Neck pain and headache: Pathophysiology, treatments and future directions

Haidar M Al-Khazali; Lotte Skytte Krøll; Håkan Ashina; Agustin Melo-Carrillo; Rami Burstein; Faisal Mohammad Amin; Sait Ashina

doi:10.1016/j.msksp.2023.102804

Neck pain and headache: Pathophysiology, treatments and future directions

Musculoskelet Sci Pract. 2023 Aug:66:102804. doi: 10.1016/j.msksp.2023.102804. Epub 2023 Jun 16.

Authors

Haidar M Al-Khazali¹, Lotte Skytte Krøll¹, Håkan Ashina², Agustin Melo-Carrillo³, Rami Burstein³, Faisal Mohammad Amin⁴, Sait Ashina⁵

Affiliations

¹ Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
² Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Brain and Spinal Cord Injury, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, MA, USA.
³ Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, MA, USA.
⁴ Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Brain and Spinal Cord Injury, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
⁵ Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Comprehensive Headache Center, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, MA, USA. Electronic address: sait.ashina@bidmc.harvard.edu.

PMID: 37394323
DOI: 10.1016/j.msksp.2023.102804

Abstract

Introduction: Neck pain is a prevalent neurologic and musculoskeletal complaint in the general population and is often associated with primary headache disorders such as migraine and tension-type headache (TTH). A considerable proportion, ranging from 73% to 90%, of people with migraine or TTH also experience neck pain, and there is a positive correlation between headache frequency and neck pain. Furthermore, neck pain has been identified as a risk factor for migraine and TTH. Although the exact underlying mechanisms linking neck pain to migraine and TTH remain uncertain, pain sensitivity appears to play an important role. People with migraine or TTH exhibit lower pressure pain thresholds and higher total tenderness scores compared with healthy controls.

Purpose: This position paper aims to provide an overview of the current evidence on the relationship between neck pain and comorbid migraine or TTH. It will encompass the clinical presentation, epidemiology, pathophysiology, and management of neck pain in the context of migraine and TTH.

Implications: The relationship between neck pain and comorbid migraine or TTH is incompletely understood. In the absence of robust evidence, the management of neck pain in people with migraine or TTH relies mostly on expert opinion. A multidisciplinary approach is usually preferred, involving pharmacologic and non-pharmacologic strategies. Further research is necessary to fully dissect the linkage between neck pain and comorbid migraine or TTH. This includes the development of validated assessment tools, evaluation of treatment effectiveness, and exploration of genetic, imaging, and biochemical markers that might aid in diagnosis and treatment.

Keywords: Migraine; Neck pain; Physical therapy; Tension-type headache.

Publication types

Review

MeSH terms

Headache
Humans
Migraine Disorders* / diagnosis
Migraine Disorders* / therapy
Neck Pain / diagnosis
Neck Pain / epidemiology
Neck Pain / therapy
Pain Threshold
Tension-Type Headache* / diagnosis
Tension-Type Headache* / epidemiology
Tension-Type Headache* / therapy