Study Finds Neck Pain Is Symptom of Migraine—Not a Trigger of the Migraine

Migraine patients have a high prevalence of neck pain, causing a scientific debate over whether neck pain is a symptom of migraine or if the neck pain triggers the migraine. New study findings suggest that neck pain associated with migraine cannot be attributed to increased trapezius activity during rest, mental stress, and physical activity or prolonged muscle activity and should be seen as an accompanying symptom of migraine.

The study, published in The Journal of Headache and Pain, measured surface electromyography (EMG) of the neck muscles in a cohort of 102 participants in order to identify the cause of neck pain and neck muscle tension reported by patients. The researchers recorded the surface EMG responses of the trapezius muscle during a paradigm including rest periods, mental stress, and physical activity.

“The purpose of this study was to evaluate the level of muscle tension during voluntary relaxation and during mental and physical tasks as well as the ability to relax after periods of mental and physical stress in patients with migraine and headache-free control participants,” wrote the authors of the study. “The question was, whether migraine patients exhibit a constantly raised muscle tone or, if not, whether migraineurs are more susceptible to increased neck muscle tension under stress (mental of physical).”

Patients included in the study attended a headache outpatient clinic in Germany. The control participants were recruited using a university platform, social media, and personal contracts. Control participants had a maximum of 3 headache attacks per year that did not fulfill the criteria of migraine or another primary headache type.

The experiment involved 7 experimental conditions that alternated with relaxation periods. Three of the condition blocks were mentally stressful while the other 4 conditions included physical lower limb activity. The EMG was measured and recorded during each block.

The results of the EMG suggested all groups showed increased trapezius activity during mental stress and physical activity compared to the rest periods. Additionally, there was no statistically significant difference between migraine patients and healthy controls for any condition, except for the initial mental stress situation where controls increased by 4.75%, episodic migraines by 17.39%, and chronic migraines by 28.61%.

“Furthermore, the results did not indicate a delayed recovery of trapezius EMG activity from mental or physical tasks, as previously reported for tension-type headache,” the authors stated. “This unanticipated result suggests that altered muscle activity during rest or during mental or physical activity is not a trait symptom of migraine, in contrast to tension-type headache.”

The researchers concluded that perceived neck tension during or before the migraine headache should be regarded as a symptom of the migraine attack, not as a trapezius muscle dysfunction that triggered the attack. However, they noted that future studies are needed to evaluate whether this conclusion can be generalized to all neck muscles.

Reference:

Luedtke K, Mehnert J, May A. Altered muscle activity during rest and during mental or physical activity is not a trait symptom of migraine—a neck muscle EMG study. J Headache Pain. doi: https://doi.org/10.1186/s10194-018-0851-5.