A significant finding in the 2020 research by Carvalho GF et al., ‘Muscle Endurance Training of the Neck Triggers Migraine Attacks’, was that patients with migraine are more likely to report neck pain and experience migraine attacks following neck muscle endurance testing, which included both flexor and extensor endurance. Participants whose accustomed head was reproduced during manual examination showed a higher prevalence of migraine attacks compared to those with only local pain.
While the authors are to be commended for the aim of this research, given the purported benefit of endurance training of the cranio-cervical flexors, this would be the protocol of choice. This needs to be clarified as it is unclear. Was the specific protocol for this training followed? Secondly, because both were included in the same session, one is left wondering if it was the extensor, flexor training, or both. (My Maitland training is coming out!) This would appear to be an essential distinction.
The research findings resonate with our clinical experiences, especially given that some sessions ceased with some participants’ onset of neck pain – why push the participants to neck pain?
In my clinical experience and that of my colleagues, migraine episodes within 24 hours of ‘strengthening’ exercises are a common occurrence.
I’ll leave the additional findings and conclusions for you to explore. Happy reading!
PS: I am grateful for the acknowledgment of my work (35). Thank you. For the record, central posteroanterior pressures on the spinous process of C2 are not part of my research or approach. Furthermore, posteroanterior pressures on the articular pillar of C2 are more likely to stress C2-3 (maximum 7° rotation) than C1-2 (at least 25° rotation). Unfortunately, similar publications erroneously recount this. Still, if unsure, simple adjustments either confirm or rule out C1-2 or C2-3.
References:
35. Watson DH, Drummond PD. Head pain referral during examination of the neck in migraine and tension-type headache. Headache 2012; 52: 1226–1235.
