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Ashina S, Bendtsen L, Burstein R, Iljazi A, Jensen RH, Lipton RB. Pain sensitivity in relation to frequency of migraine and tension-type headache with or without coexistent neck pain: an exploratory secondary analysis of the population study. Scand J Pain 2023; 23:76-87. [PMID: 36137215 DOI: 10.1515/sjpain-2022-0030] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/30/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES We aimed to investigate whether coexistent self-reported neck pain influences cephalic and extracephalic pain sensitivity in individuals with migraine and tension-type headache (TTH) in relation to diagnosis and headache frequency. METHODS A population of 496 individuals completed a headache interview based on ICHD criteria, providing data collected by self-administered questionnaires, assessments of pericranial total tenderness score (TTS) and pressure pain thresholds (PPT). Stimulus-response (SR) functions for pressure vs. pain were recorded. Presence of neck pain in the past year was assessed by the self-administered questionnaire. We categorized participants by primary headache type. We also categorized participants into 3 groups by headache frequency: chronic (≥15) or episodic (<15 headache days/month) headache and controls. TTS, PPTs and the area under the SR curve were compared between subgroups using Generalized Linear Models with pairwise comparisons controlling for age and sex. RESULTS Individuals with chronic followed by episodic headache had higher TTS than controls (overall p≤0.001). The difference between chronic and episodic headache subgroups was significant in the group with neck pain (p≤0.001) but not in the group without neck pain. In individuals with neck pain, mean TTS was higher in coexistent headache (migraine and TTH), 23.2 ± 10.7, and pure TTH, 17.8 ± 10.3, compared to pure migraine, 15.9 ± 10.9 and no headache 11.0 ± 8.3 (overall p<0.001). Temporal and finger PPTs did not statistically differ among the chronic headache, the episodic headache and controls in individuals with and without neck pain. Temporalis and trapezius SR-functions showed that tenderness was increased in individuals with chronic headache to higher degree than in those with episodic headache, and more so in those with neck pain. CONCLUSIONS Coexistent neck pain is associated with greater pericranial tenderness in individuals with chronic headache and to a lesser degree in those with episodic headache. Sensitization may be a substrate or consequence of neck pain and primary headache, but a longitudinal study would be needed for further clarification.
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Affiliation(s)
- Sait Ashina
- BIDMC Comprehensive Headache Center, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars Bendtsen
- Danish Headache Center, Department of Neurology, Faculty of Health Sciences, University of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Rami Burstein
- BIDMC Comprehensive Headache Center, Harvard Medical School, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Afrim Iljazi
- Department of Orthopedic Surgery, University of Copenhagen, Copenhagen, Denmark
| | - Rigmor Hoejland Jensen
- Danish Headache Center, Department of Neurology, Faculty of Health Sciences, University of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine and Montefiore Headache Center, Bronx, NY, USA
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Krøll LS, Hammarlund CS, Linde M, Gard G, Jensen RH. The effects of aerobic exercise for persons with migraine and co-existing tension-type headache and neck pain. A randomized, controlled, clinical trial. Cephalalgia 2018; 38:1805-1816. [PMID: 29333870 DOI: 10.1177/0333102417752119] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim To evaluate aerobic exercise in migraine and co-existing tension-type headache and neck pain. Methods Consecutively recruited persons with migraine and co-existing tension-type headache and neck pain were randomized into an exercise group or control group. Aerobic exercise consisted of bike/cross-trainer/brisk walking for 45 minutes, three times/week. Controls continued usual daily activities. Pain frequency, intensity, and duration; physical fitness, level of physical activity, well-being and ability to engage in daily activities were assessed at baseline, after treatment and at follow-up. Results Fifty-two persons completed the study. Significant between-group improvements for the exercise group were found for physical fitness, level of physical activity, migraine burden and the ability to engage in physical activity because of reduced impact of tension-type headache and neck pain. Within the exercise group, significant reduction was found for migraine frequency, pain intensity and duration, neck pain intensity, and burden of migraine; an increase in physical fitness and well-being. Conclusions Exercise significantly reduced the burden of migraine and the ability to engage in physical activity because of reduced impact of tension-type headache and neck pain. Exercise also reduced migraine frequency, pain intensity and duration, although this was not significant compared to controls. These results emphasize the importance of regular aerobic exercise for reduction of migraine burden.
