and clinical treatment according to specfic patients' needs. (AU)