Results of upper cervical palpation test in migraine patients are not explained by pain sensitization

Review written by Dr Julia Treleaven info

Key Points

  1. Upper cervical palpation test (UPT) is not related to central sensitization, neck-related disability, neck pain or headache characteristics and other measures of sensitivity.
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BACKGROUND AND OBJECTIVE

Neck pain is a common comorbidity in migraine (1), yet it can be due to several potential causes, a cervical musculoskeletal (MSK) condition, referred pain and part of the migraine attack or increased sensitivity (2). The upper cervical palpation test (UPT) has been proposed as a clinical tool to identify an element of MSK dysfunction in migraine patients by some authors (3) although others would suggest that this test should not be used in isolation and the results could also reflect central sensitivity or cervical sensitivity due to sensitivity in the trigeminocervical nucleus (4).

This study aimed to determine whether UPT findings (no pain, local pain, or referred pain) are associated with neck-related disability or central sensitization. The authors hypothesized that UPT results could be explained by either neck pain/disability or central sensitization.

Neck pain is a common comorbidity in migraine, yet it can be due to several potential causes, a cervical musculoskeletal condition, referred pain and part of the migraine attack or increased sensitivity.
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Rather than isolated tests, a comprehensive musculoskeletal assessment is now thought to be critical to identify patterns of impairment consistent with cervical dysfunction.

METHODS

  • 42 individuals with episodic migraine were assessed using a battery of validated tools: the Neck Disability Index (NDI), Central Sensitization Inventory (CSI), Allodynia Symptom Checklist (ASC-12), and quantitative sensory testing (QST) for mechanical and pressure pain thresholds at the head,
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