Neck Pain Management Crucial for Patients with Medication-Overuse Headache
A study found that patients with medication-overuse headache and neck pain experience earlier onset of primary headache and decreased quality of life.
Patients with medication-overuse headache who also have neck pain experience an earlier onset of their primary headache and decreased quality of life, according to data published in the Journal of Headache and Pain.1 The authors of the study said the findings emphasize the importance of neck pain management in this patient population.
Neck Pain Management Crucial for Patients with Medication-Overuse Headache / Aleksej - stock.adobe.com
Medication-overuse headache is a condition that typically occurs when a patient regularly uses headache medications excessively for longer than 3 months. In the United States, it is estimated to effect 5% of the general population. Medication-overuse headache can lead to many illnesses, including anxiety, depression, and obsessive compulsive disorder. It can be a debilitating condition, often having a significant impact on quality of life and productivity.2
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“Medication-overuse headache is a secondary headache disorder caused by regular frequent consumption of acute symptomatic medications in patients with primary headache disorders,” the authors wrote. “Although the association between primary headache disorders and neck pain is well recognized, the relationship between neck pain and medication-overuse headache, a highly disabling treatable secondary headache disorder, has received relatively less attention in clinical research.”
Investigators from Hallym University College of Medicine and Inje University College of Medicine conducted a study to evaluate the prevalence and clinical course of neck pain in patients with medication-overuse headache before and after treatment. Data for the study was collected from a nationwide, prospective, multicenter registry in South Korea called the Registry for Load and Management of Medication Overuse Headache. The registry was established in January 2020 to facilitate collaborative research and evaluate practical and effective approaches to managing medication-overuse headache.
The study included 635 patients with medication-overuse headache who were enrolled between April 2020 to December 2023. Of the patients, 84.1% were female, the mean age was 46, and 57.6% experienced neck pain. Among the cohort, the most common type of chronic daily headache was chronic migraine, followed by chronic tension-type headache and new daily persistent headache.
The study found that patients with neck pain had an earlier onset of their primary headache disorder compared to those without neck pain. Patients with neck pain also experienced significantly earlier onset age of chronic daily headache. Although monthly headache days were similar between the 2 groups, patients with neck pain had significantly higher levels of anxiety, more severe cutaneous allodynia and poorer quality of life.
At the initial visit, 69% of patients were prescribed antiepileptic medications and there was a significantly higher usage among patients with neck pain. In patients with neck pain, onabotulinum toxin administration decreased from 18% to 13.7% at 3-month follow-up and calcitonin gene-related peptide monoclonal antibody usage decreased slightly from 28.7% to 25.9%.
At 3-months follow-up, the proportion of severe neck pain was decreased when compared to baseline. Additionally, patients who recovered from medication-overuse headache had lower rates of severe neck pain.
“These findings are consistent with previous studies on migraine and tension-type headache patients, which had shown associations between neck pain and increased headache-related disability, anxiety, depression, and reduced quality of life,” the authors said. “These observations emphasize the detrimental impact of neck pain on various aspects of daily functioning and underscore the need for increased attention to and management of neck pain, which has often been overlooked in headache treatment.”
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