Bernal Utrera, CarlosRodríguez Blanco, Cleofás2024-04-012024-04-012024-01-12Anarte-Lazo, E. (2024). Características clínicas y factores relacionados con la cefalea asociada al latigazo cervical: implicaciones para la valoración y el diagnóstico. (Tesis Doctoral Inédita). Universidad de Sevilla, Sevilla.https://hdl.handle.net/11441/156559Introducción. La lesión por latigazo cervical (LC), generalmente causada por colisiones automovilísticas traseras, puede desencadenar una variedad de síntomas, incluyendo dolor de cabeza, que afecta aproximadamente al 60% de los pacientes en la fase aguda. A pesar de la abundante evidencia sobre el dolor de cabeza en diversas condiciones, existe una laguna de conocimiento en relación con los factores que contribuyen al dolor de cabeza asociado al LC. Objetivos. Evaluar las diferencias entre un conjunto de factores físicos, psicológicos y relacionados con el dolor entre aquellos pacientes que desarrollan dolor de cabeza poco después de una lesión por LC y aquellos que no lo hacen. Además, pretendemos evaluar si existen factores relacionados con el dolor y/o factores psicológicos medidos al inicio asociados con la presencia de dolor de cabeza seis meses después de la lesión y evaluar la asociación entre un conjunto de factores físicos, intensidad del dolor, discapacidad y miedo al movimiento. Finalmente, tenemos como objetivo realizar una presentación clínica del dolor de cabeza asociado al LC. Métodos. La metodología involucra cinco estudios transversales, un estudio prospectivo con análisis de regresión logística, un estudio prospectivo con análisis de redes y una revisión exploratoria. Se evaluaron características sociodemográficas, cuestionarios autoinformados y pruebas físicas. Los resultados indicaron diferencias en factores psicológicos, intensidad del dolor de cuello, discapacidad, pruebas físicas y sensibilidad al dolor entre pacientes con y sin dolor de cabeza post-LC. Se destacó que la intensidad del dolor de cuello y el catastrofismo ante el dolor estaban fuertemente relacionados con la presencia del dolor de cabeza. Hipótesis. En primer lugar, planteamos la hipótesis de que los pacientes en fase aguda que han sufrido un latigazo cervical y reportan dolor de cabeza sufren mayores alteraciones neuromusculoesqueléticas y de sensibilidad al dolor y presentan niveles más elevados de intensidad de dolor, factores psicológicos y otros factores relacionados con el dolor que aquellos que no presentan cefalea. Nuestra segunda hipótesis plantea que la intensidad del dolor en la fase inicial podría explicar la presencia de dolor de cabeza seis meses después de la lesión. Finalmente, nuestra hipótesis es que los factores relacionados con el dolor estarán más relacionados con el miedo al movimiento que con los factores físicos. Resultados. En la comparación entre personas con cefalea post-LC y aquellas sin cefalea, se hallaron diferencias en factores psicológicos, dolor de cuello, y diversas pruebas físicas, mientras que no se encontraron diferencias en ciertas mediciones anatómicas. Un conjunto de pruebas físicas demostró ser altamente discriminativo entre grupos. Las personas con cefalea tenían una mayor probabilidad de tener una discapacidad cervical moderada, junto con características neuropáticas del dolor, ambas son las más asociadas con la presencia de cefalea aguda después de un LC; la intensidad del dolor de cuello y el catastrofismo ante el dolor se relacionaron con la cefalea persistente. Además, se observó que las umbrales del dolor a la presión sobre estructuras nerviosas y la resistencia del cuello medidos al inicio tenían una correlación negativa con la intensidad de la cefalea seis meses después. La revisión exploratoria sugirió que la cefalea post-LC es de intensidad leve/moderada y tiende a disminuir en intensidad con el tiempo. Conclusiones. Los hallazgos sugieren que el dolor de cabeza post-LC es leve/moderado y está influenciado por alteraciones neuromusculoesqueléticas, factores psicológicos y componentes del dolor neuropático. El catastrofismo ante el dolor y la intensidad del dolor de cuello están fuertemente relacionados con la presencia de cefalea. Además, el miedo al movimiento y la discapacidad del cuello, junto con la sensibilización neural, influyen en la intensidad del dolor de cabeza.Introduction. A whiplash injury is defined as the acceleration-deceleration mechanism that produces a flexion-hyperextension movement of the neck, usually provoked by a rear-end car collision, which can lead to a variety of symptoms and clinical manifestations, which is known as whiplash-associated disorders (WAD). Headache is one of the most presented symptoms, with up to 60% of patients suffering from headache attributed to a whiplash injury in the acute phase. Scientific evidence has proven the role of cervical structures in the pathogenesis or in the contribution to the presence of headache, especially coming from upper cervical structures. Moreover, psychological factors have also been related to the presence of headache or worsening of headache. However, despite the amount of scientific evidence on different headache conditions, there is a gap in the knowledge of potential contributors to the presence of whiplash-associated headache (WAH). Objectives. To assess the differences between a set of physical, psychological, and pain-related factors between those patients who develop headache soon after a whiplash injury and those who do not. Moreover, we pretend to assess if there are pain-related factors and/or psychological factors measured at baseline associated with the presence of headache six months after the injury and to assess the association between a set of physical factors, pain intensity, disability, and fear of movement. Finally, we aim to perform a clinical presentation of WAH according to scientific literature. Methods. We performed five cross-sectional studies, a prospective study with logistic