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

16. maj 2026 opdateret af: Dilara Onan, Bozok University

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

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.

Studieoversigt

Status

Rekruttering

Betingelser

Undersøgelsestype

Observationel

Tilmelding (Anslået)

179

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiekontakt

Undersøgelse Kontakt Backup

Studiesteder

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

  • Voksen
  • Ældre voksen

Tager imod sunde frivillige

N/A

Prøveudtagningsmetode

Sandsynlighedsprøve

Studiebefolkning

Gaziantep City Hospital, Department of Neurology, Gaziantep, Türkiye.

Beskrivelse

Inclusion Criteria:

  • 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.

Exclusion Criteria:

  • 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.

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

Kohorter og interventioner

Gruppe / kohorte
Episodisk migræne
Episodisk migræne er en neurologisk tilstand karakteriseret ved tilbagevendende, moderate til svære hovedpine som forekommer mindre end 15 dage om måneden. Anfald varer typisk fra 4 til 72 timer og er ofte ledsaget af kvalme, opkastning og lys-/lydfølsomhed. Behandling involverer akut behovsmedicin og forebyggende strategier for at reducere anfaldsfrekvensen.
Kronisk migræne
Kronisk migræne defineres ved at have 15 eller flere hovedpinnedage om måneden i over tre måneder, hvor mindst otte af disse dage opfylder migrænekriterierne. Symptomer inkluderer moderat til svær dunkende smerte, kvalme, opkastning og ekstrem følsomhed over for lys, lyd eller lugt.
Episodic migraine with neck pain
Episodic migraine is a neurological condition characterized by recurrent, moderate-to-severe headaches occurring on fewer than 15 days per month. Attacks typically last 4 to 72 hours and are often accompanied by nausea, vomiting, and light/sound sensitivity. Treatment involves acute, on-demand medication and preventative strategies to reduce attack frequency. Additionally, this sample includes individuals diagnosed with episodic migraine and experiencing neck pain without having any other diagnosed neck problems.
Episodic migraine with low back pain
Episodic migraine is a neurological condition characterized by recurrent, moderate-to-severe headaches occurring on fewer than 15 days per month. Attacks typically last 4 to 72 hours and are often accompanied by nausea, vomiting, and light/sound sensitivity. Treatment involves acute, on-demand medication and preventative strategies to reduce attack frequency. Additionally, this sample includes individuals diagnosed with episodic migraine and experiencing low back pain without having any other diagnosed lower back problems.
Episodic migraine with neck pain and low back pain
Episodic migraine is a neurological condition characterized by recurrent, moderate-to-severe headaches occurring on fewer than 15 days per month. Attacks typically last 4 to 72 hours and are often accompanied by nausea, vomiting, and light/sound sensitivity. Treatment involves acute, on-demand medication and preventative strategies to reduce attack frequency. Additionally, this sample includes individuals diagnosed with episodic migraine and experiencing neck pain and low back pain without having any other diagnosed neck and lower back problems.
Chronic migraine with neck pain
Chronic migraine is defined by having 15 or more headache days per month for over three months, with at least eight of those days meeting migraine criteria. Symptoms include moderate-to-severe throbbing pain, nausea, vomiting, and extreme sensitivity to light, sound, or smell. Additionally, this sample includes individuals diagnosed with chronic migraine and experiencing neck pain without having any other diagnosed neck problems.
Chronic migraine with low back pain
Chronic migraine is defined by having 15 or more headache days per month for over three months, with at least eight of those days meeting migraine criteria. Symptoms include moderate-to-severe throbbing pain, nausea, vomiting, and extreme sensitivity to light, sound, or smell. Additionally, this sample includes individuals diagnosed with chronic migraine and experiencing low back pain without having any other diagnosed lower back problems.
Chronic migraine with neck pain and low back pain
Chronic migraine is defined by having 15 or more headache days per month for over three months, with at least eight of those days meeting migraine criteria. Symptoms include moderate-to-severe throbbing pain, nausea, vomiting, and extreme sensitivity to light, sound, or smell. Additionally, this sample includes individuals diagnosed with chronic migraine and experiencing neck pain and low back pain without having any other diagnosed neck and lower back problems.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Central Sensitization Inventory
Tidsramme: Day 1
The Central Sensitization Inventory (CSI) measures somatic and emotional symptoms common in central sensitization syndrome. Section A measures 25 symptoms with 5 response options (0 to 4). The total score ranges from 0 to 100. Section B asks patients whether they have previously been diagnosed with preliminary specific CSI conditions.
Day 1

