Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Neck Pain in Patients with Migraine

Neck pain in patients with migraine was associated with a poor clinical presentation, a new study found. 142 patients with migraine were stratified by the presence (n=99) or absence of self-reported neck pain (n=43). The clinical examination included the Migraine Disability Assessment, the 12-item Allodynia Symptom Checklist, a flexion rotation test, and the Craniocervical Flexion Test. Researchers found:

  • Migraine-related disability was reported by >80% of patients in both groups.
  • However, there was a greater prevalence and severity of cutaneous allodynia observed in the group with neck pain.
  • Reduced upper cervical mobility was verified in 67% of patients with neck pain vs 41% of those without neck pain.
  • There were no differences in migraine-related disability.


Bragatto MM, et al. Is the presence of neck pain associated with more severe clinical presentation in patients with migraine: A cross-sectional study. [Published online ahead of print May 27, 2019]. Cephalalgia. doi: 10.1177/0333102419854061.


This study adds to a long list of important evaluations of migraine patients with neck pain. In this assessment, neck pain predicted greater severity of migraine symptoms, including cutaneous allodynia and reduced range of motion. Other studies demonstrating neck pain and migraine include Blau and MacGregor who reported that 64% of 50 patients with migraine had neck pain (Headache 1994;34:88-90), and Kaniecki, who found 75% of 378 migraine patients had neck pain, with 47% reporting unilateral pain (Neurology 2002; 58 (Suppl 6): S15-20). Calhoun and colleagues evaluated 113 patients with migraine and queried symptoms. Neck pain was more common than unilaterality. Neck pain prevalence correlated with headache frequency. Depending on when the migraine was treated, 45-75% of attacks were associated with neck pain (Calhoun et al. Headache. 2010 Sep;50(8):1273-7). Thus, neck pain is correlated with both migraine severity and attack frequency and is more common than one of the diagnostic criteria for migraine, nausea. Stewart J. Tepper, MD, FAHS, Professor of Neurology, Geisel School of Medicine at Dartmouth, Director, Dartmouth Headache Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH