According to several studies, compared to nausea, neck pain is more commonly associated with migraine. There is reduced neck muscle function and cervical range of motion in migraine sufferers and is not documented in those without migraine. Similarly, a 15-year-old girl was referred by her OB/Gyn to the headache clinic for evaluation of severe right sided migraine. The intensity of pain was so severe that she had had to miss 2 weeks of school because of it.
The patient had initially developed a severe headache that lasted for 12 days 2 years earlier. After being evaluated by the paediatric neurologist, she was diagnosed with migraine for aura. The neurologist further prescribed Topomax 50 mg which reduced the frequency of her headache significantly. However, the medication gave her symptoms, including marked lethargy and the inability to think clearly that she was unable to live with. The dose was gradually tapered to 25 mg, which resulted in an increased frequency of her headaches. Diamox was added to her prescription, however, she could not tolerate the side effects. A month later, the neurologist prescribed propranolol for the headaches.
The patient described the pain as throbbing and the severity of the pain worsened with activity. So much so that it even caused her to miss school. At times, her headaches were also accompanied with dizziness and photophobia. However, she did not experience any focal neurological symptoms, nausea, sensitivity to smell or phono phobia. She would experience the headache 4 days a week before her initial appointment. She had a family history of migraine in her grandmother. She would usually take Sumatriptan 50 mg at the onset of the headache which would make her go to sleep and she would wake up 2 to 3 hours later with a significant reduction in her headache. She was using 8 pills a month at the time of her initial visit for her most severe migraines.
In addition to the headaches, she also complained of daily neck tightness. Her headaches were generally triggered due to stress, neck or shoulder tightness and neck pain. At her first appointment, her HIT-6 Score (Headache Impact Test) was 76, signifying a very severe impact on her life.
Her medical history revealed allergic rhinitis, iron deficiency anaemia, anxiety and mediated syncope. She did not use non-prescription drugs, smoke or drink alcohol and reported getting at least 8 hours of sleep every night. In addition, she was a part of the school swim team till she had surgery to repair a left labrum tear a year ago.
Therapeutic neck exercise program
The patient was afebrile, normotensive and reported positive MSK findings. The patient was put on a neck exercise protocol, spending approximately 45 minutes at the office each visit. The current location and intensity of the patient’s head and face pain was recorded at each appointment for each of the 10 locations. The patient was instructed to perform sustained neck positions and repeated neck movements under the instruction of the physician. The movements that were therapeutic were assigned to the patient as a home exercise program. She was also suggested to alter her sleep posture and to avoid neck positions that would trigger the pain, such as, sustained cervical rotation.
She was able to tolerate the exercises without any adverse effects, moreover, there was a considerable improvement in the frequency of headaches.
References
Teenage Girl with Migraine Whose Symptoms Resolve with a Therapeutic Neck Exercise Program: A Case Report https://clinmedjournals.org/articles/jfmdp/journal-of-family-medicine-and-disease-prevention-jfmdp-6-126.php?jid=jfmdp