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Headache Intensity
Tidsramme: Day 1
The Numerical Pain Rating Scale (NPRS) consists of pain levels where the person indicates the pain they are currently experiencing with a vertical line on a plane. The pain felt by the person is given on a scale of 0-10, "0: no pain", "10: I feel very severe pain".
Day 1
Headache Impact
Tidsramme: Day 1
The Headache Impact Test-6 (HIT-6) is a questionnaire for headaches that assesses vitality, pain, psychological distress, sociability, role, and cognitive functioning. Each item is scored on a 5-point Likert scale (6=never, 8=rarely, 10=sometimes, 11=very often, 13=always). The total score is determined by summing the scores on all six items and ranges from 36 to 78 points. (≤49 = little/no impact, 50-55 = some impact, 56-59 = significant impact, and 60-78 = serious impact).
Day 1
Disability for Migraine
Tidsramme: Day 1
The Migraine Disability Assessment (MIDAS) questionnaire evaluates the last 3 months of disability and consists of a 5-item self-administered test covering disability at work/school, household chores, family and social or leisure activities. The total number of days missed in these activities is the total score and classifies the disability as minimal disability (0-5 points), mild disability (6-10 points), moderate disability (11-20 points), or severe disability (≥21).
Day 1
Disability of the Neck
Tidsramme: Day 1
The Neck Disability Index includes a total of 10 questions covering topics such as pain, personal care, concentration, work, driving, and sleeping. Each question is scored on a scale of 0 to 5 points. The questionnaire is graded out of a maximum of 50 points. A score of "0" means no limitations, while a score of "50" means a complete disability.
Day 1
Disability of the Lower Back
Tidsramme: Day 1
The Oswestry Disability Index consists of 10 questions that assess the extent to which back pain affects various daily living activities such as sitting, personal care (dressing, bathing, etc.), standing, walking, sleeping, and traveling. Each question is scored on a scale of 0-5, with a total score of 0-100. Higher scores indicate a higher level of functional disability.
Day 1
Pain Catastrophizing
Tidsramme: Day 1
The Pain Catastrophizing Scale is a 13-item scale that assesses negative thoughts and feelings related to experienced pain. Each item is scored between 0-never and 4-always. The total score ranges from 0-52, with higher scores indicating a higher level of pain catastrophizing. The scale consists of subscales of "Helplessness, Magnification, and Rumination."
Day 1
Anxiety and Depression
Tidsramme: Day 1
The Hospital Anxiety and Depression Scale (HADS) consists of 14 items; 7 items assess anxiety symptoms and 7 items assess depression symptoms. Each item is scored between 0 and 3 points. By summing the subscale scores, a score of 0-21 can be obtained for each of the Depression and Anxiety subscales. For each subscale, a score of 0-7 is considered the normal range, a score of 8-10 suggests the presence of a mood disorder, and a score of 11 or higher indicates a possible mood disorder.
Day 1
Headache Awareness
Tidsramme: Day 1
The Fremantle Headache Awareness Questionnaire (FHAQ) is a Likert-type questionnaire (0=Never/Never feel like this, 1=Rarely feel like this, 2=Sometimes or occasionally feel like this, 3=Frequently feel like this, 4=Always or most of the time) that assesses altered perceptions related to headache in an individual. The questionnaire asks individuals nine questions, including how they perceive their head relative to their body and how they perceive their body position when experiencing a headache.
Day 1
Neck Awareness
Tidsramme: Day 1
The Fremantle Neck Awareness Questionnaire (FreNAQ) is a Likert-type questionnaire (0=Never/Never feel like this, 1=Rarely feel like this, 2=Sometimes or occasionally feel like this, 3=Frequently feel like this, 4=Always or most of the time) that assesses an individual's perception of altered neck-specific sensations. The questionnaire asks nine questions, including how individuals perceive their neck relative to their body and how they perceive their body position.
