The Temporal Associations of Neck Pain and Headache - Implications for the Diagnostic Approach to the Myofascial Involvement in Migraine.

BACKGROUND

Migraine remains a relevant source of disability. Peripheral pathophysiological mechanisms including the involvement of neck musculature are not yet well understood. A temporal association of headache and neck pain, and imaging tools for its assessment are not established.

OBJECTIVES

Our aim was to explore the association between headache episodes and involvement of neck muscles in patients with episodic migraine and healthy controls.

DESIGN

Controlled clinical study.

METHODS

Data of 13 migraine patients (26.92 ± 2.47 years, 12 females) and 13 matched healthy controls (26.62 ± 3.43 years) on headache, migraine, and neck pain were collected during an initial 12-week observational period. A cross-sectional examination followed that comprised clinical assessment of the upper trapezius muscle (UTM) including identification of myofascial trigger points (mTrP), algometry (pressure pain thresholds [PPT]), and B-mode (brightness mode) ultrasound measurements of muscle and fascia thickness and gray scale analysis.

RESULTS

Migraine patients reported significantly higher neck pain frequency and duration and significantly lower PPT above the UTM (P < 0.05) than controls. Mean PPT values of mTrP in patients did not significantly differ from PPT values of reference points on the same side (left: P = 0.419, right: P = 0.100). The odds ratio of co-occurring headache or migraine on days with neck pain was 5.64 (95% confidence interval [CI] [4.14;7.69]) and 7.21 (95% CI [4.95;10.49]) times higher than on neck pain-free days. Ultrasound analysis demonstrated significant differences in muscle/fascial thickness in 12 out of 24 measurements. There were no significant differences in gray scale analysis between groups. When comparing same-side ultrasound measurements of pooled reference points and mTrP, all measurements of muscle thickness (P = 0.002, 0.006, 0.002, 0.012), one measurement of fascial thickness (P = 0.006), and three measurements of gray scale (P = 0.009, 0.014; P < 0.001) yielded significant results.

CONCLUSIONS

Our data may emphasize the relevance of UTM myofascial involvement in migraine patients. This may involve the UTM as a whole, rather than single focalities. The muscular component of migraine and other headache disorders remains an overlooked part of diagnosis and treatment. Consequently, imaging methods, especially low-cost point of care tools such as ultrasound, may provide objectifiable additional data to known clinical findings.

REGISTRATION: Clinical trial registration: DRKS (German Clinical Trials Register): "Neuromodulation by stimulation of cervical afferents in migraine patients - the neurophysiological basis of repetitive peripheral magnetic stimulation (rPMS) in patients with episodic migraine" ID: DRKS00024470, https://drks.de/search/en/trial/DRKS00024470/entails.