277: Misalignment Between Patient Causal Beliefs and Cervical Musculoskeletal Disorder in Migraine

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary headache, Non-pharmacological treatments, Physiotherapy, Treatment/management

Background and Aims: Individuals with migraine frequently experience neck pain, yet patient beliefs regarding causal relationships between these symptoms are poorly understood. These beliefs may influence care-seeking: believing neck pain causes migraine may drive pursuit of neck-focused treatments, while recognising neck pain as a migraine symptom may promote migraine-directed management. This study aimed to determine (a) how often patients believe migraine results from neck pain versus neck pain results from migraine, (b) whether beliefs align with cervical musculoskeletal disorder presence (the primary indicator for neck rehabilitation referral), and (c) care-seeking implications.

Methods: This secondary analysis used data from a study classifying individuals with migraine into those with and without cervical musculoskeletal disorder via cluster analysis of physical assessments (e.g., cervical range of motion, neuromuscular function).¹ Participants reporting migraine and neck pain (n=95) completed surveys asking: "Do you think your migraine is a result of your neck pain?" and "Do you think your neck pain is a result of migraine?" (yes/no/unsure). Care-seeking implications were interpreted based on belief-disorder alignment. Believing migraine results from neck pain WITH disorder present upon assessment aligned with appropriate neck rehabilitation; WITHOUT disorder suggested potential inappropriate treatment-seeking.

Results: Ninety-five participants (87.4% female; 40.5±11.1 years; headache frequency 7.7±5.9 days/month; Neck Disability Index 25±12%) were analysed. Cervical disorder was present in 47.4%. Beliefs were asymmetric: 54.7% believed migraine resulted from neck pain; 9.5% believed neck pain resulted from migraine. Uncertainty was high for both (54.7% and 36.8% respectively). Among those WITH disorder (n=45), 51.1% believed neck contributed to migraine (appropriate), but 11.1% did not (barrier to neck rehabilitation). Among those WITHOUT disorder (n=50), 58.0% believed neck caused migraine (potential inappropriate treatment-seeking). Only 6.0% recognized neck pain was not causing migraine, and 4.0% identified neck pain as a migraine symptom.

Conclusions: Patient beliefs about neck-migraine causation were markedly asymmetric: most believed neck pain causes migraine while few recognized it as a migraine symptom. Only 29.5% of beliefs aligned with presence or absence of cervical disorder based on clinical assessments. Misalignment occurred bidirectionally: 58% without cervical disorder believed neck pain caused migraine (potential inappropriate treatment-seeking), while 11% with disorder failed to recognize potential cervicogenic contributions (barrier to treatment). These findings highlight needs for patient education about neck pain as both potential contributor and symptom of migraine, and clinical assessment to prevent over- and under-utilisation of neck rehabilitation.

References: 1. Liang Z, Thomas L, Jull G, Zareie H, Minto J, Treleaven J. Neck pain associated with migraine does not necessarily reflect cervical musculoskeletal dysfunction. Headache. 2021;61:882-94.

Presenting Author: Zhiqi Liang
Submitting Author: Zhiqi Liang

Senior Author: Zhiqi Liang

IASP 2026 Global Year theme of Neuropathic Pain: No

• Lucy Thomas: PhD - University of Queensland
• Gwendolen Jull: PhD - University of Queensland
• Aiden Chi Chiu Tso: BPhty - University of Queensland
• Faith Abigail Jiaen Lee: BPhty - University of Queensland
• Julia Treleaven: PhD - University of Queensland