Postoperative headache following acoustic neuroma resection: occipital nerve injuries are associated with a treatable occipital neuralgia

Objective.— To demonstrate that occipital nerve injury is associated with chronic postoperative headache in patients who have undergone acoustic neuroma excision and to determine whether occipital nerve excision is an effective treatment for these headaches. Background.— Few previous reports have discussed the role of occipital nerve injury in the pathogenesis of the postoperative headache noted to commonly occur following the retrosigmoid approach to acoustic neuroma resection. No studies have supported a direct etiologic link between the two. The authors report on a series of acoustic neuroma patients with postoperative headache presenting as occipital neuralgia who were found to have occipital nerve injuries and were treated for chronic headache by excision of the injured nerves. Methods.— Records were reviewed to identify patients who had undergone surgical excision of the greater and lesser occipital nerves for refractory chronic postoperative headache following acoustic neuroma resection. Primary outcomes examined were change in migraine headache index, change in number of pain medications used, continued use of narcotics, patient satisfaction, and change in quality of life. Follow‐up was in clinic and via telephone interview. Results.— Seven patients underwent excision of the greater and lesser occipital nerves. All met diagnostic criteria for occipital neuralgia and failed conservative management. Six of 7 patients experienced pain reduction of greater than 80% on the migraine index. Average pain medication use decreased from 6 to 2 per patient; 3 of 5 patients achieved independence from narcotics. Six patients experienced 80% or greater improvement in quality of life at an average follow‐up of 32 months. There was one treatment failure. Occipital nerve neuroma or nerve entrapment was identified during surgery in all cases where treatment was successful but not in the treatment failure. Conclusion.— In contradistinction to previous reports, we have identified a subset of patients in whom the syndrome of postoperative headache appears directly related to the presence of occipital nerve injuries. In patients with postoperative headache meeting diagnostic criteria for occipital neuralgia, occipital nerve excision appears to provide relief of the headache syndrome and meaningful improvement in quality of life. Further studies are needed to confirm these results and to determine whether occipital nerve injury may present as headache types other than occipital neuralgia. These findings suggest that patients presenting with chronic postoperative headache should be screened for the presence of surgically treatable occipital nerve injuries.     

Botulinum Toxin Type‐A (BOTOX®) in the Treatment of Occipital Neuralgia: A Pilot Study

Objective.— To determine the efficacy of occipital nerve blocks using reconstituted botulinum toxin type‐A (BTX‐A) in providing significant and prolonged pain relief in chronic occipital neuralgia. Background.— Occipital neuralgia is a unilateral or bilateral radiating pain with paresthesias commonly manifesting as paroxysmal episodes and involving the occipital and parietal regions. Common causes of occipital neuralgia include irritation or injury to the divisions of the occipital nerve, myofascial spasm, and focal entrapment of the occipital nerve. Treatment options include medication therapy, occipital nerve blocks, and surgical techniques. BTX‐A, which has shown promise in relief of other headache types, may prove a viable therapeutic option for occipital neuralgia pain. Methods.— Botulinum toxin type‐A (reconstituted in 3 cc of saline) was injected into regions traversed by the greater and lesser occipital nerve in 6 subjects diagnosed with occipital neuralgia. Subjects were instructed to report their daily pain level (on a visual analog pain scale), their ability to perform daily activities (on several quality of life instruments) and their daily pain medication usage (based on a self‐reported log), 2 weeks prior to the injection therapy and 12 weeks following injection therapy. Data were analyzed for significant variation from baseline values. Results.— The dull/aching and pin/needles types of pain reported by the subjects did not show a statistically significant improvement during the trial period. The sharp/shooting type of pain, however, showed improvement during most of the trial period except weeks 3‐4 and 5‐6. The quality of life measures exhibited some improvement. The headache‐specific quality of life measure showed significant improvement by 6 weeks which continued through week 12. The general health‐ and depression‐related measures showed no statistical improvement. No significant reduction in pain medication usage was demonstrated. Conclusions.— Our results indicate that BTX‐A improved the sharp/shooting type of pain most commonly known to be associated with occipital neuralgia. Additionally, the quality of life measures assessing burden and long‐term impact of the headaches, further corroborated improvement seen in daily head pain.     

