Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, Korea.
Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
J Headache Pain. 2024 Nov 4;25(1):190. doi: 10.1186/s10194-024-01876-2.
Neck pain and primary headache disorders are highly prevalent in populations and clinical cohorts. Medication-overuse headache (MOH) is a treatable secondary headache, mainly developing in migraine sufferers, that accounts for the majority of patients presenting to headache clinics. Nevertheless, the association between neck pain and MOH has not been reported. This study evaluated the prevalence and clinical course of neck pain in patients with MOH before and after MOH treatment.
We analyzed 635 MOH patients enrolled in a nationwide, prospective, multicenter MOH registry. Demographics and clinical data were collected at baseline and 3 months to evaluate changes in the status and severity of neck pain and headache. Severity of neck pain was graded into 4 groups, and severe neck pain was defined as grade 3 or 4.
Among 635 patients with MOH, 366 (57.6%) reported neck pain at baseline. MOH patients with neck pain had an earlier onset of their primary headache disorder (23.4 ± 12.7 vs. 26.2 ± 13.3 years, p = 0.007). Although monthly headache days were comparable between the patients with neck pain and those without neck pain, the neck pain group had higher levels of anxiety (7.4 ± 5.8 vs. 6.4 ± 5.4, p = 0.017), more severe cutaneous allodynia (2.4 ± 3.3 vs. 1.8 ± 3.0, p = 0.038), and poorer quality of life (171.7 ± 70.4 vs. 184.0 ± 68.9, p = 0.029). At 3 months, 456 (71.8%) were followed-up, and 257 (56.4%) were recovered from MOH. Compared to the baseline, the proportion of severe neck pain (40.4% vs. 19.4%, p < 0.001) was decreased. The proportion of severe neck pain was much lower in patients with recovery from MOH compared to those without (4.7% vs. 15.1%, p < 0.001).
Neck pain in MOH patients was associated with earlier onset of headache, higher levels of anxiety and allodynia, and poorer quality of life. Improvement in neck pain improvement was linked to recovery from MOH. These findings suggest the potential importance of integrating and management of neck pain into clinical practice for MOH.
颈痛和原发性头痛障碍在人群和临床队列中极为普遍。药物过度使用性头痛（MOH）是一种可治疗的继发性头痛，主要发生在偏头痛患者中，占头痛诊所就诊患者的大多数。然而，颈痛与 MOH 之间的关联尚未报道。本研究评估了 MOH 治疗前后 MOH 患者颈痛的患病率和临床病程。
我们分析了纳入全国性、前瞻性、多中心 MOH 登记处的 635 例 MOH 患者。在基线和 3 个月时收集人口统计学和临床数据，以评估颈痛状况和严重程度的变化以及头痛。颈痛严重程度分为 4 组，严重颈痛定义为 3 或 4 级。
在 635 例 MOH 患者中，366 例（57.6%）在基线时报告颈痛。有颈痛的 MOH 患者原发性头痛障碍的发病年龄较早（23.4±12.7 岁 vs. 26.2±13.3 岁，p=0.007）。尽管颈痛组和无颈痛组的每月头痛天数相当，但颈痛组的焦虑程度更高（7.4±5.8 分 vs. 6.4±5.4 分，p=0.017），皮肤感觉过敏更严重（2.4±3.3 分 vs. 1.8±3.0 分，p=0.038），生活质量更差（171.7±70.4 分 vs. 184.0±68.9 分，p=0.029）。3 个月时，456 例（71.8%）得到随访，257 例（56.4%）从 MOH 中恢复。与基线相比，严重颈痛的比例（40.4% vs. 19.4%，p<0.001）降低。与未恢复 MOH 的患者相比，从 MOH 中恢复的患者严重颈痛的比例低得多（4.7% vs. 15.1%，p<0.001）。
MOH 患者的颈痛与头痛发病年龄较早、焦虑和感觉过敏程度较高以及生活质量较差有关。颈痛的改善与 MOH 的恢复有关。这些发现表明，将颈痛的整合和管理纳入 MOH 的临床实践具有潜在重要性。
