General Health Professions, Physical Therapy, Sports Therapy and Rehabilitation
8
Scopus Publications
Scopus Publications
Migraine in children and adolescents: the clinical impact of allodynia Juliana Pradela, Amanda Rodrigues, Felipe Daniel Sambini, Vitória Carolina Leonel, Nathiely Viana da Silva, Fabiola Dach, Debora Bevilaqua Grossi Headache Medicine, 2025 Introduction The pathophysiology of migraine is strongly associated with central sensitization, the presence of which is related to cutaneous allodynia and cervical musculoskeletal dysfunction. However, these aspects remain understudied in children and adolescents. Thus, this study aimed to evaluate differences in clinical variables, sensitization, and musculoskeletal alterations between children (CR) and adolescents (AD) with migraine, considering the presence or absence of cutaneous allodynia. Methods One hundred and one participants aged 6 to 16 years with a clinical diagnosis of migraine were evaluated. Outcomes included cervical range of motion (ROM), pressure pain threshold (PPT) of cranio-cervical muscles, and presence of cutaneous allodynia. Results Significant differences were observed between CR and AD for age (p<0.001) and PPTs of the sternocleidomastoid (p=0.002), levator scapulae (p=0.006), suboccipital (p=0.006), trapezius (p<0.001), and anterior scalene (p<0.001) muscles. The subgroups CR and AD with and without allodynia showed significant differences in the PPTs of the sternocleidomastoid (p=0.020), levator scapulae (p=0.016), suboccipital (p=0.038), trapezius (p<0.001), anterior scalene (p<0.001) muscles, and in cervical ROM in the sagittal plane (p=0.016). The main differences were observed between adolescents and children with and without allodynia. No differences were found within the children and adolescents’ subgroups. Conclusion The presence of cutaneous allodynia is associated with increased muscle sensitivity and reduced cervical sagittal mobility. These findings highlight the importance of early assessment of allodynia and musculoskeletal sensitivity in children and adolescents with migraine.
Cervical range of motion in individuals with and without chronic subacromial pain syndrome: a cross-sectional study Jaqueline Martins, Amanda Rodrigues, Jackeline Suzan Gentil Garcia dos Anjos, Thiele de Cássia Libardoni, Débora Bevilaqua-Grossi, Anamaria Siriani de Oliveira Musculoskeletal Science and Practice, 2025 To compare cervical range of motion (ROM) between asymptomatic individuals and those with subacromial pain syndrome (SAPS), and to investigate its relationship with shoulder pain, disability, and other clinical factors. A cross-sectional study was conducted with 50 individuals with SAPS and 50 asymptomatic controls (both sexes, aged 32–66). The Shoulder Pain and Disability Index (SPADI) assessed shoulder disability, and cervical ROM was measured using a cervical range of motion ( CROM) device. Individuals with SAPS had significantly reduced cervical ROM compared to controls, confirmed by Student's t-test or Mann-Whitney test. Large effect sizes were observed (Cohen's d = 1.08 and 1.65 for right bending and extension; Mann-Whitney effect size = −0.44 to −0.56 for other movements). Pearson correlations revealed a significant inverse relationship between cervical ROM and SPADI scores (r = −0.42 to −0.61). Chi-square analysis indicated that shoulder pain was associated with cervical ROM deficits (Χ 2 = 6.83 to 27.75), with prevalence ratios ranging from 1.5 (flexion) to 4.25 (left rotation) higher in individuals with SAPS. These deficits were also associated with longer duration of shoulder pain, higher neck pain intensity, and older age. Individuals with SAPS have reduced cervical mobility compared to asymptomatic individuals, especially for cervical rotation. Cervical ROM deficits were more prevalent in individuals with SAPS and correlated with greater shoulder disability. Clinical factors such as duration of shoulder pain, neck pain intensity, and age contribute to these deficits. These findings highlight the need to assess cervical mobility in patients with SAPS. • Reduced cervical range of motion (ROM) has been observed in individuals with SAPS. • Higher SPADI scores were negatively correlated with cervical ROMs (r = −0.42 to −0.61). • Individuals with SAPS had a 1.5 to 4.25 times higher prevalence of cervical ROM deficits. • Clinical factors such as duration of shoulder pain, neck pain intensity, and age contribute to these deficits. • The study highlights the importance of cervical spine evaluation in patients with SAPS.
