Ictal neck pain investigated in the interictal state - a search for the origin of pain

Cephalalgia. 2020 May;40(6):614-624. doi: 10.1177/0333102419896369. Epub 2019 Dec 18.


Background: Neck pain is reported in more than 50% of migraine patients during migraine attacks and may be an important source to migraine pain.

Objectives: To investigate phenotypical differences between migraine patients with and without ictal neck pain in the interictal phase. Additionally, to prospectively examine the association between pericranial muscle tenderness and the impending migraine attack.

Methods: Migraine patients (n = 100) and controls (n = 46) underwent a semi-structured interview and sensory testing interictally. Pericranial muscle tenderness was determined using total tenderness score and local tenderness score. The occurrence of migraine attacks was then prospectively recorded for the following seven days.

Results: Patients with ictal neck pain had increased tenderness of pericranial neck muscles compared to migraine patients without (p = 0.023). Ictal neck pain was not associated with migraine localization, tension-type headache, or markers of central sensitization. Prospective data of 84 patients showed that tenderness of trigeminal sensory innervated muscles increased the migraine attack rate (p = 0.035).

Conclusion: The distinction of migraine patients based on the occurrence of ictal neck pain could indicate migraine subtypes and possible involvement of peripheral tissue in the pathophysiology. Whether treatment responses differ among these groups would be fascinating. Additionally, we found that cephalic muscle tenderness is a risk factor for an impending migraine attack.

Keywords: Headache; migraine; muscle; neck pain; sensory testing; trigeminal-cervical-complex.