Implanted Auriculotemporal Nerve Stimulator for the Treatment of Refractory Chronic Migraine

Objective.— To report a case of improved pain control and function in a patient with chronic migraine after treatment with auriculotemporal nerve stimulation. Methods.— The patient is a 52‐year‐old woman with refractory pain in the bilateral temporal distribution and marked phonophobia as a result of chronic migraine. Results.— After a successful trial period, the patient underwent implantation of bilateral peripheral nerve stimulators targeting the auriculotemporal nerves. At 16 months of follow up, her average pain intensity declined from 8‐9/10 on the numeric rating scale to 5/10. Her function improved as assessed by the Migraine Disability Assessment, from total disability (grade IV) to mild disability (grade II). Her phonophobia became far less debilitating. Conclusion.— Auriculotemporal nerve stimulation may be useful tool in the treatment of refractory pain in the temporal distribution due to chronic migraine.     

Role of Manual Physical Therapy and Specific Exercise Intervention in the Treatment of a Patient with Cervicogenic Headaches: A Case Report

Abstract

Headaches are a common complaint among patients seeking medical care. This case report highlights the role of physical therapy (PT) management including manual therapy and specific exercise interventions in the care of a patient with cervicogenic headaches. The patient was an 18-year-old female college student with a medical diagnosis of migraine headaches. Her history included three previous motor vehicle accidents. Treatment from her primary care physician and optometrist had had no effect on her headache intensity and frequency. Findings on the PT examination included upper cervical segmental restrictions and neuromuscular imbalances. The primary treatment strategy for this patient included cervical manipulation, neuromuscular retraining of deep neck flexors, and soft tissue manipulation. The patient demonstrated improvement with a total of seven treatment sessions over a five-week period. Neck Pain Disability Index score improved from a score of 38% perceived disability at initial examination to a score of 10% upon discharge. Headache frequency and intensity significantly improved as upper cervical segmental mobility and deep cervical flexor function improved to within normal limits. This case report demonstrates the potential role of manual physical therapy and specific exercise intervention in quickly improving function and impairments in a patient with cervicogenic headaches.     

Occipital Nerve Blockade for Cervicogenic Headache: A Double-Blind Randomized Controlled Clinical Trial

Abstract:   Cervicogenic headache is a chronic hemicranial pain, usually occurring daily. This randomized, double-blind, placebo-controlled trial evaluated the effectiveness of nerve stimulator-guided occipital nerve blockade in the treatment of cervicogenic headache. The reduction in analgesic consumption was the primary outcome measure. Fifty adult patients diagnosed with cervicogenic headache were randomly divided into two equal groups of 25 patients each. All patients in both groups received greater and lesser occipital blocks, whereas only 16 patients in each group received facial nerve blockade in association with the occipital blocks. The control group received injections of an equivalent volume of preservative-free normal saline. Pain was assessed using the visual analog scale (VAS) and the Total Pain Index (TPI). Forty-seven patients entered into the final analysis as three patients were lost to follow-up. Anesthetic block was effective in reducing the VAS and the TPI by approximately 50% from baseline values ( P  = 0.0001). Analgesic consumption, duration of headache and its frequency, nausea, vomiting, photophobia, phonophobia, decreased appetite, and limitations in functional activities were significantly less in block group compared to control group ( P  < 0.05). The nerve stimulator-guided occipital nerve blockade significantly relieved cervicogenic headache and associated symptoms at two weeks following injection.     

Repetitive Occipital Nerve Blockade for Cervicogenic Headache: Expanded Case Report of 47 Adults

Purpose: To evaluate the repetitive occipital nerve blocks using a nerve stimulator in the treatment of cervicogenic headache. Methods: This prospective noncomparative clinical interventional case‐series study included 47 patients suffering from cervicogenic headache using a repetitive guided occipital nerve blockade. Results: Forty‐one patients (87%) required more than one injection to achieve six‐month pain‐relief period. For every three years of headache history, the outcomes demonstrated that a patient needed one additional injection to the basic injection. Conclusion: The repeated nerve stimulator‐guided occipital nerve blockade is a treatment mode that may relieve cervicogenic headache with no recurrence for at least six months in addition to alleviation of associated symptoms.     

Headache and the cervical spine: a critical review

Headache related to the cervical spine is often misdiagnosed and treated inadequately because of confusing and varying terminology. Primary headaches such as tension-type headache and migraine are incorrectly categorized as "cervicogenic" merely because of their occipital localization. Cervicogenic headache as described by Sjaastad presents as a unilateral headache of fluctuating intensity increased by movement of the head and typically radiates from occipital to frontal regions. Definition, pathophysiology, differential diagnoses and therapy of cervicogenic headache are demonstrated. Ipsilateral blockades of the C2 root and/or greater occipital nerve allow a differentiation between cervicogenic headache and primary headache syndromes such as migraine or tension-type headache. Neither pharmacological nor surgical or chiropractic procedures lead to a significant improvement or remission of cervicogenic headache. Pains of various anatomical regions possibly join into a common anatomical pathway, then present as cervicogenic headache, which should therefore be understood as a homogeneous but also unspecific pattern of reaction.     

Zervikogener Kopfschmerz – Klinik, Differentialdiagnose und Therapie

Headache in association with the cervical spine is often misdiagnosed and treated inadequately because of confusing and varying terminology. Primary headaches such as tension-type headache and migraine are incorrectly categorized as “cervicogenic” merely because of their occipital localization. Cervicogenic headache described by Sjastaad presents as a unilateral headache of fluctuating intensity increased by movement of the head and typically radiating from occipital to frontal regions. Definition, pathophysiology, differental diagnosis and therapy of cervicogenic headache are demonstrated. Ipsilateral blockades of the C2–3 root and/or major occipital nerve allow differentiation between migraine and other primary headache syndromes. Neither pharmacological nor surgical or chiropractic procedures lead to an improvement or remission of cervicogenic headache. Pain of various anatomical regions possibly joins to form a common anatomical pathway and then presents as cervicogenic headache, which should therefore be understood as a homogeneous but also non-specific reaction pattern.     

Chiropractic management of mechanical neck and low-back pain: a retrospective, outcome-based analysis

BACKGROUND: Evidence suggests that spinal manipulation is an effective treatment for mechanical neck and low-back pain (LBP). Treatment efficacy is important to establish for these symptoms because combined they account for a considerable amount of disability and substantial associated direct and indirect costs to society. OBJECTIVE: The purpose of this study was to examine the outcome of patients undergoing chiropractic treatment for mechanical neck or LBP. Design and Setting: A retrospective, outcome-based analysis was done for patients seeking care at a private chiropractic practice over a 1-year period. A total of 512 files were reviewed, with 119 patients selected for inclusion. Patients were included if their chief symptom was uncomplicated mechanical neck or LBP. Diagnoses included cervical, lumbar, or sacroiliac joint sprain/strain (International Code of Diagnostics version 9 [ICD-9] code: 847.1, 847.3, 846.1, respectively), discogenic LBP (ICD-9: 722.1), and headaches (ICD-9: 784.0) because many patients with neck pain presented with concomitant headaches. Disability and pain were measured with the modified Oswestry scale (for the patients with LBP), Neck Disability Index, and an 11-box visual analogue pain scale before and after treatment. Treatment consisted of spinal manipulation, various soft-tissue techniques, home-care instructions, and ergonomic and return-to-activity advice, including rehabilitative exercises. Patients received an average of 12 treatments over a 4-week period. Statistical analysis was performed on pretreatment and posttreatment values for both disability and pain. Stratification was based on duration (acute/subacute, chronic, acute exacerbation of a chronic condition) and severity (mild, moderate, or severe) of symptoms. RESULTS: Statistically significant reductions in disability and pain scores were achieved in all groups. An average 52.5% and 52.9% reduction in pain and disability, respectively, was achieved in the low-back group. The chronic LBP group realized a less statistically significant reduction of pain and disability (19.7% and 19.8%, respectively) than the acute/subacute (66.8% and 62.5%) or the chronic/recurrent group (56. 5% and 63.4%). The differences were statistically significant. Patients with neck pain had an average 53.8% and 48.4% reduction in their pain and disability, respectively. Patients with concomitant neck pain and headaches had statistically significant higher pretreatment and posttreatment disability and pain scores than those with only neck pain. There was no statistically significant difference in outcomes between groups stratified according to pain intensity. CONCLUSIONS: Patients attending a private chiropractic clinic for treatment of mechanical neck pain or LBP had statistically significant reductions in their pain-related disability after treatment. These results indicate that chiropractic manipulation is beneficial for the treatment of mechanical neck pain and LBP. However, care must be taken when drawing conclusions from these outcomes. The study design does not account for the natural history of low back- or neck pain-related disability and therefore does not allow for claims of treatment efficacy. In addition, it has been suggested that patients presenting to medical doctors with these symptoms have significant overlying comorbidity when compared with patients presenting to a chiropractor.     