Profile of childhood headaches in a tertiary center Nathiely Viana da Silva, Juliana Pradela, Amanda Rodrigues, Roberto Satler Cetlin, Fabiola Dach, Debora Bevilaqua Grossi Headache Medicine, 2024 BackgroundThe aims of this study were to analyze the profile of childhood headache complaints in a tertiary headache center, verify the differences between children and adolescents, and provide the clinical characteristics that are related to the headaches.MethodsA review of 384 medical records of children aged between 4-12 years old (n=206) and adolescents (n=178) aged >12 to 18 years old. The variables evaluated were reported as percentages, compared between children and adolescents and selected the variables that were related to headaches diagnosis.ResultsThe majority of the sample were females (60.7%), diagnosis of migraine (70.3%), pulsatile pain (60.2%), episodic attacks (60.2%) and no need for imaging tests associated with the diagnosis (69.3%), which were associated with different clinical characteristics (LR X2(52); p<0.001; Log likelihood = -322.434; Pseud R2 = 0.154). The group of adolescents had a higher proportion of use of antidepressants (29.8%) as prophylactic medication than children, who on the other hand, had a higher prevalence of use of antivertiginous drugs (32%). The abortive medication used was common analgesics (37.8%) and the main outcome after treatment was discharge from the service (32%).ConclusionThe evaluation and the treatment for these patients should take into account the main complaints, considering the particularities of each type of headache and also the age group, in order to identify, treat the disease properly and avoid chronification and continuity in the tertiary service, referring them to less complex services.
Cervical muscle parameters and allodynia in migraine and cervical pain—A controlled study A. Rodrigues, L. M. Bigal, M. M. Bragatto, F. Dach, D. Bevilaqua‐Grossi, M. E. Bigal, C. Fernández‐de‐las‐Peñas, L. L. Florencio European Journal of Pain United Kingdom, 2024 BackgroundNeck pain is common among individuals with migraine, but there is a lack of information of how this comorbidity can be associated with cervical muscle function. This controlled cross‐sectional study aimed to compare cervical muscle function, activity, and sensitization in women with migraine, neck pain, both, and neither.MethodsThis study included women, between 18 and 55 years old, with either episodic migraine with or without aura, without any concomitant headache diagnosis; chronic neck pain, with at least moderate intensity and mild disability; or neither headache nor neck pain. Pain pressure threshold, allodynia, muscle strength, and endurance and cervical muscles activity were evaluated.ResultsOne hundred subjects, with mean age of 30.4 years old, were stratified by diagnosis (n = 25 per group) and by self‐reported pain during tests. Lower endurance during flexion was observed for migraine and neck pain (34s) relative to neck pain alone (45s), migraine (40s), and controls (58s) (p = 0.04). For extensor endurance, means were 142s, 166s, 215s, and 270s, respectively (p < 0.001). Endurance times were impacted by the presence of test‐induced pain decreasing about 40%–53% of the performance. Diagnostic groups did not differ significantly in strength (p > 0.05), but all pain groups presented significantly higher proportion of test‐induced pain, lower muscle activity during the maximal isometric voluntary contractions, and lower pressure pain thresholds.ConclusionPatients with migraine, chronic neck pain, and the association of both present altered cervical muscle function and activity. Also, test‐induced pain impacts significantly on neck muscles endurance.SignificanceThe diagnosis of migraine and chronic neck pain is associated with altered function and activity of the cervical muscles. However, the test‐induced pain had an important contribution to worse cervical muscle endurance. This suggests that the therapeutic approach should focus on de‐sensitization of the trigeminal–cervical complex when dealing with the comorbidity of migraine and cervical pain.
Craniocervical flexion test in patients with migraine: Discriminative validity and accuracy Amanda Rodrigues, Lidiane Lima Florencio, Jaqueline Martins, Marcela Mendes Bragatto, César Fernández‐de‐las‐Penãs, Fabiola Dach, Débora Bevilaqua‐Grossi International Journal of Clinical Practice, 2021 OBJECTIVES To evaluate the discriminative validity and provide a clinical cut-off of the craniocervical flexion test (CCFT) in migraineurs stratified by the report of neck pain, headache-related disability, and neck disability. METHODS Fifty women without headache and 102 women with migraine were recruited by convenience from a local tertiary care setting. Migraine diagnosis followed the International Classification of Headache Disorders. All volunteers underwent the CCFT. Patients with migraine answered the Migraine Disability Assessment (MIDAS) and Neck Disability Index (NDI) questionnaires. Discriminative validity was verified by group comparison, and the clinical cut-off was obtained and classified according to the diagnostic accuracy of the CCFT. RESULTS The CCFT presented discriminative validity for comparing control (median = 28, IQR = 6) with migraine (median = 26, IQR = 4, p = 0.01) and migraine with neck pain (median = 26, IQR = 4, p = 0.01), but not among the migraine subtypes with disability by migraine or neck pain-related disability on the MIDAS and NDI. The diagnostic accuracies were classified between poor and not discriminating with the area under the receiver operating characteristic curve ranging from 57% to 69%, and non-acceptable values of sensitivity, specificity, and positive and negative likelihood ratios. CONCLUSION The CCFT can discriminate asymptomatic controls from migraine patients with and without neck pain. However, it cannot discriminate patients with migraine according to their pain-related disability. Also, the CCFT does not offer an optimal cut-off value in migraine patients adequate to clinical practice.
