Neck Pain and Other Location Patterns in Episodic and Chronic Migraine: A Cross-Sectional Study

Abstract

Background: The pain location of migraine has limited diagnostic value and has usually been assessed using non-standard verbal descriptors.Methods: This study uses non-verbal descriptors of pain location in episodic and chronic migraineurs seen at 3 centers of different complexities (tertiary-level hospital and outpatient clinics) and from different sectors (public and private). The explicit pain location was recorded by asking patients to indicate in an electronic form 3 points on the anterolateral side and 3 points on the posterolateral side of the head and neck. A multivariate logistic regression model was fitted to assess the association of different pain location patterns with demographic and clinical variables.Results: Ninety-seven episodic migraine and 113 chronic migraine patients were included, with the most commonly affected sites being the frontal (73% and 65%, respectively), temporal (67% and 73%, respectively) and parietal (27% and 34%, respectively) regions. The posterior cervical site was most often involved in the chronic migraine group (21% vs. 33%, p=0.034). No other locations showed a significant difference. The adjusted model showed that diffuse pain (OR=13.74, CI=4.89-49.85) and the presence of medication overuse associated with tactile allodynia (OR=2.65, CI=1.05-6.87) were associated with increased odds of neck pain. Disease duration was marginally relevant (p=0.078).Conclusions: The migraine attacks most commonly involve the fronto-temporal regions, although neck pain can be more often found in chronic migraine. Some features commonly found in this group such as more diffuse pain, tactile allodynia, and medication overuse are associated with this extratrigeminal site of pain.