A prospective study on association of migraine with tension-headache: Is neck pain a common burden in India?

Abstract

Background. The present study aimed to know the association and causal relationship of neck pain with different primary and mixed-type headache disorders. Material and methods. The primary patients with headaches attending the Department of Neurology OPD throughout one-year were included in the study. The demographic features, detailed history of headaches, and the characteristics of neck pain were entered in the pre-designed proforma. With the collaboration of the Department of Neurology, All India Institute of Medical Sciences, Jodhpur, Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow and the Department of Neurology, IMS and SUM Hospital, Bhubaneswar, India. Results. A total of 601 primary headache patients were included in the study, among which a fraction of 66.4% (n=399) had the problem of neck pain either as a pre-disposing event or as a part of the headache. Females were predominately higher than males with a fraction of 67.6%. Among all the patients a fraction of 21% (n=84) had a migraine, 51% (n=203) had a tension-type headache (TTH) and 28% (n=112) had a mixed-type headache. Though several patients with migraine had neck pain as a part of migraine, neck pain was significantly associated with tension and mixed type headache than migraine headache (p<0.001 vs p=0.35). Among the mixed-quality of headaches; chronic TTH (CTTH) with episodic migraine (EM) was most common (54.5%, n=61), followed by CTTH with chronic migraine (CM) at 33% (n=37). Conclusion. The presence of neck pain in migraine headaches showed an increased association with TTH whereas the reverse may not be true. This is yet to prove whether this is a mere association or a causal relationship.