Headache and back pain often go hand in hand

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People with persistent back pain or persistent headaches are twice as likely to suffer from both disorders, a new study reveals.

The findings, published in the Journal of Headache and Pain, suggest an association between the two types of pain that could point to a shared treatment for both.

The systematic review of 14 studies with a total of 460,195 participants also found the association stronger for people affected by migraine.

The study focused on people with chronic headache disorders, those who have headaches on most days for at least three months, and people with persistent low back pain that experience that pain day after day. Both are common disorders and leading causes of disability worldwide.

Around one in five people have persistent low back pain and one in 30 have chronic headaches. The researchers estimate that just over 1 in 100 people (or well over half a million people) in the UK have both.

“In most of the studies we found that the odds were about double—either way, you’re about twice as likely to have headaches or chronic low back pain in the presence of the other,” says Martin Underwood, a professor at the University of Warwick Medical School.

“Which is very interesting because typically these have been looked as separate disorders and then managed by different people. But this makes you think that there might be, at least for some people, some commonality in what is causing the problem.

“There may be something in the relationship between how people react to the pain, making some people more sensitive to both the physical causes of the headache, particularly migraine, and the physical causes in the back, and how the body reacts to that and how you become disabled by it. There may also be more fundamental ways in how the brain interprets pain signals, so the same amount of input into the brain may be felt differently by different people.

“It suggests the possibility of an underpinning biological relationship, at least in some people with headache and back pain, that could also be a target for treatment.”

Currently, there are specific drug treatments for patients with persistent migraine. For back pain, treatment focuses on exercise and manual therapy, but can also include cognitive behavioral approaches and psychological support approaches for very disabled people with back pain. The researchers suggest that those types of behavioral support systems may also help people living with chronic headaches.

“A joint approach would be appropriate because there are specific treatments for headaches and people with migraine. Many of the ways we approach chronic musculoskeletal pain, particularly back pain, are with supportive management by helping people to live better with their pain,” says Underwood.

“We could look at developing support and advice programs that are appropriate for this population. And being aware of this relationship has the potential to change how we think about managing these people in the NHS on an everyday basis,” he says.

“There is a need for doctors and other healthcare professionals to think that when treating one issue to ask about the other and tailor the treatment accordingly. For future research, there’s probably work that needs to be done to understand what the underlying mechanisms behind this relationship are.”

Source: University of Warwick