Muscular Hyperalgesia in Young Adults with Migraine Is Associated with Headache Attacks

Background/Purpose: Migraine is associated with disability and loss of quality of life in young adults. Next to central mechanisms of migraine pathophysiology, peripheral mechanisms including the myofascial involvement of neck muscles play a role, although the timely association of headache and neck pain has not yet been thoroughly reported. Using MRI T2 sequences, differences in the upper trapezius muscle (UTM) between patients with migraine, tension-type headache, and healthy controls could be visualized. Since MRI diagnostics cannot be offered to all patients, the aim of this analysis was to assess UTM alterations of migraine patients compared with healthy controls using point-of-care measures like algometry and ultrasound.

Methods: The cohort consists of 13 migraine patients and 13 age- and sex-matched healthy controls. Headache, migraine, and neck pain were monitored over a 3-month period using calendars. Physical examination of the UTM comprised the identification of muscular pathology including myofascial trigger points, algometry (pressure pain thresholds [PPT]), and B-mode sonography.

Results: When compared with healthy controls, migraine patients had a significantly higher neck pain frequency and duration and significantly lower PPT above the UTM. The chance of having any headache or a migraine on days with neck pain was 5.6 or 7.2 times higher than on days without neck pain, respectively. Whether ultrasound demonstrates differences in muscular tissue between migraine patients and healthy controls is currently analyzed and results will be available at the time of the conference.

Conclusion: Migraine is characterized by hyperalgesia of the UTM and neck pain has a timely association with headaches/migraine attacks. Thus, the muscular involvement should be thoroughly assessed in headache patients. Given the probably bidirectional association of headaches and neck pain, neck muscles can represent an important access for muscle-targeting treatment and for disease/treatment monitoring.