Women with migraine are more likely to have worse performance of the cervical muscles, both in force production and muscle activity, compared with women without migraine, a study in the European Spine Journal reports.

Few studies have previously evaluated motor control of cervical muscles in individuals with migraine. The goal of the current study was to determine the extensor/flexor ratio of neck muscle strength and electromyographic activity during a test of maximal voluntary isometric contraction and craniocervical flexion in individuals with migraine and individuals without a history of migraine or other headaches.

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The study enrolled women with migraine (n=52) and women without a migraine history or neck pain (n=52). Participants completed the Neck Disability Index, Migraine Disability Assessment, and 12-item Allodynia Symptom Checklist questionnaires. Researchers also evaluated electromyographic activity of the sternocleidomastoid, anterior scalene, splenius capitis, and upper trapezius muscles during maximal voluntary isometric contraction and craniocervical flexion tests. All tests were performed during the interictal period.

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Participants in the migraine group had a mean of 11.9 days of headache per month and a mean intensity of 7.8 on a scale from 0 to 10. Compared with the control group, patients with migraine had lower strength of the cervical flexor muscles (P =.00) and a lower extensor/flexor neck muscle strength ratio (P =.04). The control group demonstrated better muscle performance vs the migraine group in the analysis of the distribution of the groups in the stages of the craniocervical flexion test (P <.00). Differences between the 2 groups occurred at a pressure of 30 mm Hg (P <.00). The control group also had a lower craniocervical flexion test electromyographic ratio than the migraine group at only the 30 mm Hg pressure (P =.047).

Limitations of the study were the inclusion of only women from a tertiary hospital as well as the inclusion of the craniocervical flexion test, which does not represent all daily activities.

Additionally, the researchers added that because of the study design they “can only conclude that these changes in cervical muscle performance are associated with migraine but cannot infer causality.” They also highlight that clinically, these findings, “may be generalized only to women with migraine with similar characteristics to the current sample.”


Benatto MT, Florencio LL, Bragatto MM, Lodovichi SS, Dach F, Bevilaqua-Grossi D. Extensor/flexor ratio of neck muscle strength and electromyographic activity of individuals with migraine: a cross-sectional study [published online August 9, 2019]. Eur Spine J. doi:10.1007/s00586-019-06097-9