Common Pain Mechanisms in Migraine, Migraine-Related Neck Pain, and Lower Back Pain: A Cross Sectional Study

NCT07567300 | Recruiting

• 1 other identifier: Approval No: 3/9; 02.04.2026
• Study Type: observational
• Target: 179
• Locations: 1 country
• Sites: 1

Brief Summary

Migraine is one of the primary headache disorders with a high prevalence worldwide, leading to significant disability and reduced quality of life. Trigeminal nerve activation and alterations in central pain processing mechanisms play a crucial role in the pathophysiology of migraine. Recent studies suggest that migraine may not only be a headache disorder but also a systemic pain disorder associated with changes in central pain processing mechanisms. Central sensitization is defined as increased sensitivity of nociceptive neurons in the central nervous system to afferent stimuli and is considered a key mechanism in the development and maintenance of chronic pain conditions. This condition is characterized by pain hypersensitivity, allodynia, and generalized pain sensitivity. In addition to headaches, other musculoskeletal pains are also frequently reported in migraine patients. Spinal pain, particularly neck and lower back pain, can occur in migraine sufferers, with central sensitization contributing to the condition, considering the spine as a chain. Large population-based studies have shown a significant association between primary headaches and persistent low back pain, and a higher prevalence of concomitant low back pain has been reported in individuals with chronic migraine and chronic tension-type headaches. This association is suggested to be explained by the shared nociceptive pathways of the head and spinal structures and the changes in central pain processing seen in chronic pain conditions. This relationship between migraine and musculoskeletal pain is also explained by the presence of shared neuroanatomical structures such as the trigemino-cervical complex. Nociceptive afferents from the upper cervical spine and cranial structures converge at the trigemino-cervical complex level in the brainstem, creating a predisposition to the co-occurrence of head and neck pain. This mechanism suggests that pain or dysfunction in the cervical region in migraine patients may be related to headache symptoms. Studies have shown that neck pain is more common in individuals with migraine than in the general population, and research suggests this rate may be approximately 10-12 times higher compared to healthy individuals. Furthermore, it has been reported that individuals with migraine more frequently experience tenderness in cranio-cervical muscles such as the upper trapezius, sternocleidomastoid, and suboccipital muscles, myofascial trigger points, and increased muscle sensitivity. The literature also emphasizes that these cervical symptoms may be related to migraine frequency, attack severity, and headache-related disability. These findings suggest that migraine should be considered not only as a primary headache disorder but also as a complex neurobiological condition associated with widespread pain sensitivity and musculoskeletal symptoms. A better understanding of the relationship between migraine and musculoskeletal pain could be important for developing multidisciplinary treatment approaches. However, clinical studies in the literature that evaluate migraine, accompanying neck pain, and lower back pain together in terms of common pain mechanisms are quite limited. Therefore, the rationale for this study is that examining factors such as central sensitization, pain threshold, pain catastrophizing, psychological factors, body awareness, and regional disability together in migraine patients can lead to a better understanding of the pathophysiology of migraine-related musculoskeletal pain. Based on all these reasons and evidence, the aim of this study is to investigate the possible common pain mechanisms and musculoskeletal pathophysiological processes of migraine-related neck and back pain in migraine patients with accompanying neck and/or back pain by evaluating factors such as central sensitization, pain threshold, pain catastrophizing, psychological factors, body awareness, and regional disability together.

Conditions

Neck Pain; Migraine; Low Back Pain

Keywords

migraine; neck pain; low back pain; central sensitization; pain threshold

Outcome Measures

Primary Outcomes (1)

• Central Sensitization Inventory

  The Central Sensitization Inventory (CSI) measures somatic and emotional symptoms common in central sensitization syndrome. Section A measures 25 symptoms with 5 response options (0 to 4). The total score ranges from 0 to 100. Section B asks patients whether they have previously been diagnosed with preliminary specific CSI conditions.

  Day 1

Secondary Outcomes (13)

• Headache Intensity

  Day 1

• Disability for Migraine

  Day 1

• Disability of the Neck

  Day 1

• Disability of the Lower Back

  Day 1

• Headache Impact

  Day 1

Study Arms (8)

Episodic migraine

Episodic migraine is a neurological condition characterized by recurrent, moderate-to-severe headaches occurring on fewer than 15 days per month. Attacks typically last 4 to 72 hours and are often accompanied by nausea, vomiting, and light/sound sensitivity. Treatment involves acute, on-demand medication and preventative strategies to reduce attack frequency.

