Migraine treatment is often delayed beyond 30 minutes of headache onset in patients with comorbid neck pain, according to researchers.
LOS ANGELES—The presence of neck pain is associated with delayed treatment of migraine, according to research presented at the 52nd Annual Meeting of the American Headache Society. This relationship is indicated by a higher pain burden at the time of initial treatment and by the longer time before treatment initiation, reported Sutapa Ford, PhD, and Anne H. Calhoun, MD.
“This delay has several possible explanations,” stated Drs. Ford and Calhoun. “One is that migraineurs simply fail to relate neck pain to their migraine attacks. Beyond this, we believe that neck pain is so prevalent in migraine—particularly as it undergoes chronification—that migraineurs are inured to its presence and therefore ignore neck pain until it increases in severity or until headache pain intensity surpasses it.” Dr. Ford is a Clinical Assistant Professor, Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, and Dr. Calhoun is an Adjunct Professor of Psychiatry at the University of North Carolina. They are partners and cofounders of the Carolina Headache Institute in Chapel Hill.
Hyperalgesia or Allodynia?
“The high prevalence of neck pain in migraine—and its reported association with treatment resistance and disability—suggest that neck pain in this setting may represent hyperalgesia or allodynia,” Dr. Ford told Neurology Reviews. “In light of these findings, patients should consider migraine treatment while neck pain remains in the mild stage. Delaying treatment until neck and headache pain increases to moderate to severe intensity leads to suboptimal treatment outcomes.”
Headache Intensity and Treatment
The researchers conducted a prospective, observational study of 113 patients with episodic or chronic migraine. A headache medicine specialist examined each patient to confirm the diagnosis of migraine and to exclude cervicogenic headache and fibromyalgia. Data regarding all migraines were recorded during the course of at least one month and until six qualifying migraines had been treated.
Patients had a total of 2,411 headache days; 786 were for migraine. Complete data were available for 749 migraine attacks, and a majority of these attacks were treated in the moderate pain stage. According to the investigators, the overall presence of neck pain was associated with a delay in treatment beyond 30 minutes of migraine onset.
“Among subjects with neck pain, those with moderate or severe neck pain were more likely to treat within 30 minutes of migraine onset than those with mild neck pain,” reported the researchers. “Subjects with neck pain initiated treatment at greater headache pain intensity than those without.”
—Colby Stong