Migraine Symptoms: Neck Pain
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For years, people with Migraine have been asking me about neck pain and Migraines.

They wanted to know if they were alone in having neck pain with their Migraines, if the neck pain could be triggering the Migraines, if triptans (Imitrex, Maxalt, Zomig, etc.) could be causing their neck pain, and more. They were frustrated, and I was frustrated because I didn’t have solid answers for them.

Finally, a group of researchers led by Dr. Anne Calhoun answered some of the questions about Migraine and neck pain.1

PREVALENCE OF NECK PAIN STUDY:

Study objective:

“To determine the prevalence of neck pain at the time of migraine treatment relative to the prevalence of nausea, a defining associated symptom of migraine.”1

Migraine and neck painStudy methods:

  • Study participants were recruited from an academic Migraine and headache clinic and the general public.
  • In order to clearly identify neck pain associated with Migraine, patients with fibromyalgia, known or suspected cervicogenic headache, and history of significant cervical trauma or surgery were excluded.
  • Potential participants were examined by Migraine and headache specialists to confirm Migraine diagnosis in accordance with the International Headache Society’s International Classification of Headache Disorders, 2nd Edition (ICHD-II).
  • Study participants recorded details of all Migraines in a daily diary over at least one month and until six Migraines had been treated.

Study results:

  • Study participants recorded a total of 2,411 “headache” days, of which 786 were identified as Migraine days.
  • Neck pain was more prevalent than nausea, regardless of the treatment stage.
  • Neck pain was more prevalent than nausea, regardless of the intensity of the headache pain at the time of treatment.
  • There was a correlation between neck pain and chronicity as Migraines moved from episodic to chronic.

Study conclusions:

Calhoun et. al. concluded:

“Neck pain is a common and integral feature of migraine. In this sample of migraineurs, neck pain was more commonly associated with migraine than was nausea, one of the defining characteristics of the disorder. Greater awareness of neck pain as an associated symptom of migraine may improve diagnostic accuracy and have a beneficial impact on time to treatment.”

NECK PAIN AND MIGRAINE TREATMENT STUDY:

Ford and Calhoun also studied the impact of neck pain on Migraine treatment and presented their findings in a research poster at the 52nd Annual Scientific Meeting of the American Headache Society. This research is an extension of the first study, performed with data collected from the same participants during that study.

Study objective:

“This study will examine whether presence of neck pain is associated with a delay in migraine treatment.”2

Study methods:

  • There were 113 study participants whose Migraine frequency ranged from episodic to chronic.
  • Participants were examined by by Migraine and headache specialists to confirm Migraine diagnosis in accordance with the International Headache Society’s International Classification of Headache Disorders, 2nd Edition (ICHD-II).
  • Potential participants with fibromyalgia and cervicogenic headache were excluded.
  • Study participants recorded details of all Migraines in a daily diary over at least one month and until six Migraines had been treated.

Study results:

  • Presence of neck pain in the hour before initial treatment was associated with:
    • Treatment being delayed more than 30 minutes past the beginning of the headache.
    • Treatment being started at a higher headache pain intensity.
  • When neck pain accompanied Migraine, participants with moderate or severe neck pain were more likely to treat the Migraine within 30 minutes of the begging of the headache than participants with mild neck pain.

Study conclusions:

Presence of neck pain was associated with delayed Migraine treatment as indicated by:

  1. higher pain intensity at the time of initial treatment and
  2. longer wait times before beginning treatment.

Ford and Calhoun offered explanations for this delay in treatment:

  1. Migraineurs fail to relate neck pain to their Migraine attacks.
  2. Neck pain is so prevalent in Migraine that Migraineurs have become accustomed to it and ignore neck pain until its severity increases or until the headache pain becomes worse than the neck pain.

Summary and comments:

Neck pain can indeed be a symptom of a Migraine attack. In this study it was, in fact, more common than nausea, which is so commonly associated with Migraine that it’s part of the International Headache Society’s diagnostic criteria for Migraine.

Neck pain during Migraine resulted in delayed treatment possibly because Migraineurs don’t recognize neck pain as a Migraine symptom or because they’ve become so used to it that they ignore it.

Both physician and patient education need to be modified to include neck pain as an acknowledged symptom of Migraine, and the International Headache Society should review their diagnostic criteria for the possible inclusion of neck pain.

Patients who experience neck pain during or near a Migraine should discuss it with their doctors to ensure that it is part of their Migraine and not another unrelated issue.

Live well,
Teri Robert Signature

Page copy protected against web site content infringement by Copyscape© Teri Robert, 2012

view references
1 Calhoun, Anne H., MD; Ford, Sutapa, PhD; Millen, Cori, DO; Finkel, Alan G., MD; Truong, Young, PhD; Nie, Yonghong, MS. “The Prevalence of Neck Pain in Migraine.” Headache 2010;50:1273-1277. doi: 10.1111/j.1526-4610.2009.01608.x. 2 Ford, S.; Calhoun, A.H. “Presence of Neck Pain Delays Migraine Treatment.” Poster Presentation #PO-22. 52nd Annual Scientific Meeting, American Headache Society. Los Angeles. June, 2010. 3 The International Headache Society. “The International Classification of Headache Disorders, 2nd edition.” Cephalalgia 2004; 24 suppl 1:1-160.
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