Episodic migraine with neck pain

Episodic migraine is a neurological condition characterized by recurrent, moderate-to-severe headaches occurring on fewer than 15 days per month. Attacks typically last 4 to 72 hours and are often accompanied by nausea, vomiting, and light/sound sensitivity. Treatment involves acute, on-demand medication and preventative strategies to reduce attack frequency. Additionally, this sample includes individuals diagnosed with episodic migraine and experiencing neck pain without having any other diagnosed neck problems.

Episodic migraine with low back pain

Episodic migraine is a neurological condition characterized by recurrent, moderate-to-severe headaches occurring on fewer than 15 days per month. Attacks typically last 4 to 72 hours and are often accompanied by nausea, vomiting, and light/sound sensitivity. Treatment involves acute, on-demand medication and preventative strategies to reduce attack frequency. Additionally, this sample includes individuals diagnosed with episodic migraine and experiencing low back pain without having any other diagnosed lower back problems.

Episodic migraine with neck pain and low back pain

Episodic migraine is a neurological condition characterized by recurrent, moderate-to-severe headaches occurring on fewer than 15 days per month. Attacks typically last 4 to 72 hours and are often accompanied by nausea, vomiting, and light/sound sensitivity. Treatment involves acute, on-demand medication and preventative strategies to reduce attack frequency. Additionally, this sample includes individuals diagnosed with episodic migraine and experiencing neck pain and low back pain without having any other diagnosed neck and lower back problems.

Chronic migraine

Chronic migraine is defined by having 15 or more headache days per month for over three months, with at least eight of those days meeting migraine criteria. Symptoms include moderate-to-severe throbbing pain, nausea, vomiting, and extreme sensitivity to light, sound, or smell.

Chronic migraine with neck pain

Chronic migraine is defined by having 15 or more headache days per month for over three months, with at least eight of those days meeting migraine criteria. Symptoms include moderate-to-severe throbbing pain, nausea, vomiting, and extreme sensitivity to light, sound, or smell. Additionally, this sample includes individuals diagnosed with chronic migraine and experiencing neck pain without having any other diagnosed neck problems.

Chronic migraine with low back pain

Chronic migraine is defined by having 15 or more headache days per month for over three months, with at least eight of those days meeting migraine criteria. Symptoms include moderate-to-severe throbbing pain, nausea, vomiting, and extreme sensitivity to light, sound, or smell. Additionally, this sample includes individuals diagnosed with chronic migraine and experiencing low back pain without having any other diagnosed lower back problems.

Chronic migraine with neck pain and low back pain

Chronic migraine is defined by having 15 or more headache days per month for over three months, with at least eight of those days meeting migraine criteria. Symptoms include moderate-to-severe throbbing pain, nausea, vomiting, and extreme sensitivity to light, sound, or smell. Additionally, this sample includes individuals diagnosed with chronic migraine and experiencing neck pain and low back pain without having any other diagnosed neck and lower back problems.

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

Gaziantep City Hospital, Department of Neurology, Gaziantep, Türkiye.

You may qualify if:

• Being between 18 and 65 years of age,
• Being able to read and understand Turkish,
• Agreeing to participate voluntarily,
• Having an episodic or chronic migraine diagnosis according to the International Classification of Headache Disorders Edition 3 criteria;
• Having neck pain and/or lower back pain without any underlying diagnosis accompanying the migraine diagnosis.

You may not qualify if:

• A history of neurological disorder (e.g., Multiple Sclerosis),
• Inflammatory rheumatic disorders (e.g., Rheumatoid Arthritis), generalized chronic pain syndromes (e.g., Fibromyalgia),
• Any other headache disease, any other systemic disease,
• Acute fracture and infection,
• Spinal surgery or spinal disease diagnosis within the last 6 months,
• Serious musculoskeletal trauma within the last 6 months,
• Pregnancy,
• A cognitive or psychiatric condition that would prevent completion of the questionnaires,
• In the control group without a migraine diagnosis,
• A history of recurrent headaches within the last year.

