Migraine Treatment Delayed by Neck Pain

Patient Expert

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A 2010 study showed that neck pain is more common as a symptom of Migraine than nausea.2 (See Neck Pain as a Migraine Symptom.) Now researchers are finding that when a Migraineur has neck pain, Migraine treatment is often delayed.1

The study

Study objectives:

"This study will examine whether presence of neck pain is associated with a delay in Migraine treatment. Background: We have previously shown that neck pain is exceedingly common in Migraine. We have further shown that its presence on the day preceding Migraine is associated with impaired treatment response, and that neck pain is predictive of Migraine-related disability independent of headache frequency and severity."2

Study methods:

  • Prospective participants were examined by Migraine and headache specialists to confirm diagnosis of Migraine and exclude both cervicogenic headache and fibromyalgia.
  • 113 participants kept a detailed diary for at least one month and until six Migraine had been treated.
  • Participants treated their Migraines at the stage during which they usually treated.
  • Researchers performed the chi-square test of independence to examine the relationship between presence of neck pain and treaing the Migraines within 30 minutes of onset.*

Study results:

  • Study participants recorded 2,411 "headache" days
  • 786 of the 2,411 headaches were Migraines
  • There was complete data for 749 Migraine attacks, the majority of which were treated in the moderate pain stage.
  • Presence of neck pain in the hour preceding initial Migraine treatment was associated with delay in treatment beyond 30 minutes of onset.
  • When neck pain accompanied Migraine, participants who experienced moderate or severe neck pain were more likely to treat within 30 minutes of headache onset than those with mild neck pain.

Study conclusions:

"In this study, presence of neck pain was associated with delayed treatment of Migraine, as indicated both by a higher pain burden at the time of initial treatment and by longer wait times before treatment initiation. The authors speculate that this delay may have several explanations. One is that Migraineurs simply fail to relate neck pain to Migraine attacks. Beyond this, the authors believe that neck pain is so prevalent in Migraine--particularly as it undergoes chronification--that Migraineurs are inured to its presence and therefore ignore neck pain until it increases in severity or until headache pain intensity surpasses it."

Summary and comments:

Thankfully, it's now recognized that neck pain is a possible Migraine symptom. Migraineurs have been reporting this and wondering about it for quite some time. Now that the research has established such a high prevalence of neck pain as a Migraine symptoms, efforts need to be made to educate patients and doctors alike on this issue.

This study points toward two important issues:

  • Migraineurs may not relate their neck pain to their Migraines.
  • Migraineurs have become so used to the neck pain that they may tend to ignore it until its severity increases or the Migraine reaches the headache phase.

These are both issues that can be addressed via patient education. If you have neck pain, and you're not sure if it's part of your Migraine symptoms, discuss it with your doctor. It has been shown that treating Migraines is more effective when treating as early in the Migraine attack as possible. You and your doctor can discuss your symptoms and the optimal time for you to start treating your Migraine attacks.


Resources and Notes:

1 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.

2 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. Published Online: Jan. 20, 2010.

3 StatTrek.com "AP Statistics Tutorial: Chi-Square Test for Independence."

  • The chi-square test is applied when the group being studied has two categorical variables to see if there is a significant association between the two variables. In this case, the two variables were 1) presence of neck pain and 2) how quickly the participants treated their Migraines.

Medical review by John Claude Krusz, PhD, MD

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