Balance alterations are associated with neck pain and neck muscle endurance in migraine

Influence of cervical muscle strength and pain severity on functional balance and limits of stability in elderly individuals with chronic nonspecific neck pain: a cross-sectional study

BACKGROUND

Chronic nonspecific neck pain (CNSNP) is a common musculoskeletal disorder, particularly in the elderly, leading to reduced cervical muscle strength, impaired functional balance, and decreased postural stability. This study investigated the correlation between cervical muscle strength, functional balance, and limits of stability (LOS) in elderly individuals with CNSNP. Additionally, it assessed the moderating effect of pain severity on the relationship between cervical muscle strength and these balance outcomes.

METHODS

A prospective study included a total of 186 participants, including 93 with CNSNP and 93 asymptomatic individuals, were recruited. Cervical flexor and extensor muscle strength were assessed using an ergoFET hand-held dynamometer. Functional balance was measured using the Berg Balance Scale (BBS) and Timed Up and Go (TUG) test, while LOS were evaluated using the Iso-Free machine.

RESULTS

Individuals with CNSNP exhibited significantly lower cervical flexor strength (32.45 ± 5.67 N vs. 40.75 ± 5.20 N, p < 0.001) and extensor strength (28.30 ± 6.05 N vs. 36.90 ± 5.90 N, p < 0.001) compared to asymptomatic individuals. Functional balance was also poorer in the CNSNP group, with lower BBS scores (47.85 ± 4.20 vs. 53.65 ± 3.85, p < 0.001) and slower TUG times (11.30 ± 2.05 s vs. 8.45 ± 1.80 s, p < 0.001). Cervical muscle strength showed moderate to strong positive correlations with LOS (r = 0.56 to 0.62, p < 0.001) and BBS (r = 0.48 to 0.53, p < 0.001). Pain severity significantly moderated the relationship between cervical muscle strength and functional balance (β = 0.20, p = 0.045) as well as LOS (β = 0.22, p = 0.038), suggesting that higher pain levels diminish the positive effects of muscle strength on balance.

CONCLUSION

Cervical muscle strength plays a crucial role in maintaining functional balance and postural stability in elderly individuals with CNSNP. Pain severity moderates the relationship between cervical muscle strength and balance outcomes, emphasizing the importance of integrating muscle strengthening and pain management in rehabilitation programs for elderly individuals with CNSNP to optimize postural control and minimize fall risk.

The Effect of OnabotulinumtoxinA on Headache Intensity and Number of Monthly Headache Days in Individuals with Chronic Migraine with Different Levels of Neck Disability

One of the treatment methods used in chronic migraine is OnabotulinumtoxinA. The effects of OnabotulinumtoxinA on headache intensity (HI) and number of monthly headache days (NMHD) in chronic migraine (CM) patients classified according to neck disability levels are unknown. Our aim was to investigate the effect of OnabotulinumtoxinA on the HI and the NMHD in individuals with CM with different levels of neck disability. One hundred sixteen patients were enrolled in the study. The OnabotulinumtoxinA protocol was administered as per Follow-the-Pain PREEMPT. The Neck Disability Index was used to evaluate neck disability. Primary outcome measures were headache intensity, assessed with the Visual Analogue Scale, and the number of monthly headache days recorded from patients' diaries. Secondary outcome measures were migraine disability, assessed with the Migraine Disability Assessment Test, and quality-of-life, assessed with the Headache Impact Test-6. All assessments were made at baseline and end of the treatment. The OnabotulinumtoxinA treatment showed a greater improvement effect in the number of monthly headache days (p = 0.000) and migraine disability (p = 0.000) parameters in the severe and complete disability groups. CM patients with complete and severe neck disability received the most benefit in reducing the NMHD at 3 months after OnabotulinumtoxinA treatment, but the HI decreased at a similar level in all neck disability groups.