July 23, 2020

Ep. 46 Satpute Interview

37 minutes

Kiran Satpute (e-mail, ResearchGate, Twitter) of Navale College of Physiotherapy is interviewed by Stephen M. Shaffer regarding a publication from the Journal of Manual and Manipulative Therapy titled, “Headache symptom modification: the relevance of appropriate manual therapy assessment and management of a patient with features of migraine and cervicogenic headache – a case report.” This episode contains information that will be interesting for practitioners who want to learn about and explore how to clinically approach the tenuous dividing lines between cervicogenic and migraine headaches.

In addition, an array of different publications were mentioned during this interview including: Bragatto et al 2019 (presence of neck pain is associated with high severity of migraine symptoms); Peris et al 2017 (neck pain as the most common trigger for migraine headache; incorrectly referred to as being published in 2016 during the interview; Bogduk et al 2009 (trigeminocervical complex); Vernon et al 2009 (animal studies show sensitization in headache); Watson and Drummond 2014 (Human studies show sensitization in headache); Ferracini 2017 (weakness in deep neck flexor muscles, reduced upper cervical range of motion, multiple trigger points in neck muscles, and headache reproduction or resolution after application of cervical passive accessory intervertebral motion in migraineurs); Bragatto et al 2019 and Florencino et al 2019 (weakness, poor endurance, and decreased cervical ROM in migraineurs); Liang et al 2019 (systematic review and meta analysis stating that the evidence of cervical spine musculoskeletal impairments in migraineurs is of low quality); Jull and Hall 2018 (debates whether neck pain is part of migraine symptomology, a consequence of headache, or a result of cervical musculoskeletal dysfunction); Bartsch et al in various papers (the sensitized trigeminal nucleus may be responsible for neck pain in migraineurs even in the absence of musculoskeletal dysfunction of the cervical spine); Janani et al 2018 (approximately 30% greater resting neck muscle activity in migraineurs compared to the headache-free controls); Lipton et al 2020 (explained the importance of neck evaluation in migraineurs; 50% of migraineurs are not taking their prescribed medications; non steroidal anti-inflammatory medication and opioid use increased in this population); International Headache Society (IHS) and the International Classification of Headache Disorders (ICHD-3); Sjaastad et al 1998 (Cervicogenic Headache International Study Group, a diagnostic criteria for cervicogenic headache); Watson and Drummond 2014 (reproduction and elimination of headache is common after palpation of the upper cervical spine in both migraine and cervicogenic headaches); Jull et al 2007 (cervical rotation ROM, pain on palpation of the upper cervical spine, and weakness of deep neck flexors shown by craniocervical flexion test have 100% sensitivity and 94% specificity to identify cervicogenic headache from migraine and other headache forms); Howard et al 2015 (systematic review providing evidence for manual therapy examination of the cervical spine to assist in the diagnosis of cervicogenic headache); Hall et al 2010 (upper cervical rotation range is significantly different in migraine and cervicogenic headache populations as measured with the flexion-rotation test); Amin et al 2018 (systematic review stating that regular exercise may alter migraine trigger threshold); Jull et al 2002 (deep neck flexor exercise protocol); and Vernon et al 2015 (Headache Activities of Daily Living Index).