Original Article

Adolescent cervical disc degeneration in MRI does not predict adult headache or neck pain: A 5-year follow-up of adolescents with and without headache

Cephalalgia 2014, Vol. 34(9) 679–685 ! International Headache Society 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0333102414521509 cep.sagepub.com

Katri Laimi1,2, Johanna Pitka¨nen1, Liisa Metsa¨honkala3,4, Tero Vahlberg5, Marja Mikkelsson6,7, Minna Erkintalo8, Minna Aromaa2,9, Pa¨ivi Rautava2,10, Pirjo Anttila11, Airi Oksanen1, Mikhail Saltychev1 and Matti Sillanpa¨a¨2,3 Abstract Aim: The impact of early degenerative changes of the cervical spine on pain in adulthood is unknown. The objective was to determine whether degeneration in adolescence predicts headache or neck pain in young adulthood. Methods: As part of a follow-up of schoolchildren with and without headache, 17-year-old adolescents with headache at least three times a month (N ¼ 47) and adolescents with no headache (N ¼ 22) participated in a magnetic resonance imaging (MRI) study of the cervical spine. The same adolescents were re-examined by phone interview at the age of 22 years (N ¼ 60/69, 87%). Results: Mild disc degeneration at the age of 17 years was common, but was not associated with either frequent or intensive headache or neck pain at the age of 22 years. Conclusion: Mild degenerative changes of the cervical spine in 17-year-old adolescents cannot be regarded as a cause of future headache or neck pain. Keywords Adolescent, disc degeneration, headache, MRI, neck pain Date received: 29 August 2013; revised: 6 November 2013; accepted: 5 January 2014

Introduction Degeneration of the cervical spine is common in healthy adults and also in adolescence (1–3). It is not known if early degenerative changes of the cervical spine lead to pain in adult years as has been shown in subjects with early degeneration of the lumbar spine (4). In few follow-up studies of healthy adults, the association between degeneration and pain has not been clear. In a 10-year magnetic resonance imaging (MRI) follow-up study of 223 healthy adults, degeneration of the cervical spine progressed in 85% of participants. In the follow-up phase, the progression of disc space narrowing was associated with the incidence of stiff shoulders, while decrease in the signal intensity of the intervertebral disc was more common in painless participants when compared with those with incident neck pain (1). In another 10-year X-ray follow-up study of

1

Department of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, Finland 2 Department of Public Health, University of Turku, Finland 3 Department of Child Neurology, Turku University Hospital, Finland 4 Department of Child Neurology, Helsinki University Hospital, Finland 5 Department of Biostatistics, University of Turku, Finland 6 Rehabilitation Centre, Pa¨ija¨t-Ha¨me Central Hospital, Finland 7 School of Medicine, University of Tampere, Finland 8 Department of Radiology, Turku University Hospital, Finland 9 Child and Adolescent Health Care Unit, Turku City Hospital, Finland 10 Turku Clinical Research Centre, Turku University Hospital, Finland 11 Department of Pediatrics, Turku University Hospital, Finland Corresponding author: Katri Laimi, Department of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, P.O. Box 28, Turku 20701, Finland. Email: [email protected]

680 healthy adults, only baseline disc degeneration at level C6/7 was shown to predict the incidence of neck pain (5). In our previous cross-sectional study on the same study population of schoolchildren, headache was associated with muscle pain, but not with dysfunction of the upper neck (6). Mild degenerative changes of the cervical spine were found in 67% of participants at the age of 17 years, with no difference between adolescents with and without headache (2). The purpose of the present study was to determine whether disc degeneration of the cervical spine in adolescence predicts headache or neck pain 5 years later in young adults. The hypothesis was that early degeneration leads to pain in forthcoming years.

Cephalalgia 34(9)

Questionnaire at 12 years Year 1998: 1135 (81%) of all 1409 schoolchildren answered

Clinical examinationat 13 years Random sample 327 of 1135 participants 70/70 with migraine (IHS 1.1-1.2) 70/70 with tension-type HA (IHS 2.1-2.2) 69/70 with migrainous disorder (IHS 1.7) 33/47 with tension-type HA not fulfilling criteria (IHS 2.3) 69/70 healthy controls No. of participants 311/327 (95%)

Clinical examination at 16 years 228/311 participants of the clinical examination at 13 years 33/43 with HA secondary to traumaor refractive error at 12 years 43/69 with HA not classifiable at 12 years No. of participants 304/423 (72%)

Methods Sample The present study is part of a population-based followup study of headache in schoolchildren. A flow chart shows the participation rates of all study phases (Figure 1). The original source population covered all 12-year-old schoolchildren in the city of Turku (total population of 170,931, year 1998) in south-western Finland (7). The details of the study design have been published previously (2,6–8). Adolescents with headache at least three times a month (N ¼ 47/59, 80%) and adolescents with no headache (N ¼ 22/37, 59%) attended MRI of the cervical spine at the age of 17 years. Of headache sufferers, those with weekly neck pain (N ¼ 17) or with infrequent (0 or

Adolescent cervical disc degeneration in MRI does not predict adult headache or neck pain: A 5-year follow-up of adolescents with and without headache.

The impact of early degenerative changes of the cervical spine on pain in adulthood is unknown. The objective was to determine whether degeneration in...
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