COMPARISON BETWEEN NECK PAIN DISABILITY AND CERVICAL RANGE OF MOTION IN PATIENTS WITH EPISODIC AND CHRONIC MIGRAINE:A CROSS-SECTIONAL STUDY Gabriela F. Carvalho, MD, a Thais C. Chaves, PhD, b Maria C. Gonçalves, PhD, a Lidiane L. Florencio, MD, a Carolina A. Braz, PT, c Fabíola Dach, PhD, b Cesar Fernández de Las Peñas, PhD, d and Débora Bevilaqua-Grossi, PhD e ABSTRACT Objective: The purpose of this study was to evaluate neck pain–related disability and cervical range of motion (CROM) in patients with episodic migraine (EM) and chronic migraine (CM) and to examine the correlation of both outcomes. Methods: This cross-sectional study consisted of 91 patients with EM and 34 with CM. Cervical range of motion was measured with the CROM device, and pain during the cervical movement was recorded. Self-reported disability related to neck pain was assessed with the Neck Disability Index. Results: Patients with CM showed higher Neck Disability Index scores and more moderate and severe disability (P = .01). Severe disability as a result of neck pain was associated with 7.6-fold risk of developing CM (P = .003). No significant differences in CROM were identified between groups. Moderate negative correlations between CROM and disability were found for 4 motions within the CM group (- 0.60 b r b - 0.39) and with 3 in the EM group (- 0.48 b - 0.45). Disability was positively and moderately correlated to pain evoked during CROM in both groups (0.34 b r b 0.51). Conclusion: This study found that neck pain was highly prevalent in patients with migraine. Neck pain–related disability increased with increased frequency of the migraine attacks and was associated with the risk of migraine chronicity. The correlation between CROM and neck pain disability was more evident in patients with CM and in patients with pain during cervical movement. (J Manipulative Physiol Ther 2014;xx:1-6) Key Indexing Terms: Neck Pain; Headache; Migraine Disorders; Range of Motion O ver the last few decades, the assessment and treatment as well as the understanding of headaches have advanced significantly, and physical therapy has started to be included in the management of various types of headaches. 1-4 Among headaches, migraine is prominent due its wide prevalence and association with significant disability and the economic impact. 5,6 Although migraine pathophysiology cannot be directly related to musculoskeletal disorders, neck pain is frequently reported by patients with migraine 7,8 even more often than reports of nausea. 9 The association between neck pain and migraine is strong. 9 The presence of migraine is a risk factor for the development of neck pain, 7,10,11 and cervical dysfunction may influence the natural history of migraine by increasing the risk of chronification. 9 It has been speculated that cervical symptoms are secondary to the activation of the trigeminocervical nucleus caudalis, which receives convergent nociceptive trigeminal and cervical afferent fibers. 12-14 Despite this established association, exami- nation of the cervical spine in patient with migraine is infrequently performed as well as the indication to a physiotherapy treatment for neck pain. Patients with migraine often have neck stiffness with impairments in the neuromuscular function of the neck, forward head posture (head protrusion), trigger points in the a PhD Student, Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation, Ribeirão Preto, São Paulo, Brazil. b Professor, University of São Paulo, Department of Neurosciences, Ribeirão Preto, São Paulo, Brazil. c Graduate Student, Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation, Ribeirão Preto, São Paulo, Brazil. d Professor, University of Rey Juan Carlos, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Madrid, Spain. e Professor, University of São Paulo, Departament of Biome- chanics, Medicine and Locomotor Apparatus Rehabilitation, Ribeirão Preto, São Paulo, Brazil. Submit requests for reprints to: Gabriela F. Carvalho, PT, MD, PhD Student, Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation, Ribeirão Preto, São Paulo, Brazil. (e-mail: gabriela.fisioterapia@gmail.com8 gabicarvalho7@hotmail. com). Paper submitted January 15, 2014; in revised form April 9, 2014; accepted May 21, 2014. 0161-4754 Copyright © 2014 by National University of Health Sciences. http://dx.doi.org/10.1016/j.jmpt.2014.09.002