neck pain

3 January 2023

Botox and Neck Pain?

It’s good to see researchers paying more attention to neck pain as a symptom of migraine. One example is a study being published this year in the journal Toxins.

In this case, the study focused on onabotulinumtoxinA treatment, commonly known under the brand name of Botox. Botox has become a well-known treatment for chronic migraine, although we still have a lot to learn about the best way to use it.

This study focused not only on headache pain, but also neck disability and pain. Researchers used the Neck Disability Index (NDI), a ten-question survey filled out by patients to measure just how much neck pain is affecting their lives (see this example). For example, do you have trouble driving because of the pain? Are you avoiding recreational activities? Is neck pain robbing you of sleep?

A single onabotulinumtoxinA session did significantly decrease neck pain and disability in the patients over the next three months. Significant disability due to neck pain became mild, and headache pain decreased as well.

The authors of the study noted that this could mean a significantly better quality of life. These were patients who, at the beginning, were significantly disabled by both headache and neck pain.

This was a short-term study, so the researchers would like to see if these improvements hold over a longer period of time, with further treatments.

Still, there are a couple of things that can be taken from this study. First, be aware of neck pain and stiffness, during and in-between your migraine attacks. This is a symptom which may be causing you a lot more trouble than you realize. Second, if you have chronic migraine and have considered Botox as a treatment, this might be a further reason to give it a try. Be sure to keep track of both your headache and migraine symptoms and your neck pain, and share your results with your doctor.

For more on this study, see the pdf here: OnabotulinumtoxinA Treatment in Chronic Migraine: Investigation of Its Effects on Disability, Headache and Neck Pain Intensity

12 September 2022

Headache from Neck Problems? Still Tricky to Diagnose.

James Discoveries & Stats, Information, Uncategorized 1

New research coming from France and Canada indicates that cervicogenic headache, headache coming from problems in the neck, is still not-so-easy to diagnose.

The cervical spine (image courtesy of Anatomography)

All of us would love to know if solving a neck problem would resolve our headaches. But this is tricky, because many types of headaches are related to neck pain. Migraine is often accompanied by neck pain, for example. That doesn’t mean that treating the neck will resolve the migraine symptoms.

But in the case of cervicogenic headache, there will be evidence that the headache is caused by problems in the neck.

The International Classification of Headache Disorders 3 describes it this way: Headache caused by a disorder of the cervical spine and its component bony, disc and/or soft tissue elements, usually but not invariably accompanied by neck pain.

Of course, your chances of diagnosing this type of headache if you have no neck pain are even slimmer.

A recent study published in August by Musculoskeletal Science and Practice (Cervicogenic headache, an easy diagnosis? A systematic review and meta-analysis of diagnostic studies) looked especially at a common method to diagnose cervicogenic headache, called the cervical flexion-rotation test. This test is done by a specialist who will test the rotation of the neck. (You can certainly notice problems on your own, but this test does need to be done by someone who is trained to notice small differences. More on the cervical flexion-rotation test.)

The researchers concluded that this test had “a small to moderate effect on the probability of a patient having” a cervicogenic headache, as opposed to another type of headache. In other words, it’s a good way to point at least a few patients in the right direction, but it’s not in any sense the final word.

There are other ways to diagnose, although this may be the key one. So in the end, your doctor will need to try a few things and draw on his or her experience, so that you can decide together whether further neck treatment will be of help.

A nerve block is another way to diagnose cervicogenic headache. If blocking nerve sensitivity in the neck stops headache symptoms, you’ve narrowed down the location of the problem.

Nerve blocks are also sometimes used as a treatment. But it’s important to realize that cervicogenic headache does not have one specific cause, although the general location of the cause will be the same. So treatments will vary quite a bit, depending on what the neck problem actually is, which can range from something simple to something quite serious.

Finding a specialist with experience in this type of headache will certainly help. If you suspect that your neck problems are causing or even triggering headache attacks, do mention it to your doctor.

29 May 2019

Botox Side Effects: Long Term

James Discoveries & Stats 1

A new study casts some light on Botox (onabotulinumtoxinA) treatment and how side effects change over time. If you’re using Botox to treat chronic migraine, or if you’re considering it, take the time to look at this study.

This study comes out of the USA and was published this month in Drug Safety: The Official Journal of the International Society of Pharmacovigilance. It compiles about two years of information from what was called the COMPEL study – The Chronic migraine OnabotulinuMtoxinA Prolonged Efficacy open-Label Study. Although “long term” was only about 2 years, the study does provide valuable insights into the side effects of Botox.

Before we get to the specific side effects, it’s worth noting that the study does confirm the general safety of Botox treatment. Although many patients withdrew from the study for various reasons (such as simply not staying in contact or not following the study protocols), only 3.5% withdrew specifically because of “adverse events” or side effects.

