Some Headaches May Really Stem From Neck Muscles Interview with:
Nico Sollmann, M.D., Ph.D.
Resident in the Department of Diagnostic and Interventional Radiology
University Hospital Ulm, and the
Department of Diagnostic and Interventional Neuroradiology
University Hospital Rechts der Isar in Munich, Germany What is the background for this study?

Response: Neck pain is very common among patients with primary headache disorders, such as tension-type headache or migraine. However, neck pain is mostly neglected during diagnosis as well as for treatment concepts in patients with such headache disorders. 

Our study revealed alterations of the trapezius muscles in subjects with tension-type headache and subjects with tension-type headache plus migraine attacks by using quantitative magnetic resonance imaging. We suggest that those changes (i.e., increase of T2 values of the trapezius muscles) may be related to subtle edematous changes within the musculature, which might stem from inflammation. . What are the main findings?

Response: Given that we also found significant associations between those muscular changes and the number of days a subject suffered from headache over the 30 days prior to imaging as well as neck pain, our study may provide objective evidence for the interrelationship between the neck area and the brain in headache disorders What should readers take away from your report?

Response: Primary headache disorders may be linked to neck pain, and quantitative magnetic resonance imaging may help to visualize and objectify changes of neck musculature that might be related to subjectively perceived pain. Involvement of neck muscles in primary headache disorders may relate to subtle inflammatory alterations in muscle tissue. What recommendations do you have for future research as a result of this study?

Response: The application of quantitative magnetic resonance imaging can objectively detect changes of the trapezius muscles in subjects suffering from headache disorders, thus providing a quantitative biomarker. Such a biomarker has not yet been available, and it could be used to phenotype patients, monitor the disease status, as well as treatment effects.

In a planned randomized controlled trial, we would like to combine quantitative magnetic resonance imaging (for diagnostics) with peripheral magnetic stimulation (for treatment) to provide a comprehensive framework combining a novel treatment approach with therapy monitoring. Such a trial could help to elucidate effects of peripheral magnetic stimulation by an objective method that is targeting the neck musculature in headache disorders, thus providing the possibility to potentially relieve muscular pain and headache.

No disclosures. The study has been published as an open-access article in the meantime for more detailed information. (


  1. RSNA 2023 abstract:
  2. Sollmann N, Schandelmaier P, Weidlich D, Stelter J, Joseph GB, Börner C, Schramm S, Beer M, Zimmer C, Landgraf MN, Heinen F, Karampinos DC, Baum T, Bonfert MV. Headache frequency and neck pain are associated with trapezius muscle T2 in tension-type headache among young adults. J Headache Pain. 2023 Jul 12;24(1):84. doi: 10.1186/s10194-023-01626-w. PMID: 37438700; PMCID: PMC10337094.

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Neck Pain Relief Utilizing Progressive Resistance Exercise Interview with:
PhD, Dip WDP, BPhysio(Hons)
Insurance Work and Health Group
Senior Research Fellow Department of Physiotherapy
Adjunct Senior Lecturer,Health Services Division
School of Public Health and Preventive Medicine
Monash University Melbourne, VIC Australia

ROSS ILES  PhD, Dip WDP, BPhysio(Hons) Insurance Work and Health Group Senior Research Fellow Department of Physiotherapy Adjunct Senior Lecturer Health Services Division School of Public Health and Preventive Medicine Monash University Melbourne, VIC Australia
Dr. ILES  What is the background for this study

Response: Chronic neck pain is estimated to have a worldwide mean lifetime prevalence of 48.5%, and the pain and disability associated with this condition accounts for 2.5% of the total years lost to disability in Australia. Chronic neck pain is known to be associated with neck muscle weakness in all planes of movement of up to 66% when compared to participants presenting with no history of neck pain. Therefore, neck strengthening exercises are commonly utilised in the treatment of chronic neck pain, with many different programs being described within the literature. Studies investigating the effect of strengthening exercises on chronic neck pain have found a short to intermediate term improvement in pain by a moderate to large amount. However, many strengthening programs do not target the multi-directional weakness which has been shown to be prevalent in this population group.

