Neck pain associated with migraines may not indicate cervical musculoskeletal dysfunction

In people who have neck pain related to their migraines, the presence of neck pain is not necessarily indicative of cervical musculoskeletal dysfunction, according to study results published in Headache.

Neck pain is a common symptom of migraines. Despite limited evidence to support the effectiveness of topical throat treatment for migraines, recommendations exist. Misdiagnosis of cervicogenic headache, which may result in delays in adequate migraine treatment, has created frustration among neurologists.

To fill the knowledge gap, a team of researchers in Australia conducted a cross-sectional, single-blind study to determine the incidence of cervical musculoskeletal dysfunction in patients with neck pain during migraines. They also tried to assess whether hypersensitivity to pain affects cervical musculoskeletal function in this patient population.

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The study researchers included a total of 177 participants in the study: 124 patients with migraines, 21 patients with idiopathic neck pain and 32 healthy control patients. Of the migraine sufferers, 89% reported having neck pain.

Compared to patients with episodic migraines, those with chronic migraines had greater neck disability (P = 0.025) and neck pain intensity (P = 0.049). Compared to idiopathic neck pain, patients with chronic migraines still had significantly greater neck discomfort and neck pain intensity (P = 0.005 and P = 0.049, respectively).

Using partitioning around Medoide and Ward’s hierarchical agglomerative clustering methods, study researchers found two well-separated clusters of cervical musculoskeletal function. There were 108 patients in the first cluster and 69 patients in the second cluster. All healthy controls were found in cluster 1, while all participants with idiopathic neck pain were found in cluster 2; 61% of the patients with migraines were found in cluster 1, while 39% of the patients with migraines were found in cluster 2. All patients with migraines who had no neck pain were found in cluster 1; however, patients with chronic and episodic migraines were found in both clusters.

No significant differences in headache or neck pain and disability were observed between the musculoskeletal clusters. In addition, the pain hypersensitivity measures were not significantly associated with a musculoskeletal cluster, suggesting that the pain hypersensitivity in migraines was not related to musculoskeletal dysfunction.

The authors found that the results of the study increase the “need for an individualized, qualified assessment of cervical musculoskeletal function to distinguish between a central and peripheral origin of neck pain or a combination of both”.

“One should not rely solely on pain or tenderness, which often reflects the general hypersensitivity to pain that is common in people with migraines. People with migraines with neck pain should not be viewed as a homogeneous group in future clinical studies on the effectiveness of neck interventions, ”the study leaders concluded.

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Liang Z, Thomas L, Jull G, Minto J, Zareie H, Treleaven J. Neck pain associated with migraines does not necessarily reflect cervical musculoskeletal dysfunction. Headache. 2021; 61 (6): 882-894. doi: 10.1111 / head.14136