Common Pain Mechanisms in Migraine, Migraine-Related Neck Pain, and Lower Back Pain: A Cross Sectional Study

Официальное название

From Mechanisms to Clinical Evidence: A Cross-Sectional Study of Common Pain Mechanisms in Migraine, Migraine-Related Neck Pain, and Lower Back Pain

Обзор

Migraine is one of the primary headache disorders with a high prevalence worldwide, leading to significant disability and reduced quality of life. Trigeminal nerve activation and alterations in central pain processing mechanisms play a crucial role in the pathophysiology of migraine. Recent studies suggest that migraine may not only be a headache disorder but also a systemic pain disorder associated with changes in central pain processing mechanisms. Central sensitization is defined as increased sensitivity of nociceptive neurons in the central nervous system to afferent stimuli and is considered a key mechanism in the development and maintenance of chronic pain conditions. This condition is characterized by pain hypersensitivity, allodynia, and generalized pain sensitivity. In addition to headaches, other musculoskeletal pains are also frequently reported in migraine patients. Spinal pain, particularly neck and lower back pain, can occur in migraine sufferers, with central sensitization contributing to the condition, considering the spine as a chain. Large population-based studies have shown a significant association between primary headaches and persistent low back pain, and a higher prevalence of concomitant low back pain has been reported in individuals with chronic migraine and chronic tension-type headaches. This association is suggested to be explained by the shared nociceptive pathways of the head and spinal structures and the changes in central pain processing seen in chronic pain conditions. This relationship between migraine and musculoskeletal pain is also explained by the presence of shared neuroanatomical structures such as the trigemino-cervical complex. Nociceptive afferents from the upper cervical spine and cranial structures converge at the trigemino-cervical complex level in the brainstem, creating a predisposition to the co-occurrence of head and neck pain. This mechanism suggests that pain or dysfunction in the cervical region in migraine patients may be related to headache symptoms. Studies have shown that neck pain is more common in individuals with migraine than in the general population, and research suggests this rate may be approximately 10-12 times higher compared to healthy individuals. Furthermore, it has been reported that individuals with migraine more frequently experience tenderness in cranio-cervical muscles such as the upper trapezius, sternocleidomastoid, and suboccipital muscles, myofascial trigger points, and increased muscle sensitivity. The literature also emphasizes that these cervical symptoms may be related to migraine frequency, attack severity, and headache-related disability. These findings suggest that migraine should be considered not only as a primary headache disorder but also as a complex neurobiological condition associated with widespread pain sensitivity and musculoskeletal symptoms. A better understanding of the relationship between migraine and musculoskeletal pain could be important for developing multidisciplinary treatment approaches. However, clinical studies in the literature that evaluate migraine, accompanying neck pain, and lower back pain together in terms of common pain mechanisms are quite limited. Therefore, the rationale for this study is that examining factors such as central sensitization, pain threshold, pain catastrophizing, psychological factors, body awareness, and regional disability together in migraine patients can lead to a better understanding of the pathophysiology of migraine-related musculoskeletal pain. Based on all these reasons and evidence, the aim of this study is to investigate the possible common pain mechanisms and musculoskeletal pathophysiological processes of migraine-related neck and back pain in migraine patients with accompanying neck and/or back pain by evaluating factors such as central sensitization, pain threshold, pain catastrophizing, psychological factors, body awareness, and regional disability together.

Первичные конечные точки

• Central Sensitization Inventory [Срок оценки: Day 1]

Вторичные конечные точки (12)

• Headache Intensity [Срок оценки: Day 1]
• Disability for Migraine [Срок оценки: Day 1]
• Disability of the Neck [Срок оценки: Day 1]
• Disability of the Lower Back [Срок оценки: Day 1]
• Headache Impact [Срок оценки: Day 1]
• Pain Catastrophizing [Срок оценки: Day 1]
• Anxiety and Depression [Срок оценки: Day 1]
• Headache Awareness [Срок оценки: Day 1]
• Neck Awareness [Срок оценки: Day 1]
• Back Awareness [Срок оценки: Day 1]
• Pressure Pain Threshold Assessment [Срок оценки: Day 1]
• Allodynia [Срок оценки: Day 1]

Критерии участия

Критерии включения

• Being between 18 and 65 years of age,
• Being able to read and understand Turkish,
• Agreeing to participate voluntarily,
• Having an episodic or chronic migraine diagnosis according to the International Classification of Headache Disorders Edition 3 criteria;
• Having neck pain and/or lower back pain without any underlying diagnosis accompanying the migraine diagnosis.

Критерии исключения

• A history of neurological disorder (e.g., Multiple Sclerosis),
• Inflammatory rheumatic disorders (e.g., Rheumatoid Arthritis), generalized chronic pain syndromes (e.g., Fibromyalgia),
• Any other headache disease, any other systemic disease,
• Acute fracture and infection,
• Spinal surgery or spinal disease diagnosis within the last 6 months,
• Serious musculoskeletal trauma within the last 6 months,
• Pregnancy,
• A cognitive or psychiatric condition that would prevent completion of the questionnaires,
• In the control group without a migraine diagnosis,
• A history of recurrent headaches within the last year.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Дизайн исследования

Модель наблюдения

Другое

Центры проведения

Turkey (Türkiye) · 1 центр

• Gazi University — Gaziantep

Публикации

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Идентификаторы

NCT: NCT07567300 · Approval No: 3/9; 02.04.2026

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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