To evaluate the impact of neck pain with Headache in migraine participants eligible for preventive treatment with ≥6 monthly headache days (MHDs).

Neck pain is common before or during headache in persons with migraine. It is associated with increased disease burden and correlated with higher headache frequency. This analysis focused on individuals with ≥6 MHDs, to align with the AHS Consensus Statement candidacy for prevention with any level of disability.

CaMEO-I, a longitudinal, web-based survey with cross-sectional modules conducted in 2021-2022 across six countries, identified respondents who met modified ICHD-3 criteria for migraine in adults ≥ 18 years of age. These analyses are confined to the US sample.  Data analysis evaluated the differences between the neck pain with headache (NPWH) and neck pain free subgroups based on sociodemographic and clinical characteristics, the Allodynia Symptom Checklist (ASC-12), the Migraine Disability Assessment Scale (MIDAS), the Migraine Symptom Severity Scores (MSSS), the Migraine-specific Quality of Life (MSQ v2.1) questionnaire and medication use.

Among 638 eligible respondents, 82.3% experience neck pain associated with migraine attacks/headache. The proportion with NPWH increased with MHDs: 78.4% with 6-7 MHDs to 87.4% with ≥15 MHDs (trend test P=0.025).   NPWH was not associated with age, gender, Body Mass index (BMI) or employment status. Participants with NPWH were more likely to have allodynia (77.0% vs 42.5%, p<0.001), moderate or severe MIDAS disability (78.5% vs. 65.5%, p<0.003), higher MSSS (17.8 vs 15.8, p<0.001) and lower MSQ v2.1 scores in all 3 domains (p<0.001).  Preventive migraine medication use did not significantly differ with NPWH.

Neck pain with headache is a common feature of migraine in people eligible for preventive treatment. Those with NPWH had significantly more allodynia and disability but were no more likely to receive preventive treatment. NPWH should be considered as a symptom of migraine associated with disease burden.