Background: Primary headache disorders are common and burdensome conditions. They are associated to several comorbidities, such as cardiovascular or psychiatric ones, which, in turn, contribute to the global burden of headache. The aim of this study is to provide a comprehensive description of the pooled prevalence of comorbidities of primary headache disorders using a meta-analytical approach based on studies published between 2000 and 2020. Methods: Scopus was searched for primary research (clinical and population studies) in which medical comorbidities were described in adults with primary headache disorders. Comorbidities were extracted using a taxonomy derived from the Global Burden of Disease (GBD) study. We compared prevalence of comorbidities among headache sufferers against general population using GBD-2019 estimates, and compared comorbidities’ proportions in clinical vs. population studies, and by age and gender. Results: A total of 139 studies reporting information on 4.19 million subjects with primary headaches were included: in total 2.75 million comorbidities were reported (median per subject 0.64, interquartile range 0.32–1.07). The most frequently addressed comorbidities were: depressive disorders, addressed in 51 studies (pooled proportion 23 %, 95 % CI 20–26 %); hypertension, addressed in 48 studies (pooled proportion 24 %, 95 % CI 22–26 %); anxiety disorders addressed in 40 studies (pooled proportion 25 %, 95 % CI 22–28 %). For conditions such as anxiety, depression and back pain, prevalence among headache sufferers was higher than in GBD-2109 estimates. Associations with average age and female prevalence within studies showed that hypertension was more frequent in studies with higher age and less females, whereas fibromyalgia, restless leg syndrome, and depressive disorders were more frequent in studies with younger age and more female. Conclusions: Some of the most relevant comorbidities of primary headache disorders – back pain, anxiety and depression, diabetes, ischemic heart disease and stroke – are among the most burdensome conditions, together with headache themselves, according to the GBD study. A joint treatment of headaches and of these comorbidities may positively impact on headache sufferers’ health status and contribute to reduce the impact of a group of highly burdensome diseases.

Strength and power asymmetries have been observed in different sports, including soccer. Such asymmetries, as well as the bilateral deficit (BLD), can be assessed during different tasks, static or dynamic, and with different methods and devices, in order to detect the possible different aspects, as well as the association with physical performance and injuries. The aim of this study was to investigate the association between muscle asymmetries and BLD during a countermovement jump (CMJ), and tensiomyography (TMG) parameters and asymmetries, in the lower limbs of male soccer players. A total of 23 male soccer players (18 ± 4 years) were recruited. Bilateral and unilateral CMJs were performed, and peak power (W) and height (cm) were obtained. TMG was performed on different muscles of the lower limbs, and lateral and functional symmetries were obtained. Playing position and history of injuries were collected. CMJ inter-limb symmetry was found to significantly correlate with biceps femoris (r = 0.574, p = 0.004) and soleus (r = 0.437, p = 0.037) lateral symmetry. Players in central roles presented significantly worse functional symmetry scores of the knee than defense players (−17.5%, 95% CI −31.2–−3.9; p = 0.10). Participants reporting a history of injury at the ankle were characterized by significantly lower functional symmetry in both the dominant (43%, 39.5–48.0 vs. 74.5%, 46.5–89.3, p = 0.019) and non-dominant (45%, 42.5–46.0 vs. 81.0%, 45.8–90.3, p = 0.024) ankle. Findings from this preliminary study suggest an association between lower-limb muscle asymmetries during a dynamic task, such as jumping, and muscle contractile properties evaluated with TMG; moreover, functional asymmetries may be present after ankle injuries. Future studies in larger samples should evaluate the presence of such asymmetries as predictors or characteristics of different muscular and joint injuries.

The main aim of this study was to investigate the efficacy of a dual task protocol in people with episodic migraine with respect to both active exercises only and cognitive task only treatments, concerning some neurophysiological and clinical outcomes. A randomized control trial was adopted in people with episodic migraine without aura. Some neurophysiological and clinical outcomes were collected (t0): resting motor threshold (rMT), short intracortical inhibition (SICI) and facilitation (ICF), pressure pain threshold (PPT), trail making test (TMT), frontal assessment battery (FAB), headache-related disability (MIDAS) and headache parameters. Then, participants were randomized into three groups: active exercise only (n = 10), cognitive task only (n = 10) and dual task protocol (n = 10). After 3 months of each treatment and after 1-month follow-up the same neurophysiological and clinical outcomes were revaluated. A significant time x group effect was only found for the trapezius muscle (p = 0.012, pη2 = 0.210), suggesting that PPT increased significantly only in active exercise and dual task protocol groups. A significant time effect was found for rMT (p < 0.001, pη2 = 0.473), MIDAS (p < 0.001, pη2 = 0.426), TMT (p < 0.001, pη2 = 0.338) and FAB (p < 0.001, pη2 = 0.462). A repeated measures ANOVA for SICI at 3 ms highlighted a statistically significant time effect for the dual task group (p < 0.001, pη2 = 0.629), but not for the active exercises group (p = 0.565, pη2 = 0.061), and for the cognitive training (p = 0.357, pη2 = 0.108). The dual task protocol seems to have a more evident effect on both habituation and sensitization outcomes than the two monotherapies taken alone in people with migraine.

Context: Shoulder muscles are active during front-crawl swimming to provide propulsion and stabilize the glenohumeral and scapulothoracic joints. Researchers have proposed that fatigue might contribute to altered activation of these muscles and represent a risk factor for injuries. Tensiomyography (TMG) might function as a noninvasive tool to detect changes in contractile measures of the skeletal muscles due to exercise-induced neuromuscular fatigue, though it has not yet been used in the shoulder muscles of swimmers. Objective: To assess the effects of a fatiguing swimming protocol on shoulder muscle TMG measures and isometric strength in competitive swimmers. Design: Cross-sectional study. Setting: Swimming pool facility. Patients or Other Participants: A total of 14 young front-crawl competitive swimmers (11 males and 3 females; age = 21 ± 3 years [range, 17–26 years], height = 1.78 ± 0.06 m, mass = 73.1 ± 9.2 kg). Main Outcome Measure(s): Participants completed TMG and isometric strength assessments before and after 30-minute, high-intensity swim training. The TMG assessment was performed on 7 muscles of the shoulder according to front-crawl biomechanics and the applicability of the technique to obtain data, such as time to contraction and muscle-belly radial displacement. Isometric strength was assessed using a digital handheld dynamometer during shoulder flexion, extension, external rotation, and internal rotation. Results: Fatigue induced a smaller radial displacement, mostly observable in latissimus dorsi (−1.0 mm; 95% CI = −1.7, −0.3 mm; P = .007) and pectoralis major muscles (−1.4 mm; 95% CI = −2.4, −0.4 mm; P = .007). Only shoulder extension showed an isometric strength reduction after the fatiguing protocol (−0.03 N/kg; 95% CI = −0.05, −0.01 N/kg; F_1,13 = 4.936; P = .045; η_p² = 0.275). Conclusions: This study provides preliminary evidence for the usefulness of TMG to detect fatigue-induced changes in contractile properties of the shoulder muscles in swimmers, in particular the latissimus dorsi and pectoralis major.