Migraine and neck pain: Mechanisms of comorbidity

Abstract

Neck pain and migraine are common diseases. Neck pain seldom occurs in a patient with migraine. However, the relationship between migraine and neck pain has been inadequately investigated.Objective: to analyze neck pain in patients with migraine to determine possible comorbidity mechanisms of these diseases.Patients and methods. The investigation enrolled 63 patients with chronic migraine (CM) and 40 with episodic migraine (EM) diagnosed in accordance with the International Classification of Headache Disorders, 3rd edition (ICHD-3). Winking reflex (WR) and nociceptive flexion reflex (NFR) were examined to evaluate the function of antinociceptive systems.Results. In the patients with CM, neck pain was more common than in those with EM (53.03% versus 14.02%); and panful tenderness, sensitivity, and tension of neck muscles were more marked. There was also a significant reduction in WR and NFR thresholds. Neck pain was noted to be an integral component of the pathogenesis of CM in a large number of patients with this condition. The authors proposed several pathophysiological mechanisms of a relationship between migraine and neck pain. Neck muscles and craniovertebral junction areas serve as a source for the arrival of nociceptive pain pulses in the central nervous system (peripheral sensitization), promoting pain chronization. Muscle dysfunction in this area may be, in turn, a reflection of central sensitization and impaired descending pain control.

Keywords

• migraine
• myofascial pain syndrome
• neck pain
• neck tension.