Cervical Stability and Body Awareness in Migraine

Primary outcomes

1. Migraine Disability Assessment Questionnaire-MIDAS

   Time frame: up to 3 months

   It is a questionnaire consisting of five questions related to disability over the past three months. Individuals score the number of days lost due to headache in three domains: schoolwork, paid work, and household activities. Additionally, they report the number of extra days with significant activity limitations (defined as at least a 50% reduction in productivity) in paid and household work. The MIDAS score is calculated by summing the scores of these five items.

2. Bournemouth Neck Questionnaire:

   Time frame: up to 3 months

   This questionnaire consists of seven items, each scored on a scale from 0 to 10. It evaluates the impact of pain on daily activities, pain severity, levels of anxiety and depression, kinesiophobia, and the ability to cope with pain.

3. Fremantle Neck Awareness Questionnaire

   Time frame: up to 3 months

   This questionnaire consists of nine items, each scored on a scale from 0 to 4. It assesses awareness of the cervical region. Higher scores indicate poorer body awareness.

4. Body Awareness Questionnaire

   Time frame: up to 3 months

   This questionnaire consists of 18 items, each scored on a scale from 1 to 7, and is used to assess body awareness. Higher scores indicate better body awareness.

5. Body Awareness Rating Questionnaire

   Time frame: up to 3 months

   This questionnaire consists of 24 items divided into four domains: function, mood, sensation/emotion, and awareness. Each item scores a 7-point Likert type scale. Each factor's scores range between 6 to 42 and higher scores indicates higher body awareness

6. Cervical Spine Stability

   Time frame: up to 3 months

   The craniocervical flexion test will be performed using a pressure biofeedback unit (Stabilizer, Chattanooga, Australia). The test consists of five stages. During the test, participants will lie in a supine position with the head and neck in neutral alignment, and the device will be placed under the suboccipital region.

   In the initial stage, the pressure will be set at 20 mmHg, and participants will be instructed to perform a craniocervical flexion movement. Subsequently, the test will proceed through five incremental stages, increasing the pressure in 2 mmHg increments from the initial 20 mmHg up to a maximum of 30 mmHg.

   At each pressure level, participants will be asked to maintain the movement for 10 repetitions of 10 seconds each. Based on these stages, the Activation Score and Performance Index will be calculated

7. Cervical Proprioception

   Time frame: up to 3 months

   Joint position error test will be conducted using a laser pointer attached to the participant's head. While sitting on a chair with back support, participants will face a wall where a target will be placed 90 cm away.

   Participants will first be asked to sense the starting position (the center of the target). Then, with their eyes closed, they will be instructed to return their head to the starting position from various directions (flexion, extension, and rotation).

   The deviation from the target center will be measured in centimeters, and the test will be repeated three times. The average of the three trials will be used as the final score.