Cervical musculoskeletal impairments in migraine and tension-type headache and relationship to pain related factors: An updated systematic review and meta-analysis

Background: An updated systematic review of cervical musculoskeletal dysfunction in migraine and tension-type headache is needed. Influencing factors (pain hypersensitivity with cervical musculoskeletal testing, active trigger points and tenderness) have not been investigated.

Objectives: To i) update evidence for cervical musculoskeletal impairments in migraine and tension-type headache ii) report on accompanying pain associated with testing, active trigger points and tenderness in headache; iii) determine relationships between these sensitivity features and cervical musculoskeletal impairments in headache.

Methods: Five databases were searched for observational studies. Quality of studies was assessed with JBI Critical Appraisal. Meta-analysis was performed using random effect models. Certainty of the evidence was assessed using GRADE.

Results: Seventy-seven studies were included comprising 2551 participants. New findings in migraine were increased forward head posture in standing (MD = -2.51°[-4.94°, -0.09°]), reduced flexion/rotation range (MD = -9.47°[-15.78°, -3.16°]), reduced flexor strength (Std. MD = -0.34[-0.57, -0.10]) and endurance (MD = -14.37[-28.15, -0.58]), and reduced extensor strength (Std. MD = -0.34[-0.60, -0.08]) in migraine. Tension-type headache had reduced extensor strength (Std. MD = -0.45[-0.85, -0.04]). Certainty was very low for all findings due to heterogeneity and small effect size. Active trigger points and tenderness were common, particularly, in chronic headache. A negative relationship between cervical musculoskeletal performance and active trigger points and tenderness was found in 2 from 77 studies (r < - 0.47).

Conclusions: Several cervical musculoskeletal impairments are present in migraine and tension-type headache with very low certainty. Caution is needed since few studies considered factors that would influence testing.