Sponsors & Collaborators

• Bozok University: lead

Study Sites (1)

Gazi University

Gaziantep, Merkez, Turkey (Türkiye)

RECRUITING

Related Publications (19)

• Yalin OO, Uluduz D, Sungur MA, Sart H, Ozge A. Identification of Allodynic Migraine Patients with the Turkish Version of the Allodynia Symptom Checklist: Reliability and Consistency Study. Noro Psikiyatr Ars. 2017 Sep;54(3):260-266. doi: 10.5152/npa.2016.15953. Epub 2016 Apr 15.

  PMID: 29033640 BACKGROUND

• Castien RF, Coppieters MW, Durge TSC, Scholten-Peeters GGM. High concurrent validity between digital and analogue algometers to measure pressure pain thresholds in healthy participants and people with migraine: a cross-sectional study. J Headache Pain. 2021 Jul 12;22(1):69. doi: 10.1186/s10194-021-01278-8.

  PMID: 34253164 BACKGROUND

• Erol E, Yildiz A, Yildiz R, Apaydin U, Gokmen D, Elbasan B. Reliability and Validity of the Turkish Version of the Fremantle Back Awareness Questionnaire. Spine (Phila Pa 1976). 2019 May 1;44(9):E549-E554. doi: 10.1097/BRS.0000000000002909.

  PMID: 30325886 BACKGROUND

• Onan D, Gokmen D, Ulger O. The Fremantle Neck Awareness Questionnaire in Chronic Neck Pain Patients: Turkish Version, Validity and Reliability Study. Spine (Phila Pa 1976). 2020 Feb 1;45(3):E163-E169. doi: 10.1097/BRS.0000000000003207.

  PMID: 31425430 BACKGROUND

• Onan D, Arikan H, Vuralli D, Akgor MC, Pala AB, Yanik E, Can AI, Ulutas C, Yesildas PY, Yildirim I, Gelener P, Demirel EA, Ekizoglu E, Ozge A. Assessment of Head Awareness in Patients with Chronic Migraine Using the Fremantle Headache Awareness Questionnaire: Turkish Version, Validity, and Reliability Study. Noro Psikiyatr Ars. 2025 Sep 19;63:308-315. doi: 10.29399/npa.29190. eCollection 2026.

  PMID: 41777502 BACKGROUND

• Aydemir, O., Hastane anksiyete ve depresyon olcegi Turkce formunun gecerlilik ve guvenilirligi. Turk Psikiyatri Derg., 1997. 8: p. 187-280.

  BACKGROUND

• Yakut E, Duger T, Oksuz C, Yorukan S, Ureten K, Turan D, Frat T, Kiraz S, Krd N, Kayhan H, Yakut Y, Guler C. Validation of the Turkish version of the Oswestry Disability Index for patients with low back pain. Spine (Phila Pa 1976). 2004 Mar 1;29(5):581-5; discussion 585. doi: 10.1097/01.brs.0000113869.13209.03.

  PMID: 15129077 BACKGROUND

• Aslan E, Karaduman A, Yakut Y, Aras B, Simsek IE, Yagly N. The cultural adaptation, reliability and validity of neck disability index in patients with neck pain: a Turkish version study. Spine (Phila Pa 1976). 2008 May 15;33(11):E362-5. doi: 10.1097/BRS.0b013e31817144e1.

  PMID: 18469684 BACKGROUND

• Ugurlu, M., et al., Validity of Turkish form of Pain Catastrophizing Scale and modeling of the relationship between pain-related disability with pain intensity, cognitive, and emotional factors. Psychiatry and Clinical Psychopharmacology, 2017. 27(2): p. 189-196.

  BACKGROUND

• Duzce Keles E, Birtane M, Ekuklu G, Kilincer C, Caliyurt O, Tastekin N, Is EE, Ketenci A, Neblett R. Validity and reliability of the Turkish version of the central sensitization inventory. Arch Rheumatol. 2021 Oct 18;36(4):518-526. doi: 10.46497/ArchRheumatol.2022.8665. eCollection 2021 Dec.

  PMID: 35382371 BACKGROUND

• Ertas M, Siva A, Dalkara T, Uzuner N, Dora B, Inan L, Idiman F, Sarica Y, Selcuki D, Sirin H, Oguzhanoglu A, Irkec C, Ozmenoglu M, Ozbenli T, Ozturk M, Saip S, Neyal M, Zarifoglu M; Turkish MIDAS group. Validity and reliability of the Turkish Migraine Disability Assessment (MIDAS) questionnaire. Headache. 2004 Sep;44(8):786-93. doi: 10.1111/j.1526-4610.2004.04146.x.

