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Neck musculoskeletal dysfunction in patients with chronic primary headaches

Elizagaray-García I, de-Toro-Cañizares CM, Díaz-de-Terán J, Gil-Martínez A, Luedtke K

The journal of headache and pain, 2026

129 participants

Abstract

Objective: To compare cervical musculoskeletal findings in chronic forms of migraine, tension-type headache, cluster headache, and healthy controls and identify which variables were most strongly associated with headache frequency, neck disability and impact in each headache group.

Methods: Single-blinded cross-sectional study with a non-probabilistic sample. A blinded physiotherapist assessed 129 participants: chronic migraine (n = 35), chronic tension-type headache (n = 30), chronic cluster headache (n = 34) and headache-free controls (n = 30). Psychosocial and cervical musculoskeletal variables (head posture, total cervical active range of motion, flexion-rotation test, motor control, symptom reproduction and resolution) were compared. Backward linear regression analyses were performed to explore associations between cervical variables and headache frequency. neck disability and headache-related impact.

Results: Compared to controls, chronic cluster headache showed reduced total cervical active range of motion [F(3,128) = 8.8; p = 0.001, d = 0.75], retraction [F(3,128) = 4.66; p = 0.007, d = 0.70], protraction [F(3,128) = 7.77; p = 0.017, d = 0.73] and flexion-rotation [F(3,128) = 3.68; p = 0.014, d = 0.72]. While sex confounded total active range of motion (p = 0.009); neither variable influenced protraction or retraction (all p ≥ 0.26). Familiar head pain was evoked more in chronic migraine (68.6%) and tension-type headache (72.4%) than controls (23.3%) [χ²(1) = 20.85;…

How strong is the evidence?

Evidence Hub reads this as a cross-sectional, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause. Reported size: 129 participants or records.

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