RESEARCH SUBMISSIONS

Neck pain associated with migraine does not necessarily reflect cervical musculoskeletal dysfunction

Zhiqi Liang MPhty, BAppSci (Phty)

Corresponding Author

Zhiqi Liang MPhty, BAppSci (Phty)

School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia

Correspondence

Zhiqi Liang, School of Health and Rehabilitation Sciences, The University of Queensland, Level 3 Therapies Annexe 84A, St Lucia, QLD 4072, Australia.

Email: [email protected]

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Lucy Thomas PhD, MMedSc

Lucy Thomas PhD, MMedSc

School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia

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Gwendolen Jull PhD, MPhty

Gwendolen Jull PhD, MPhty

School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia

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Joanne Minto MPhty, BAppSci (Phty)

Joanne Minto MPhty, BAppSci (Phty)

School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia

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Hossein Zareie FRACP, MD

Hossein Zareie FRACP, MD

Department of Neurology, Royal Brisbane & Women's Hospital, Herston, QLD, Australia

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Julia Treleaven PhD, BPhty

Julia Treleaven PhD, BPhty

School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia

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First published: 02 July 2021
Citations: 19

Funding information

This study was funded by the Physiotherapy Research Foundation, Australian Physiotherapy Association: PG18-009

Abstract

Objective

To identify how frequently the neck pain associated with migraine presents with a pattern of cervical musculoskeletal dysfunction akin to cervical musculoskeletal disorders, and to determine if pain hypersensitivity impacts on cervical musculoskeletal function in persons with migraine.

Background

Many persons with migraine experience neck pain and often seek local treatment. Yet neck pain may be part of migraine symptomology and not from a local cervical source. If neck pain is of cervical origin, a pattern of musculoskeletal impairments with characteristics similar to idiopathic neck pain should be present. Some individuals with migraine may have neck pain of cervical origin, whereas others may not. However, previous studies have neglected the disparity in potential origins of neck pain and treated persons with migraine as a homogenous group, which does not assist in identifying the origin of neck pain in individuals with migraine.

Methods

This cross-sectional, single-blinded study was conducted in a research laboratory at the University of Queensland, Australia. Persons with migraine (total n = 124: episodic migraine n = 106, chronic migraine = 18), healthy controls (n = 32), and persons with idiopathic neck pain (n = 21) were assessed using a set of measures typically used in the assessment of a cervical musculoskeletal disorder, including cervical movement range and accuracy, segmental joint dysfunction, neuromuscular and sensorimotor measures. Pain hypersensitivity was assessed using pressure pain thresholds and the Allodynia Symptom Checklist. People with migraine with diagnoses of comorbid neck disorders were excluded. Cluster analysis was performed to identify how participants grouped on the basis of their performance across cervical musculoskeletal assessments. Post hoc analyses examined the effects of pain hypersensitivity on musculoskeletal function, and if any symptoms experienced during testing were related to musculoskeletal function.

Results

Two distinct clusters of cervical musculoskeletal function were found: (i) neck function similar to healthy controls (n = 108) and (ii) neck dysfunction similar to persons with neck pain disorders (n = 69). Seventy-six of the individuals with migraine (62 with neck pain and 14 without neck pain) were clustered as having normal cervical musculoskeletal function, whereas the remaining 48 with neck pain had cervical dysfunction comparable with a neck disorder. Musculoskeletal dysfunction was not related to pain hypersensitivity or symptoms experienced during testing.

Conclusions

Neck pain when present with migraine does not necessarily indicate the existence of cervical musculoskeletal dysfunction. Skilled assessment without reliance only on the person reporting symptoms is needed to identify actual cervical dysfunction. Treatments suitable for neck musculoskeletal disorders would seem inappropriate for the individuals without cervical dysfunction. Future studies evaluating any potential effects of such treatments should only select participants with neck pain of cervical origin.

CONFLICT OF INTEREST

All authors report no conflict of interest.