Overview

Both migraine and neck pain are among the top 10 leading causes of years lived with a disability worldwide. Many individuals with migraine suffer neck pain, which increases the burden of headache.

The presence of neck pain in migraine is linked to migraine chronicity as well as a poorer response to medical treatment, but the reasons for neck pain in migraine are unclear. On one hand, convergence of head and neck afferents in the trigeminocervical nucleus allows bidirectional referral of pain between the head and neck. This means that neck pain could be a referred symptom from headache due to central sensitisation, and part of the migraine symptomatic complex; or, it may reflect nociception from upper cervical musculoskeletal structures, with potential to contribute to the headache experience.

On the other hand, neck pain in migraine could be a comorbid musculoskeletal neck disorder, unrelated to migraine. There is limited evidence for identifying any of these mechanisms, yet each has different implications for management. This lack of knowledge may be why neck treatment in patients with migraine has uncertain efficacy. Our research aims to clarify mechanisms underlying neck pain in migraine by examining a comprehensive set of cervical impairments alongside behaviour of neck pain in relation to migraine, and features of pain sensitisation.

Importance of the funds

The grant will fund a research assistant that will ensure assessor blinding, which is vital for the validity of this research.

Migraine is a common disabling condition that presents in many different ways. In order to distinguish differences, we need a large number of volunteers to participate in this study. We hope the results of our study will help clinicians identify patients for whom management of cervical musculoskeletal dysfunction may or may not assist in migraine management. We also hope to identify patient subgroups, which will direct future studies into the efficacy of local neck treatment in the overall management of migraine.

Zhiqi Liang is a Specialist Musculoskeletal Physiotherapist (as awarded by the Australian College of Physiotherapists in 2014) and a current PhD candidate under the advisory of Dr Lucy Thomas, Dr Julia Treleaven and Emeritus Professor Gwendolen Jull.