Percutaneous Peripheral Nerve Stimulation for the Treatment of Chronic Low Back Pain: Two Clinical Case Reports of Sustained Pain Relief

As the leading cause of disability among U.S. adults, chronic low back pain (LBP) is one of the most prevalent and challenging musculoskeletal conditions. Neuromodulation provides an opportunity to reduce or eliminate the use of opioids to treat chronic LBP, but the cost and invasiveness of existing methods have limited its broad adoption, especially earlier in the treatment continuum. The present case report details the results of a novel method of short‐term percutaneous peripheral nerve stimulation (PNS) in 2 subjects with chronic LBP. At the end of the 1‐month therapy, stimulation was discontinued and the leads were withdrawn. PNS produced clinically significant improvements in pain (62% average reduction in Brief Pain Inventory Question #5, average pain), and functional outcomes (73% reduction in disability, Oswestry Disability Index; 83% reduction in pain interference, Brief Pain Inventory). Both subjects reduced nonopioid analgesic use by 83%, on average, and the one subject taking opioids ceased using all opioids. The only adverse event was minor skin irritation caused by a topical dressing. The clinically significant improvements were sustained at least 4 months after start of therapy (79% average reduction in pain; both reported minimal disability; 100% reduction in opioids; 74% reduction nonopioids). The results reveal the utility of this novel, short‐term approach and its potential as a minimally invasive neuromodulation therapy for use earlier in the treatment continuum to produce sustained pain relief and reduce or eliminate the need for analgesic medications, including opioids, as well as more expensive and invasive surgical or therapeutic alternatives.     

Occipital Nerve Blocks: When and What to Inject?

Introduction.— Occipital nerve block (ONB) is a promising treatment for headaches. Its indications, selection criteria, and best techniques are not clear, however. Objective.— To summarize in narrative format what is known about ONBs and what needs to be learned. Methods.— MD Consult and Google Scholar were searched using the terms occipital, suboccipital, block, and injection to identify relevant articles that were reviewed. This process was repeated for all additional pertinent articles identified from these articles, and so on, until no additional articles were identified. Results.— A total of 21 articles were identified. Conclusions.— Occipital nerve block is an effective treatment for cervicogenic headache, cluster headache, and occipital neuralgia. While a double blinded randomized placebo controlled clinical trial is lacking, multiple open label studies reported favorable results for migraine. Two other possible uses of ONB worthy of further study are use as a rescue treatment and as an adjunctive treatment for medication overuse headache. ONB may be effective for tension headache, but only under very specific circumstances. ONB is either ineffective or only effective under as yet unstudied circumstances for hemicrania continua and chronic paroxysmal hemicrania. Some practitioners use occipital nerve (ON) tenderness to palpation (TTP) or reproduction of headache pain with ON pressure (RHPONP) as selection criteria for identifying appropriate patients. While only a clinical trial can produce a definitive answer, current evidence suggests that these selection criteria are not necessary for cervicogenic headache or cluster headache. Occipital neuralgia by definition involves TTP of the ONs. Whether RHPONP or ON TTP predicts success in migraine is unclear, and may relate to whether steroids are used. A single blinded randomized controlled trial evaluating local anesthetic with steroids vs local anesthetic alone for transformed migraine reported slightly worse results with steroids, but there are several alternate explanations for this finding other than steroids being counterproductive. The technique of repetitive ONBs deserves further study.     

Post-traumatic myofascial pain of the head and neck

Post-traumatic myofascial pain describes the majority of chronic head and neck pain seen in clinical practice. If conditions such as vascular headaches, neuropathic pain, degenerative cervical joint disease, and dental pain are excluded, myofascial tissues are directly or indirectly involved in all other forms of head and neck pain. The most common of these include temporomandibular disorders, neck pain such as whiplash-associated disorder, cervicogenic headaches, and tension-type headaches. The pathophysiology of these conditions is not widely understood; however, peripheral and central mechanisms appear to play a role.     

Effects of Deep Cervical Flexor Training on Pressure Pain Thresholds Over Myofascial Trigger Points in Patients With Chronic Neck Pain

Objective

The purpose of this study was to assess the effects of a low-load training program for the deep cervical flexors (DCFs) on pain, disability, and pressure pain threshold (PPT) over cervical myofascial trigger points (MTrPs) in patients with chronic neck pain.

