5 Cervical musculoskeletal impairments in migraine and tension type headache: A systematic review and meta-analysis

Aims: Neck pain is common in migraine and tension type headache (TTH). This review aimed to examine the evidence for cervical musculoskeletal impairments in these headaches. Methods: Databases PubMed (Medline), EMBASE, CINAHL, SCOPUS, and Web of Science were searched from inception to December 2018. Observational studies using a comparator group were included. Risk of bias was assessed using the Appraisal tool for Cross-Sectional Studies. Results were pooled using random effects meta-analysis. Level of evidence for each outcome was assigned based on risk of bias, consistency of results and magnitude of difference between participants with headache and controls. (PROSPERO registration: CRD42018083683). Results: Of 48 studies included, the majority were rated moderate risk of bias due to possible confounding influences. In total, 17 cervical outcomes were assessed, with confidence in findings ranging from very low to moderate levels. Compared to controls, participants with TTH had greater forward head posture (FHP) (MD = -6.18 degrees, 95% CI [-8.18 degrees, -4.18 degrees]) and less cervical range of motion (ROM) (greatest difference transverse plane MD = -15.0 degrees, 95% CI [-27.7 degrees, -2.3 degrees]. Participants with migraine demonstrated minimally reduced cervical ROM (greatest difference sagittal plane MD = -5.4 degrees, 95% CI [-9.9 degrees, -0.9 degrees]. No differences presented in head posture, strength, craniocervical flexion test performance or joint position error between migraineurs and controls. Conclusions: TTH presented with more findings of cervical musculoskeletal impairments than migraine however levels of confidence in findings were low. Future studies should differentiate episodic from chronic headache, identify coexisting musculoskeletal cervical disorders, and describe neck pain behaviour in headache.