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Patient-Assessed Neck Tenderness Predicts Migraine
Response to Triptans
R.G. Kaniecki
Posted: June 2007  
Abstrace presented at American Headache Society Meeting
June 7-11, 2007, Chicago, IL
Headache   2007;47:748

Objectives:   To determine the utility of using patient-assessed neck tenderness as a marker for responses of migraine-associated head and neck pain to acute triptan therapy.

Background:   Among the non-traditional associated features of migraine, neck pain may be the most common. Although unlisted on the migraine diagnostic criteria outlined by the International Headache Society, the prevalence of migraine-associated neck pain has been reported between 64-75% in 2 recently published series. The etiology of migraine-associated neck pain remains a matter of speculation, with the anatomic substrate likely the trigeminocervical complex. Neck pain which occurs early in the course of migraine might represent migraine trigger, prodrome, or referred pain, while such pain later in the attack potentially suggests the additional possibility of an allodynic response.

Methods:   Seventy-two subjects reporting neck pain during headache attacks were recruited for this study. Of these subjects, 42 described neck pain occurring prior to head pain, while the other 30 described neck pain comcomitant or subsequent to head pain during attacks of acute migraine. Patients were advised to treat with their typical triptan agent at the onset of migraine pain, regardless of location, and response was defined as freedom from either head or neck pain at 2 hours ost-triptan therapy.

Conclusions:   Of those individuals reporting neck pain as an associated symptom with migraine, the presence of patient-assessed neck tenderness is a strong predictor of acute migraine response to triptan therapy. Therapeutic refractoriness may be representative of central sensitization in these patients.