Common Mechanisms in Migraine, Migraine-Related Neck Pain, and Low Back Pain: Implications for Treatment
Abstract
Aim: Chronic pain conditions, such as migraine, migraine-related neck pain (NP), and low back pain (LBP), are central pain processing disorders that frequently coexist. This narrative review aims to synthesize central sensitization (CS), pain spread and pharmacological and rehabilitation-based interventions for these three conditions and their common underlying mechanisms.
Methods: A comprehensive literature search was conducted in PubMed and Web of Science to identify clinical and neurophysiological studies investigating CS, nociceptive processing, pharmacological and non-pharmacological approaches for migraine, migraine-related NP, and LBP.
Results: Current evidence suggests that migraine, migraine-related NP, and LBP share cortical hyperexcitability, impaired descending inhibitory control and altered spinal and supraspinal nociceptive processing. Persistent nociceptive input can contribute to multi-site pain phenotypes by facilitating the spread of pain beyond the area of origin. Motor dysfunction, psychological factors, such as fear-avoidance and decreased quality of life, contribute to the maintenance of CS. Pharmacological treatments for migraine-related NP follow migraine treatment principles, although an additional cervical musculoskeletal defect may require independent, non pharmacological management. Physical therapy and rehabilitation approaches can regulate central pain mechanisms and improve functional outcomes in all three conditions. However, the strength of…
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