Through a case series of patients with chronic neck pain we aimed to determine whether a neck-specific progressive resistance program targeting all planes of cervical movement led to a change in pain and disability, and to investigate the relationship between neck strength, pain, and disability.

Data analysis was performed on patients after completing nine sessions of a neck-specific progressive resistance exercise intervention utilising the Melbourne Protocol and the Multi-Cervical Unit (MCU) technology under supervision of the treating physiotherapist. Participants completed isotonic exercises against the MCU provided resistance in the planes of cervical flexion, extension, and lateral flexion, all at neutral cervical rotation and 25 degrees left and right. Neck pain and disability were assessed with the Numerical Rating Scale (NRS) and Neck Disability Index (NDI) respectively, with neck strength measured and recorded through the MCU.

Neck Pain: Deep Tissue Massage Can Offer Short Term Pain Relief Interview with:

Oscar Javier Pico-Espinosa | MD, MSc, PhD (c) Epidemiology
Karolinska Institutet  What is the background for this study?

Response: Persistent neck pain is a common condition and one of the main causes of sick leave worldwide. Patients often utilize non-pharmacological therapies such as massage or exercises. However, the evidence supporting the effectiveness of such treatments is either lacking or conflicting. With that in mind, we designed the Stockholm Neck (STONE) trial, where we compared deep tissue massage, strengthening and stretching exercises and a combination of those two (up to six sessions over six weeks), versus advice (up to three sessions of advice to stay active).

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Neck and Back Pain More Common in Diabetes Interview with:

Manuela L. Ferreira PhD
Institute of Bone and Joint Research
The Kolling Institute, Sydney Medical School

Paulo H. Ferreira PhD
Musculoskeletal Health Research Group
Faculty of Health Sciences
University of Sydney, Sydney, NSW, Australia  What is the background for this study?  What are the main findings?

Response: One in four Australians experience back pain or neck pain. Diabetes is also a worldwide prevalent condition, and currently affects over 382 million people. These two diseases often co-exist and have very similar underlying mechanisms, such as obesity and physical inactivity. We were unsure whether having one condition would lead to developing the other, however.

We have found 11 studies published to date, and assessing the relation between back or neck pain and diabetes. The studies included over 165,000 participants published in the USA, Canada, Finland, Denmark, Iran and Spain.

When we pooled the results of these studies together, we observed that people with type 2 diabetes are 35% more likely to also have low back pain (compared to people without diabetes). The risk of having severe back pain symptoms in people with type 2 diabetes is 63% higher and the risk of having severe neck pain is almost 30% higher, than in people with no diabetes.  We could not identify, however, whether type 2 diabetes can lead to back or neck pain, and it is possible that the two conditions are associated via other underlying mechanisms such as obesity and physical inactivity.

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Early Physical Therapy Can Be Protective Against Chronic Opioid Use Interview with:

Steven Z. George, PT, PhD  Professor Director of Musculoskeletal Research Duke Clinical Research Institute Vice Chair of Clinical Research Orthopaedic Surgery

Dr. George

Steven Z. George, PT, PhD 
Director of Musculoskeletal Research
Duke Clinical Research Institute
Vice Chair of Clinical Research
Orthopaedic Surgery What is the background for this study? What are the main findings?Response: This study adds to existing health services research investigating the sequence of services/providers for musculoskeletal pain and its impact on opioid use.

The study suggest that early physical therapy (PT) for the 4 most common musculoskeletal conditions (back, neck, shoulder, and knee) can be protective of chronic/long term opioid use for individuals that were opioid naïve when presenting for their care.  What is different about this study is that the 4 conditions were studied in the same cohort and the same definition of early PT was used (many of the previous studies just looked at 1 conditions, and used different definitions of early physical therapy).  The other thing that was different is that we used a larger dataset of private insurance providers, so this study cuts across different regions of the study (many of the previous studies included one health system).

There was notable consistency in the findings for the 4 conditions and protection of any opioid use, but there were some contingencies.

First was that there was no benefit on decreased dosage for individuals with neck pain – as that was not expected.

Second was that in a follow up sensitivity analysis it looked like the largest benefit of early physical therapy may be for those with back and knee pain.  Continue reading