Neck pain in episodic migraine: premonitory symptom or part of the attack?

Christian Lampl,Mirjam Rudolph,Dimos D Mitsikostas,Christina I Deligianni

doi:10.1186/s10194-015-0566-9

Christian Lampl, Mirjam Rudolph + Show 2 more

Open Access

https://doi.org/10.1186/s10194-015-0566-9

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Abstract

BackgroundWhether neck pain (NP) is a prodromal migraine symptom or belongs to the migraine attack feature remains controversial.MethodsIn order to prospectively record neck pain (NP) and non-headache symptoms and to evaluate the percentage of patients having NP as clear premonitory, non-headache symptom of their migraine, a specific self fulfilled questionnaire was designed to record NP and premonitory symptoms in a migraine cohort. All patients who reported NP anytime during the migraine phase were allocated to 3 groups: A = NP starts with the onset of headache; B = NP starts < 2 h before the onset of headache; C = NP starts 2-48 h before the onset of headache.ResultsData were evaluated from 487 migraineurs with episodic migraine (73.1 % females; 77 % had migraine without aura). 338 patients (69.4 %) reported NP anytime during the migraine phase. 184 patients (group A; 54.4 %) noticed NP with the start of the headache phase; 118 patients (group B; 24.2 %) reported NP within 2 h before the headache phase; 36 patients (group C; 7.4 %) experienced NP 2-48 h before the headache phase. In group B we found a high proportion of typical migraine associated symptoms and NP progressed into the headache phase in 82.2 %.ConclusionsThese data indicate that NP is a very common feature of migraine attacks and is more likely to be part of the migraine attack than a prodromal migraine symptom.

Highlights

Whether neck pain (NP) is a prodromal migraine symptom or belongs to the migraine attack feature remains controversial
If NP occurred in a time period of 2 h before the aura in migraine with aura and before the onset of pain in migraine without aura, with any accompanying typical migraine symptoms it was interpreted as part of the migraine attack itself
Demographic details: the study consists of 487 migraineurs with episodic migraine (Fig. 1; 356 females [73.1 %] and 131 male [26.9 %]). 77 % of patients had migraine without aura; mean age was 38 years; mean age at onset of migraine was 21 years

Summary

Introduction

Whether neck pain (NP) is a prodromal migraine symptom or belongs to the migraine attack feature remains controversial. Neck pain (NP) ranks among the most common complaints in medicine, affecting 14–71 % of adults [1]. Different features of NP such as pericranial muscle tenderness, myofascial referred pain from neck muscles, and the dysfunction of the joints of the upper cervical spine have been associated with headache [3, 4]. Many migraine sufferers report neck discomfort and stiffness before and/ or during an attack. The pain of migraine is most commonly perceived in the ophthalmic distribution of the trigeminal nerve, a substantial percentage of migraineurs reported to experience pain in the neck and occiput with their attacks [5]. In one of first studies in the early 90 it was reported that one third of patients have NP in the prodromal (premonitory) state, again one third in the

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