Neck Pain Common in Migraine Headaches, Leads to Greater Disability

Approximately 70% of patients with migraine headaches also experience neck pain, which is associated with increased disability, depression, anxiety, allodynia, reduced quality of life and work productivity, and suboptimal acute treatment outcomes, according to the findings of a study published in the journal Headache.

Neck pain, often experienced during migraine episodes, significantly contributes to overall disease burden. It is associated with more frequent headaches, severe daily life limitations, and a higher prevalence of cutaneous allodynia, highlighting its impact on migraine health outcomes.

Researchers conducted a global, prospective, cross-sectional, observational web-based study, The Chronic Migraine Epidemiology and Outcomes – International (CaMEO-I) to evaluate the frequency and impact of neck pain accompanying headaches in patients with migraine from Canada, France, Germany, Japan, the United Kingdom, and the United States. The outcomes of interest included the occurrence and intensity of neck pain accompanied by headaches in individuals with migraine, migraine-related disability, treatment satisfaction, psychological distress, and physical health metrics.

The researchers recruited participants through online methods via a web-based panel across the 6 countries. Respondents who reported headaches within the past year were classified as having either migraine or non-migraine headaches, based on adapted criteria from the International Classification of Headache Disorders, 3^rd edition (N=51,969). Those diagnosed with migraine completed a survey, which included specific assessments tailored to their migraine symptoms and characteristics.

In the study, 57.4% (51,969) of respondents reported experiencing 1 or more headaches within the past year. Out of the total number of individuals, 14,492 (27.9%; mean age, 40.7; women, 68.4%; body mass index [BMI], 26.0) were identified as having migraine, while 37,477 (72.1%; mean age, 42.1; women, 72.5%; BMI, 26.4) were classified as experiencing non-migraine headaches. Compared with 36.1% of patients with non-migraine headaches, 68.3% with migraine reported neck pain during headaches.

Neck pain during headaches was reported by 33.8% of individuals with tension-type headaches and 51.8% of those with non-tension-type headaches meeting probable migraine criteria. Among those with migraine, individuals who experienced neck pain during headaches exhibited a significantly higher symptom burden across all countries.

Individuals with neck pain during migraine experienced higher rates of moderate-to -severe disability (47.7% vs 28.9%), reduced work productivity (median interquartile range [IQR], 50 vs 30), and lower quality of life (median IQR Role Function–Restrictive score, 60 vs 68.6). They also had an increased prevalence of depression (40.2% vs 28.2%) and anxiety (41.2% vs 29.2%), higher rates of cutaneous allodynia during headaches (54% vs 36.6%), and poorer acute treatment optimization (61.1% vs 53.3%; all P <.001).

Study limitations included reliance on self-report data and potential selection bias, as well as the lack of reliability testing for the single-item question on neck pain with headache, limiting causal inference and generalizability to all patients with migraine.

“These results are a striking illustration of the far-reaching impact of neck pain on emotional and social well-being and the ability to perform work and daily living activities among people with migraine,” the researchers concluded.

This research was supported by Allergan (now AbbVie). Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.