Migraine-Related Neck Pain Does Not Always Reflect Musculoskeletal Dysfunction in the Neck

First published: July 2, 2021 https://doi.org/10.1111/head.14136

Commentary

Migraine-associated neck pain can be complained of, but this study was designed to determine the frequency with which it exhibits a pattern of cervical musculoskeletal dysfunction similar to cervical musculoskeletal disorders and to determine whether pain hypersensitivity affects cervical musculoskeletal function in people with migraine.

This cross-sectional, single-blind study was conducted in a laboratory at the University of Queensland, Australia. People with migraine (total n = 124: temporary migraine n = 106, chronic migraine = 18), healthy controls (n = 32), and people with idiopathic neck pain (n = 21) were assessed using a series of measures typically used in the assessment of cervical musculoskeletal disorders, including cervical range of motion and accuracy, segmental joint dysfunction, and neuromuscular and sensorimotor measures. A series of measurements were used to evaluate the results.

Pain sensitivity was assessed using the threshold of tenderness and the dyspareunia symptom checklist, and individuals with migraine who were diagnosed with comorbid cervical disorders were excluded.

The results revealed two distinct clusters of cervical musculoskeletal function.

(i) neck function similar to that of healthy controls (n = 108)

(ii) Neck dysfunction similar to those with neck pain disorders (n = 69).

Seventy-six people with migraine (62 with neck pain and 14 without neck pain) were clustered as having normal neck musculoskeletal function, while the remaining 48 people with neck pain were found to have neck dysfunction comparable to neck disorders.

Musculoskeletal dysfunction was not shown to be associated with pain hypersensitivity or symptoms experienced during testing.

These conclusions mean that neck pain in the presence of migraine does not necessarily indicate the presence of musculoskeletal dysfunction in the neck.

Identifying actual neck dysfunction requires a skilled evaluation that does not rely solely on the person reporting symptoms. Because treatments appropriate for neck musculoskeletal disorders are inappropriate for individuals without neck dysfunction, future studies evaluating the potential effects of such treatments should select only participants with neck pain.

The result is that there is no need for unnecessary treatment.