Methods

Thirty patients with chronic idiopathic neck pain participated in a 6-week program of specific training for the DCF, which consisted of active craniocervical flexion performed twice per day (10-20 minutes) for the duration of the trial. Perceived pain and disability (Neck Disability Index, 0-50) and PPT over MTrPs of the upper trapezius, levator scapulae, and splenius capitis muscles were measured at the beginning and end of the training period.

Results

After completion of training, there was a significant reduction in Neck Disability Index values (before, 18.2 ± 12.1; after, 13.5 ± 10.6; P < .01). However, no significant changes in PPT were observed over the MTrPs.

Conclusion

Patients performing DCF training for 6 weeks demonstrated reductions in pain and disability but did not show changes in pressure pain sensitivity over MTrPs in the splenius capitis, levator scapulae, or upper trapezius muscles.     

Diagnosis and Management of Cervicogenic Headache and Local Cervical Syndrome with Multiple Pain Generators

Abstract

Numerous pain generators can be responsible for cervicogenic headache and pain in both the cervical and thoracic regions. A 45-year-old female presented in the clinic with a 20-year history of cervicogenic and migraine headaches, accompanied by a prolonged history of local cervical and interscapular pain. The cervicogenic symptoms were attributed to secondary discrelated changes in the cervical spine, as evidenced by specific provocation behaviors and segmental limitation patterns. The patient was educated regarding the presenting problems, and ergonomic changes were initiated. The limitations were addressed with joint-specific mobilization techniques, accompanied by specific home exercises. The patient demonstrated initial rapid improvements that were characterized by reduced symptoms and increased motion, followed by gradual full motion recovery and resolution of cervicogenic symptoms. This recovery pattern suggests the efficacy of manual techniques in the management of cervicogenic headaches and local cervical syndrome, even in the context of rather prolonged symptoms.     

Chronic neck pain and cervicogenic headache.

Acute and chronic neck pain and headaches are a major medical, industrial, and financial problem. In many cases, the pathophysiology is unknown, and the disability is often greatly in excess of the apparent tissue pathology and physiological impairment. Diagnosis and management of neck pain and cervicogenic headache calls for a rational and comprehensive approach. Many cases will have no identifiable pathology, and the pain and disability will continue despite the best efforts of all concerned.     

Die epifasziale Elektrostimulation des N. occipitalis bei therapierefraktärer Okzipitalisneuralgie

BACKGROUND: The term "neuralgia of the occipital nerve" in clinical work includes different kinds of pain in the occipital region. Correctly, this diagnosis should be reserved for such pain syndromes which, corresponding to the definition of neuralgia, are due to damage of the cervical roots C1-C3 or of the major occipital nerve arising from those roots. We introduce an operative method to treat chronic therapy-resistant headaches in the area of the major and minor occipital nerve. The courses of three of the first patients operated in our hospital are described. METHODS: An electrode with four poles is positioned epifacially in the area of the affected nerve in local anaesthesia. In cooperation with the patient the correct position of the electrode and the right poling have to be found. Afterwards, the electrode is externalized after subcutaneous tunneling. For several weeks, the patients stimulate while being at home. If they report about a satisfactory reduction of pain, a subcutaneous receiver for use with an external stimulator is implanted. RESULTS: Most of the patients who received an electrode had a satisfying reduction of pain of 50-100% during the testing period so that the receiver was implanted. We had no success in two patients whose occipital nerves were destroyed by previous operations so that the system was explanted. CONCLUSIONS: The epifacial stimulation of the occipital nerve is an effective method to treat neuralgia of this nerve. Patients with destruction of the nerve have to be excluded, because in their cases the stimulation does not work.     

Suboccipital Nerve Blocks for Suppression of Chronic Migraine: Safety,Efficacy, and Predictors of Outcome

(Headache 2010;50:1041‐1044) Background.— Approximately 1 in 50 Americans is afflicted by chronic migraine (CM). Many patients with CM describe cervicogenic headache. Options for treating CM effectively are at present quite limited. Objective.— To determine the safety and efficacy of occipital nerve blocks (ONBs) used to treat cervicogenic chronic migraine (CCM) and to identify variables predictive of a positive treatment response. Methods.— Using a uniform dose and injection paradigm, we performed ONBs consecutively on a series of patients presenting with CCM. Patients were stratified according to specific findings found to be present or absent on physical examination. A positive treatment outcome was defined as a 50% or greater reduction in headache days per month over the 30 days following treatment relative to the 30‐day pre‐treatment baseline. We used a 5‐point Likert scale as one of the secondary outcome variables. Results.— We treated 150 consecutive patients with unilateral (37) or bilateral (113) ONBs. At the 1‐month follow‐up visit 78 (52%) exhibited evidence of a positive treatment response according to the primary outcome variable, and 90 (60%) reported their headache disorder to be “better” (44; 29%) or “much better” (46; 30%). A total of 8 (5%) patients reported adverse events within the ensuing 72 hours, and 3 (2%) experienced adverse events that reversed spontaneously but required emergent evaluation and management. Conclusion.— For suppression of CCM, ONBs may offer an attractive alternative to orally administered prophylactic therapy.     

