Neck Pain Linked to Migraine May Not Indicate Cervical Musculoskeletal Dysfunction

Among people who have neck pain associated with their migraine, the presence of neck pain is not necessarily indicative of cervical musculoskeletal dysfunction, according to study results published in Headache.

Neck pain is a common symptom in migraines. Despite limitations in evidence to support the efficacy of local neck treatment during migraines, recommendations are prevalent. Misdiagnosis of cervicogenic headache, potentially leading to delays in appropriate migraine management, have caused frustration among neurologists.

To address the knowledge gap, a team of investigators in Australia conducted a cross-sectional, single-blinded study to identify the frequency of cervical musculoskeletal dysfunction in patients with neck pain during migraine. Additionally, they sought to assess whether pain hypersensitivity affects cervical musculoskeletal function in this patient population.

Study researchers included a total of 177 participants in the study: 124 patients with migraine, 21 patients with idiopathic neck pain, and 32 healthy control patients. Among patients with migraine, 89% reported to having neck pain.

Compared with patients with episodic migraines, those with chronic migraines had greater neck disability (P =.025) and neck pain intensity (P =.049). Compared with idiopathic neck pain, patients with chronic migraine still had significantly greater neck disability and neck pain intensity (P =.005 and P =.049, respectively).

Using partitioning around medoids and Ward’s hierarchical agglomerative clustering methods, the study researchers found 2 well-separated clusters of cervical musculoskeletal function. There were 108 patients in the first cluster and 69 patients in the second cluster. All healthy controls were found in cluster 1, while all participants with idiopathic neck pain were found in cluster 2; 61% of patients with migraine were found in cluster 1, while 39% of patients with migraine were found in cluster 2. All patients with migraine who did not have neck pain were found in cluster 1; however, patients with chronic and episodic migraine were found in both clusters.

Between the musculoskeletal clusters, there were no significant differences observed in headache or neck pain features and disability. Additionally, pain hypersensitivity measures were not significantly linked to a musculoskeletal cluster, suggesting that pain hypersensitivity in migraine is unrelated to musculoskeletal dysfunction.

The authors noted that the outcomes of the study raised the “need for an individualized skilled assessment of cervical musculoskeletal function to differentiate a central versus peripheral origin of neck pain or a combination of both.”

“There should be no reliance on only pain or tenderness, which often reflects the general pain hypersensitivity commonly present in persons with migraine. Persons with migraine with neck pain should not be regarded as a homogenous group in future clinical trials on the efficacy of neck interventions,” the study investigators concluded.


Liang Z, Thomas L, Jull G, Minto J, Zareie H, Treleaven J. Neck pain associated with migraine does not necessarily reflect cervical musculoskeletal dysfunction. Headache. 2021;61(6):882-894. doi:10.1111/head.14136