Differences in headache characteristics, cervical musculoskeletal impairments, signs of sensitization, and psychological burden between different migraine phenotypes assessed during the ictal/perictal phase

Background and aims: Assess if district migraine phenotype identified during the ictal/perictal phase using ten simple clinical and psychophysical bedside tools are differently affected by the disease

Methods: In this observational study, healthy subjects and migraine patients(episodic/chronic) assessed in the ictal/perictal phase were included. Migraine patients were subgrouped into different clusters: Cluster 1.1 no psychophysical impairments, Cluster 1.2: increased pain sensitivity and cervical musculoskeletal impairment.
The following variables were assessed: Clinical characteristics: disease duration, diary (headache frequency/intensity); headache-disability(HDI); neck-disability(NDI); psychological burden(HADS). Psychophysical characteristics: cervical active range of motion(AROM, flexion, extension, right/left lateral flexion, right/left rotation); quantitative sensory testing(QST): static pressure-pain threshold(sPPT) and mechanical pain threshold(MPT) over temporalis, sPPT and dynamic PPT(dPPT) over the neck, sPPT and MPT over the hand, and sPPT over the leg

Results: 156 subjects were included. Cluster 1.2 had higher headache intensity (p=0.48), disability (p=0.003), neck-disability (p=0.005), and psychological burden (p=0.005) compared to Cluster 1.1. Cluster 1.2 had reduced AROM in all directions (p<0.023) and reduced values in all QST (p<0.001) compared to controls and reduced AROM in flexion, left/right lateral flexion (p<0.045), and reduced values in all QST (p<0.001), but not MPT over the hand compared to Cluster 1.1.
Cluster 1.1 had no difference in AROM and higher sPPT values over temporalis, neck, and leg (p<0.049).

Conclusions: The migraine phenotype with increased pain sensitivity and cervical musculoskeletal impairment is worse affected by the disease, showing worse clinical and psychophysical characteristics. On the other hand, a migraine phenotype with no psychophysical impairments showed sing of hypoalgesia compared to controls