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Affiliation(s)
- Lotte Skytte Krøll
- 1 Department of Health Sciences, Lund University, Lund, Sweden.,2 Danish Headache Centre, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
| | | | - Mattias Linde
- 3 Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gunvor Gard
- 1 Department of Health Sciences, Lund University, Lund, Sweden
| | - Rigmor Højland Jensen
- 2 Danish Headache Centre, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
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Krøll LS, Hammarlund CS, Westergaard ML, Nielsen T, Sloth LB, Jensen RH, Gard G. Level of physical activity, well-being, stress and self-rated health in persons with migraine and co-existing tension-type headache and neck pain. J Headache Pain 2017; 18:46. [PMID: 28421374 PMCID: PMC5395520 DOI: 10.1186/s10194-017-0753-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/06/2017] [Indexed: 01/03/2023] Open
Abstract
Background The prevalence of migraine with co-existing tension-type headache and neck pain is high in the general population. However, there is very little literature on the characteristics of these combined conditions. The aim of this study was to investigate a) the prevalence of migraine with co-existing tension-type headache and neck pain in a clinic-based sample, b) the level of physical activity, psychological well-being, perceived stress and self-rated health in persons with migraine and co-existing tension-type headache and neck pain compared to healthy controls, c) the perceived ability of persons with migraine and co-existing tension-type headache and neck pain to perform physical activity, and d) which among the three conditions (migraine, tension-type headache or neck pain) is rated as the most burdensome condition. Methods The study was conducted at a tertiary referral specialised headache centre where questionnaires on physical activity, psychological well-being, perceived stress and self-rated health were completed by 148 persons with migraine and 100 healthy controls matched by sex and average age. Semi-structured interviews were conducted to assess characteristics of migraine, tension-type headache and neck pain. Results Out of 148 persons with migraine, 100 (67%) suffered from co-existing tension-type headache and neck pain. Only 11% suffered from migraine only. Persons with migraine and co-existing tension-type headache and neck pain had lower level of physical activity and psychological well-being, higher level of perceived stress and poorer self-rated health compared to healthy controls. They reported reduced ability to perform physical activity owing to migraine (high degree), tension-type headache (moderate degree) and neck pain (low degree). The most burdensome condition was migraine, followed by tension-type headache and neck pain. Conclusions Migraine with co-existing tension-type headache and neck pain was highly prevalent in a clinic-based sample. Persons with migraine and co-existing tension-type headache and neck pain may require more individually tailored interventions to increase the level of physical activity, and to improve psychological well-being, perceived stress and self-rated health.
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Affiliation(s)
- Lotte Skytte Krøll
- Department of Health Sciences, Lund University, P.O. Box 157, 221 00, Lund, Sweden. .,Danish Headache Centre, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Nordre Ringvej 69, 2600, Glostrup, Denmark.
| | | | - Maria Lurenda Westergaard
- Danish Headache Centre, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Nordre Ringvej 69, 2600, Glostrup, Denmark
| | - Trine Nielsen
- Danish Headache Centre, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Nordre Ringvej 69, 2600, Glostrup, Denmark
| | - Louise Bönsdorff Sloth
- Danish Headache Centre, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Nordre Ringvej 69, 2600, Glostrup, Denmark
| | - Rigmor Højland Jensen
- Danish Headache Centre, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Nordre Ringvej 69, 2600, Glostrup, Denmark
| | - Gunvor Gard
- Department of Health Sciences, Lund University, P.O. Box 157, 221 00, Lund, Sweden
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Ashina S, Lipton RB. Exploring the impact of comorbid primary headaches and neck pain. Scand J Pain 2015; 8:23-24. [DOI: 10.1016/j.sjpain.2015.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Sait Ashina
- Department of Neurology, Headache Program , Icahn School of Medicine at Mount Sinai , Mount Sinai Beth Israel , New York , NY , USA
| | - Richard B. Lipton
- Department of Neurology , Montefiore Headache Center , Albert Einstein College of Medicine , Bronx , NY , USA
- Department of Epidemiology and Population Health , Albert Einstein College of Medicine , Bronx , NY , USA
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