regression analysis, a prospective study including two network analyses and a scoping review. Among cross-sectional studies, we performed a test-retest intra-rater reliability study and four studies comparing neuromusculoskeletal, psychological and/or pain-related factors between those who present with headache and those who do not soon after a whiplash injury. In our studies, we evaluated sociodemographic features such as age, sex, height and weight, and different neuromusculoskeletal, psychological and pain-related factors. Among them: · Self-reported questionnaires: Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia-11 (TSK-11), Neck Disability Index (NDI), State-Trait Anxiety Inventory (STAI), Visual Analogue Scale (VAS) for pain intensity, Numerical Rating Scale for pain intensity (NRS), Central Sensitization Inventory (CSI), Pain Detect Questionnaire (PDQ) and Self-Reported Leeds Assessment of Neuropathic Sings and Symptoms (S-LANSS). · Physical testing for assessing neuromusculoskeletal impairments: Cervical Range of Motion (CROM), Flexion-Rotation Test (FRT), Forward Head Posture (FHP), Passive Accessory Intervertebral Movements (PAIVMs), Muscle Palpation (MP), Pain Pressure Pain Thresholds (PPTs) over neural structures, Upper Limb Tension Tests (ULTTs), Cranio-Cervical Flexion Test (CCFT) and Muscular Endurance (ME) of cervical flexors and extensors. All studies included a descriptive and inferential analysis. Correlation analysis, odds ratio, logistic regression analysis, discriminative analysis and network analysis were also performed. The scoping review was synthesized narratively. Hypothesis. Firstly, we hypothesize that acute-phase patients who have experienced whiplash and report headaches suffer from greater neuromusculoskeletal and pain sensitivity alterations, and exhibit higher levels of pain intensity, psychological factors, and other pain-related factors than those who do not experience headaches. Secondly, it is hypothesized that the pain intensity in the initial phase could explain the presence of headaches six months after the injury. Finally, our hypothesis is that pain-related factors will be more associated with fear of movement than with physical factors. Results. When people with WAH were compared to those who did not present with headache soon after a whiplash injury, differences were found in all the psychological factors, neck pain intensity, NDI, most of physical tests, S-LANSS and PDQ. No differences were found for PAIVMs over the spinous process of C3, both sides of zygapophyseal joints of C3-C4, CROM in extension, FHP both in standing and sitting positions, and all the assessments of ULTTs, headache provocation over C1, C3, less painful side of C0-C1, C1-C2, C2-C3 and both sides of C3-C4, both sides of sternocleidomastoid and suboccipital muscles, less painful side of trapezius, masseter and temporalis muscles, and the CSI. Moreover, we found that a group of tests including FRT, CROM, ME, CCFT, PAIVMs, MP and PPTs could discriminate between groups with high sensitivity and specificity. In that sense, most of the tests demonstrated good or excellent reliability. People with headache present up to 34 times more likelihood of presenting with moderate NDI than people without headache, and together with S-LANSS is the variable more associated with the presence of headache in the acute stage. Neck pain intensity and PCS t baseline are the variables more associated with the presence of headache. A structure composed of NDI, neck pain intensity, headache intensity and TSK-11 demonstrated the biggest association in the two network analyses, measured at baseline and six months after the injury; nonetheless, PPTs over neural structures and neck endurance measured at baseline demonstrated a negative correlation with headache intensity six months after the whiplash injury. Finally, our scoping review found that WAH appears to be of mild/moderate intensity, typically with episodes of short duration which is commonly experienced in the occipital region amongst other regions, and with a tendency to reduce in intensity over time. Conclusions. The findings coming from different studies composing this thesis suggest that WAH, which appears to be of mild/moderate intensity, may be influenced by some neuromusculoskeletal impairments, although other factors such as neuropathic pain components may be considered. We found that psychological factors are more prevalent in those who present with headache than in those who do not. Furthermore, pain catastrophism and neck pain intensity were the variables most strongly associated with the presence of headache six months after the injury. Moreover, while the highest association with headache intensity was found for neck pain intensity, fear of movement and neck disability, sensitization over neural structures and lack of endurance shortly after the injury demonstrated a correlation with headache intensity at the six-month follow-up. This thesis may contribute to the assessment and diagnosis of WAH by providing reference values and significant associations between various factors that have been shown to be particularly relevant in other clinical cases of headache patients.application/pdf287 p.spaAttribution-NonCommercial-NoDerivatives 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc-nd/4.0/Trastornos Asociados al Latigazo CervicalDolor de Cabeza Asociado al Latigazo CervicalDolor de CuelloDiscapacidad del CuelloCatastrofismo ante el DolorMiedo al MovimientoFactores FísicosAlteraciones NeuromusculoesqueléticasAnsiedadCaracterísticas de Dolor NeuropáticoSensibilización CentralCaracterísticas ClínicasWhiplash-Associated DisordersWhiplash-Associated HeadacheNeck PainNeck DisabilityPain CatastrophismFear of MovementPhysical FactorsNeuromusculoskeletal ImpairmentsAnxietyNeuropathic Pain FeaturesCentral SensitizationClinical Featuresinfo:eu-repo/semantics/doctoralThesisinfo:eu-repo/semantics/openAccess