Day 1
Back Awareness
Tidsramme: Day 1
The Fremantle Back Awareness Questionnaire (FBAQ) is a Likert-type questionnaire (0=Never/Never feel like this, 1=Rarely feel like this, 2=Sometimes, or occasionally feel like this, 3=Frequently feel like this, 4=Always or most of the time) that assesses an individual's altered perception of their waist. The questionnaire asks individuals nine questions, including how they perceive their waist relative to their body and how they perceive their body position.
Day 1
Pressure Pain Threshold Assessment
Tidsramme: Day 1
Pressure pain threshold measurements will be performed using an analog algometer to objectively assess pain sensitivity. The pressure pain threshold is defined as the pressure value at which an individual first reports a sensation of pain during mechanical pressure application, and it is a reliable and widely used method in the assessment of musculoskeletal pain and central sensitization. Measurements will be performed bilaterally over the temporalis muscle, superior trapezius muscle, suboccipital muscles, and lumbar paraspinal muscles to assess migraine-related pain sensitivity and possible generalized sensitivity. The analog algometer probe will be placed perpendicular to the measurement point, and the pressure will be increased gradually. Participants will be asked to report their first sensation of pain, and the value at this point will be recorded. Three repetitions will be performed for each measurement point, and the average value will be used in the analyses.
Day 1
Allodynia
Tidsramme: Day 1
The "Allodynia Symptom Checklist (ASC-12)" is a 12-item questionnaire where zero points are awarded for "Not applicable to me," "Never," and "Rarely," one point for "Less than half," and two points for "More than half." Total scores range from "0" to "24." Allodynia levels are determined as follows: 0-2 points: none, 3-5 points: mild, 6-8 points: moderate, 9 and above: severe.
Day 1
Demographic and Clinic Evaluations
Tidsramme: Day 1
Demographic and clinical information such as sex, age, weight, height, education level, occupation, medical history, family history, number of years diagnosed with migraine (if any), migraine triggers, symptoms experienced during attacks, number of headache days per month, number of headache attacks per month, duration of attacks, and localization of headaches will be recorded for all patients.
Day 1

Samarbejdspartnere og efterforskere

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Sponsor

Bozok University

Efterforskere

  • Ledende efterforsker: Dilara Onan, PhD, Yozgat Bozok University
  • Studiestol: Merve Ceren Akgör, Neurologist, Department of Neurology, University of Health Sciences, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Türkiye
  • Studiestol: Doğan Porsnok, PhD, Bingol University
  • Studiestol: Pelin Yenilmez Yeşildaş, Neurologist, Gaziantep City Hospital, Department of Neurology

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Generelle publikationer

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Anslået)

30. april 2026

Primær færdiggørelse (Anslået)

17. juni 2026

Studieafslutning (Anslået)

30. juni 2026

Datoer for studieregistrering

Først indsendt

22. april 2026

Først indsendt, der opfyldte QC-kriterier

4. maj 2026

Først opslået (Faktiske)

5. maj 2026

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

19. maj 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

16. maj 2026

Sidst verificeret

1. maj 2026

Mere information

Begreber relateret til denne undersøgelse

Nøgleord

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • Approval No: 3/9; 02.04.2026

Plan for individuelle deltagerdata (IPD)

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UBESLUTET

IPD-planbeskrivelse

The datasets used and/or analysed during the current study will be available from the corresponding author on reasonable request.

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