Neck Inflammation Tied To Headaches

“Our imaging approach provides first objective evidence for the very frequent involvement of the neck muscles in primary headaches, such as neck pain in migraine or tension-type headache, using the ability to quantify subtle inflammation within muscles,” said Nico Sollmann, M.D., Ph.D., resident in the Department of Diagnostic and Interventional Radiology at University Hospital Ulm, and the Department of Diagnostic and Interventional Neuroradiology at University Hospital Rechts der Isar in Munich, Germany. 

2 in 3 American adults suffer from tension-type headaches. The most common primary headaches are tension-type headaches and migraines. Those experiencing tension-type headaches often feel a tightening in the head and a mild to moderate dull pain on both sides of their head. These headaches are often associated with muscle tension and stress, but the exact origin and distinct underlying causes are not fully understood.

According to the American Migraine Foundation, over 37 million Americans are affected by migraines, and globally up to 148 million people suffer from chronic migraine episodes. Migraines are typically characterized by severe throbbing pain, which may occur on one side of the head or the pain is worse on one side. Migraines have been known to cause nausea, weakness, and extreme sensitivity to both light and sound. Migraine attacks can last for hours to multiple days with the pain becoming so bad that it interferes with daily activities. 

Neck pain has been associated with primary headaches, but there are no objective biomarkers for myofascial involvement. (Myofascial pain is associated with irritation or inflammation of the muscle/connective tissue surrounding the muscle). This study investigated the involvement of the trapezius muscles in primary headache disorders by quantitative 3D turbo spin-echo magnetic resonance imaging (MRI), as well as the associations between muscle T2 values with headache and neck pain frequency.

This study involved 50 participants between the ages of 20- 31 years old; 16 had tension-type headaches, and 12 had tension-type headaches plus migraines, and they were matched with 22 healthy controls. The tension type headache plus migraine group had the highest muscle T2 values, and muscle T2 value was significantly associated with the number of headache days as well as presence of neck pain. These increased values could indicate inflammation arising from the nervous system, and increased sensitivity of nerve fibers with myofascial tissues. 

“The quantified inflammatory changes of neck muscles significantly correlate with the number of days lived with headache and the presence of subjectively perceived neck pain,” Dr. Sollmann said. “Those changes allow us to differentiate between healthy individuals and patients suffering from primary headaches.”

“Our findings support the role of neck muscles in the pathophysiology of primary headaches,” Dr. Sollmann said. “Therefore, treatments that target the neck muscles could lead to a simultaneous relief of neck pain, as well as headache.” Adding that “Our imaging approach with delivery of an objective biomarker could facilitate therapy monitoring and patient selection for certain treatments in the near future.”