  PMID: 15330825 BACKGROUND

• Borner-Schroder C, Lachhammer T, Behrendt P, Pfeifer T, Kolorz P, Lense S, Pompignoli J, Reichert M, Schramm S, Heinen F, Sollmann N, Bonfert MV. The Temporal Associations of Neck Pain and Headache - Implications for the Diagnostic Approach to the Myofascial Involvement in Migraine. J Cent Nerv Syst Dis. 2025 Dec 11;17:11795735251404279. doi: 10.1177/11795735251404279. eCollection 2025.

  PMID: 41394282 BACKGROUND

• Al-Khazali HM, Younis S, Al-Sayegh Z, Ashina S, Ashina M, Schytz HW. Prevalence of neck pain in migraine: A systematic review and meta-analysis. Cephalalgia. 2022 Jun;42(7):663-673. doi: 10.1177/03331024211068073. Epub 2022 Feb 15.

  PMID: 35166137 BACKGROUND

• Al-Khazali HM, Kroll LS, Ashina H, Melo-Carrillo A, Burstein R, Amin FM, Ashina S. Neck pain and headache: Pathophysiology, treatments and future directions. Musculoskelet Sci Pract. 2023 Aug;66:102804. doi: 10.1016/j.msksp.2023.102804. Epub 2023 Jun 16.

  PMID: 37394323 BACKGROUND

• Yoon MS, Manack A, Schramm S, Fritsche G, Obermann M, Diener HC, Moebus S, Katsarava Z. Chronic migraine and chronic tension-type headache are associated with concomitant low back pain: results of the German Headache Consortium study. Pain. 2013 Mar;154(3):484-492. doi: 10.1016/j.pain.2012.12.010. Epub 2012 Dec 28.

  PMID: 23375162 BACKGROUND

• Vivekanantham A, Edwin C, Pincus T, Matharu M, Parsons H, Underwood M. The association between headache and low back pain: a systematic review. J Headache Pain. 2019 Jul 15;20(1):82. doi: 10.1186/s10194-019-1031-y.

  PMID: 31307372 BACKGROUND

• Ji RR, Nackley A, Huh Y, Terrando N, Maixner W. Neuroinflammation and Central Sensitization in Chronic and Widespread Pain. Anesthesiology. 2018 Aug;129(2):343-366. doi: 10.1097/ALN.0000000000002130.

  PMID: 29462012 BACKGROUND

• Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011 Mar;152(3 Suppl):S2-S15. doi: 10.1016/j.pain.2010.09.030. Epub 2010 Oct 18.

  PMID: 20961685 BACKGROUND

• Suzuki K, Suzuki S, Shiina T, Kobayashi S, Hirata K. Central Sensitization in Migraine: A Narrative Review. J Pain Res. 2022 Sep 7;15:2673-2682. doi: 10.2147/JPR.S329280. eCollection 2022.

  PMID: 36101891 BACKGROUND

MeSH Terms

Conditions

Neck Pain; Migraine Disorders; Low Back Pain

Condition Hierarchy (Ancestors)

Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Headache Disorders, Primary; Headache Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Back Pain

Study Officials

• Merve Ceren Akgör, Neurologist

  Department of Neurology, University of Health Sciences, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Türkiye

  STUDY CHAIR

• Doğan Porsnok, PhD

  Bingol University

  STUDY CHAIR

• Pelin Yenilmez Yeşildaş, Neurologist

  Gaziantep City Hospital, Department of Neurology

  STUDY CHAIR

• Dilara Onan, PhD

  Yozgat Bozok University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Dilara ONAN, PhD

CONTACT

+905358642234; dilaraonan@gmail.com

Pelin YENİLMEZ YEŞİLDAŞ, Neurologist

CONTACT

+905392040612; pelinnyenilmez@gmail.com

Study Design

• Study Type: observational
• Observational Model: OTHER
• Time Perspective: PROSPECTIVE
• Target Duration: 1 Day
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: April 22, 2026
• First Posted: May 5, 2026
• Study Start: April 30, 2026
• Primary Completion: June 17, 2026
• Study Completion: June 30, 2026
• Last Updated: May 19, 2026

Record last verified: 2026-05

Locations

TU (1)