Only a small percentage of those were “serious adverse events”, and the researchers believe that only 1 patient (716 started the study) had a serious adverse event actually related to the Botox treatment – and that was a rash. Of course, there are always patients who respond poorly to medication (or even to food!), so this is a pretty good record.

But Botox is not completely free and clear, because there were reported side effects. First, let’s look at the common ones. Then stay tuned for a very important clarification.

Here are the most common side effects. None of these were common – in other words, you’d be unlikely to find even one patient in 10 with the most common side effect.

Neck pain
Eyelid ptosis (droopy eyelid)
General stiffness or weakness
Pain at injection site
Headache and/or migraine symptoms
Facial paresis (muscle weakness)
Skin tightness

Now if you’ve experienced any of these side effects, there may be some good news for you. The side effects did tend to lessen with repeated treatments.

In this study, treatments were given every 12 weeks. The neck pain was the worst after the first cycle – it decreased significantly after that. Headache and migraine symptoms were the worst during the first two cycles (migraine symptoms actually increased during the second cycle), and then significantly decreased. Droopy eyelid decreased significantly in the second cycle, and then almost disappeared.

Generally speaking, side effects decreased after the third cycle. By the fourth treatment, side effects were drastically decreased.

Now if treatment isn’t helping at all, you’re not likely to stick with it for four treatments. Remember, at every 12 weeks, that’s about 11 months. However, if you find that Botox is helping after you’ve tried it two or three times, you might be encouraged to know that the side effects should be far less at treatment 4 (or even 3) and beyond.

Also remember, there are ways to be safer with Botox treatment. See How to be Safe with Botox (10 tips).

It will be interesting to see even longer term studies in the future. But at this point, this study confirms what other studies have shown us. Side effects are minimal, and tend to be even fewer as the months pass.

To read the abstract, or the whole study, visit Long-Term Safety and Tolerability of OnabotulinumtoxinA Treatment in Patients with Chronic Migraine: Results of the COMPEL Study.

14 May 2018

What Role does Neck Pain play in a Migraine Attack?

James Discoveries & Stats 0

As we have discussed before, migraine and neck pain very often go together. You may remember the perhaps surprising results of our poll a few years ago – Migraine Symptom: Neck Pain (poll results). And, some of the research that tells us that neck pain in migraine is more common than nausea.

Neck Massage — Neck massage – could it fight migraine?

A study published this spring (Clinical characterization of neck pain in migraine.) investigated the timing and apparent role of neck pain in migraine.

A lot of the report isn’t a surprise. Over 42% of patients reported neck pain as a part of their migraine attack. Both men and women experienced neck pain.

Now this may surprise some people. In 32% of cases, the neck pain appeared to be a trigger. But in 68%, the neck pain was a part of the attack itself, not a trigger at all. And almost 28% experienced neck pain after the headache was gone!

Researchers concluded that neck pain is commonly either a trigger or an actual symptom of migraine, most often a symptom during the main part of the attack.

Around the same time, Curelator came out with another puzzling result. For those using their app, many found that neck pain was a sign that they would be less likely to have an attack!

So what’s up with that?

Well, we’re not sure. But it could be that patients with neck pain from other sources are taking care to deal with the neck pain – thus helping fight migraine as well. This could include massage or certain neck exercises.

Read the Curelator article here: How can neck pain be a protector for migraine attacks?

For now, it’s important for patients and doctors to be aware of neck pain. Patients need to be checked in case their neck pain is a sign of something that is causing both the pain and the migraine attacks. And yes, fighting neck pain may fight migraine symptoms in some cases.

15 March 2018

Change in Headache Symptoms, and Neck Pain

James Discoveries & Stats, Tips 1

I admit, sometimes I’m not the master of brilliant headlines. But this recent study is interesting and helpful, even if it’s a little hard to describe in a few words.

Researchers and Australia and the Philippines decided to study the changes in migraine and tension-type headache over a period of 6 months. 79 patients were in the study. The question was – how much do symptoms change over the course of a few months, or from one day to another? Are there any factors that we can see that could explain why one condition improves and another does not?

Of the two, migraine was certainly the most volatile from day to day, with the most change. But both conditions saw a lot of change (not surprisingly) over the course of 6 months.

But perhaps the most interesting finding was one factor that predicted whether the patient would be more or less disabled after 6 months.

Neck Dysfunction and Headache Before the six months began, patients were checked for “cervical musculoskeletal impairments”. In other words, which patients had neck trouble – a problem with range of motion, dysfunction.

Patients with cervical joint dysfunction were far more likely to be just as disabled at the end of 6 months as they were at the beginning – 6 times more likely.

If this is impeding your improvement, it’s probably time to talk to your doctor and a physiotherapist to see what you can do to improve the situation. It could be that neck problems are triggering a pain cycle and making your headache condition worse.

Neck pain is extremely common in migraine in particular, but it’s often ignored. Paying attention and looking for treatment could make a big difference in your path to health.

More information: Six-Month Changes in Migraine and Non-Migraine Headaches