From the Guidelines
Chronic shoulder pain can potentially trigger migraines due to referred pain patterns and shared neural pathways between the neck, shoulders, and head. The connection between chronic shoulder pain and migraines is complex and involves multiple mechanisms. When shoulder muscles remain tense for extended periods, they can create trigger points that refer pain to the head, potentially initiating migraine attacks 1. Additionally, chronic pain from shoulder issues can sensitize the trigeminal nerve system, which is heavily involved in migraine pathophysiology 1. The constant stress response from ongoing shoulder pain may also lower the threshold for migraine attacks by increasing cortisol levels and creating neurochemical imbalances.
Some key points to consider in the management of chronic shoulder pain and migraines include:
- Addressing both conditions simultaneously through physical therapy focusing on proper posture and shoulder mechanics
- Using anti-inflammatory medications like ibuprofen (400-800mg every 6-8 hours) or naproxen (500mg twice daily) to reduce pain and inflammation
- Utilizing muscle relaxants such as cyclobenzaprine (5-10mg) to help manage muscle tension
- Implementing stress reduction techniques to help mitigate the stress response and lower the threshold for migraine attacks
- Considering trigger point injections or nerve blocks in severe cases
It is essential to note that migraine is a prevalent and disabling condition that affects approximately 16% of people in the United States, with females being more affected than males 1. Migraine-related disability has increased in the United States, and it is crucial to address both chronic shoulder pain and migraines to improve quality of life (QoL) and reduce functional disability. Management of chronic shoulder pain and migraines should prioritize a multidisciplinary approach, including physical therapy, pharmacologic treatments, and stress reduction techniques, to reduce the frequency and severity of migraine headache and improve overall QoL.
From the Research
Association Between Chronic Shoulder Pain and Migraines
- Chronic shoulder pain has been linked to migraines in several studies, suggesting a possible association between the two conditions 2, 3.
- A study published in 2016 found that self-reported neck and shoulder pain in adolescents is associated with episodic and chronic migraine, with the strength of the association increasing with the frequency of migraine 2.
- Another study published in 2012 found that muscular pain, particularly in the neck and shoulder region, is more prominent in individuals with migraine or mixed migraine and tension-type headache, and that the frequency of muscular pain increases significantly with growing chronicity of tension-type headache 3.
Possible Mechanisms and Treatments
- The exact mechanism by which chronic shoulder pain may contribute to migraines is not fully understood, but it is thought to involve the activation of trigger points in the neck and shoulder muscles, which can lead to the onset of migraine or exacerbate existing pain 4.
- Treatment options for chronic shoulder pain and migraines may include botulinum toxin A injections, which have been shown to be effective in reducing muscle hyperactivity and relieving pain in some patients 5.
- Steroid injections and nonsteroidal anti-inflammatory agents may also be used to treat shoulder pain, although their effectiveness compared to other treatments is still being studied 6.
Key Findings and Implications
- The presence of myofascial trigger points in the head and neck-shoulder muscles may be a contributing factor to migraine-related disability in women with episodic and chronic migraine 4.
- The association between chronic shoulder pain and migraines highlights the importance of considering the role of muscular pain in the diagnosis and treatment of headache disorders 2, 3.
- Further research is needed to fully understand the relationship between chronic shoulder pain and migraines, and to develop effective treatment strategies for patients with these conditions 2, 5, 6, 4, 3.