Neck pain in patients with migraine is heterogeneous with most unlikely to be related to cervical musculoskeletal dysfunction, Australian researchers have shown.

And given the study suggests neck pain in patients with migraine does not necessarily indicate a local neck cause, interventions such as physiotherapy may not be appropriate, they suggest.

A cross sectional study of 177 adults compared measures such as cervical movement range and accuracy, segmental joint dysfunction, neuromuscular and sensorimotor measures in patients with migraine, healthy controls and people with idiopathic neck pain.

Neck pain was reported by most patients with migraine (89%), especially those with chronic rather than episodic migraine.

Clinical assessment in the Queensland study found 61% of migraine patients had patterns of cervical musculoskeletal function similar to the healthy controls.

“The neck pain in these individuals is likely to be part of the migraine symptomatic complex and related to sensitisation mechanisms,” the investigators said.

The remainder of migraine patients (39%) tested more like the patients with idiopathic neck pain.

“This study could not determine whether the cervical musculoskeletal dysfunction, when present, was comorbid or a secondary consequence of migraine, although with respect to the latter it had similar frequency in both episodic and chronic migraine.”

The study authors said the findings supported assessment across multiple domains of musculoskeletal function rather than relying on disconnected individual findings.

“Future clinical trials should carefully select participants with migraine who have true cervical musculoskeletal dysfunction associated with their neck pain so that the effects of local neck musculoskeletal treatment on both the neck pain and migraine can be evaluated in those for whom it may be indicated.”

They also noted that, where possible, clinical assessment should be avoided around the time of migraine when sensory thresholds were lower.

“About 30% of participants with migraine in this study reported subsequent aggravation of symptoms despite our close monitoring, pacing of tests, and discontinuation of assessments when symptoms did not settle.”

The study was published in The Journal of Head and Face Pain.