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

Börner-Schröder, Corinna; Lachhammer, Thomas; Behrendt, Paula; Pfeifer, Theresa; Kolorz, Paulina; Lense, Sarah; Pompignoli, Julie; Reichert, Miriam; Schramm, Severin; Heinen, Florian; Sollmann, Nico; Bonfert, Michaela V. (2025): The Temporal Associations of Neck Pain and Headache – Implications for the Diagnostic Approach to the Myofascial Involvement in Migraine. Journal of Central Nervous System Disease, 17. pp. 1-16. ISSN 1179-5735

Abstract

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.

• Dokumententyp: Artikel (Klinikum der LMU)
• Organisationseinheit (Fakultäten): 07 Medizin > Klinikum der LMU München > Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital
• DFG-Fachsystematik der Wissenschaftsbereiche: Lebenswissenschaften