Headache Disability Among Adolescents: A Student Population‐Based Study

(Headache 2010;50:210‐218) Objective.— To examine the extent and to identify the relevant predictors of headache disabilities in adolescents. Background.— Headaches are common in adolescents but their impact and related factors have not been extensively studied in adolescent communities. Method.— We recruited and surveyed 3963 students aged 13‐15 from 3 middle schools using self‐administered questionnaires. The questionnaires were used to make 3 assessments: (1) headaches were diagnosed using a validated headache questionnaire; (2) headache disabilities were valuated using the 6‐question Pediatric Migraine Disability Assessment; (3) depression was measured using the Adolescent Depression Inventory. Results.— The student response rate was 93%. In total, 484 students (12.2%) had migraines with or without auras, 444 (11.2%) had probable migraines, and 1092 (27.6%) had tension‐type headaches. The students with migraine had the highest Pediatric Migraine Disability Assessment scores (10.7 ± 20.0); whereas, the students with tension‐type headaches had the lowest scores (2.0 ± 4.4). Logistic regression analyses indicated that there were a number of independent predictors for moderate to severe headache‐related disability (Pediatric Migraine Disability Assessment score ≥31), including a migraine or probable migraine diagnosis, a higher depression score, severe headache intensity, and frequent headaches. Conclusions.— The Pediatric Migraine Disability Assessment provides a simple tool to measure the impact of headaches in adolescents. Adolescents with migraine headaches suffered the greatest level of disability. Higher depression scores were associated with more severe headache‐related disabilities in adolescents, independent of headache frequency and severity.     

Headache and Cervical Spine Disorders: Classification and Treatment with Transcutaneous Electrical Nerve Stimulation

SYNOPSIS
A clearer definition of the relationship between headache and disorders of the cervical spine appearsnecessary not only for classification purposes but also for a more rational approach to the management ofsuch conditions. The classification proposed here would distinguish headaches etiologically related to cervicalspine disorders from those in which these disorders might represent just one of several triggering orcomplicating factors. The first group includes cervicogenic headache, occipital neuralgia, auriculotemporalneuralgia, cervicalgia and cervicobrachialgia; the second group includes muscle-contraction headache andmixed headache. Treatment with transcutaneous electrical nerve stimulation (TENS) was applied in 10 patientswith cervicogenic headache, 15 patients with occipital neuralgia, and 35 patients with muscle-contraction ormixed headache. Good results, i.e. HI improvement >60% in 70–80% of cases, were obtained in all three groupsof patients, with no significant differences between them.     

Comparison Between Neck Pain Disability and Cervical Range of Motion in Patients With Episodic and Chronic Migraine: A Cross-Sectional Study

ObjectiveThe purpose of this study was to evaluate neck pain–related disability and cervical range of motion (CROM) in patients with episodic migraine (EM) and chronic migraine (CM) and to examine the correlation of both outcomes.MethodsThis cross-sectional study consisted of 91 patients with EM and 34 with CM. Cervical range of motion was measured with the CROM device, and pain during the cervical movement was recorded. Self-reported disability related to neck pain was assessed with the Neck Disability Index.ResultsPatients with CM showed higher Neck Disability Index scores and more moderate and severe disability (P = .01). Severe disability as a result of neck pain was associated with 7.6-fold risk of developing CM (P = .003). No significant differences in CROM were identified between groups. Moderate negative correlations between CROM and disability were found for 4 motions within the CM group (− 0.60 < r < − 0.39) and with 3 in the EM group (− 0.48 < − 0.45). Disability was positively and moderately correlated to pain evoked during CROM in both groups (0.34 < r < 0.51).ConclusionThis study found that neck pain was highly prevalent in patients with migraine. Neck pain–related disability increased with increased frequency of the migraine attacks and was associated with the risk of migraine chronicity. The correlation between CROM and neck pain disability was more evident in patients with CM and in patients with pain during cervical movement.