title: Presence of neck pain may delay migraine treatment.
abstract: OBJECTIVE
  To determine whether the presence of neck pain (NP) is associated with a delay in migraine treatment.
  
  
  BACKGROUND
  We have previously shown that 1) NP is exceedingly common in migraine; 2) its presence on the day preceding migraine is associated with impaired treatment response; and 3) NP is predictive of migraine-related disability independent of headache frequency and severity.
  
  
  METHODS
  This was a prospective, observational, cross-sectional study of 113 patients with migraine, ranging in attack frequency from episodic to chronic migraine. Subjects were examined by headache specialists to confirm the diagnosis of migraine and exclude both cervicogenic headache and fibromyalgia. Details of all headaches were recorded over the course of at least 1 month and until 6 qualifying migraines had been treated. Subjects were permitted to treat at the stage they customarily treated. A chi-square test of independence was performed to examine the relationship between the presence of NP and treatment within 30 minutes of headache onset. Analysis of variance was used to test the relationship of NP intensity with headache intensity at the time of migraine treatment.
  
  
  RESULTS
  Subjects recorded 2411 headache days, 786 of which were migraines, the majority of which were treated in the moderate pain stage. Presence of NP in the hour preceding initial migraine treatment was associated with delay in treatment beyond 30 minutes of headache onset (P < 0.01) and initiation of treatment at a greater headache pain intensity (P < 0.001). When NP accompanied migraine, those with moderate or severe NP were more likely to treat within 30 minutes of headache onset than those with mild NP (P < 0.05).
  
  
  CONCLUSIONS
  Presence of NP was associated with delayed treatment of migraine, as indicated not only by higher pain burden at time of treatment but also by delay beyond 30 minutes.
authors.affiliation: Carolina Headache Institute, University of North Carolina, School of Medicine, Chapel Hill, NC 27516, USA. calhouna@carolinaheadacheinstitute.com
authors.forename: Anne H
authors.initials: AH
authors.lastname: Calhoun
authors.forename: Sutapa
authors.initials: S
authors.lastname: Ford
authors.forename: Amy P
authors.initials: AP
authors.lastname: Pruitt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D005260:Female; D005356:Fibromyalgia / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D019547:Neck Pain / Q000150:complications*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult