Summary: Researchers found a clear association between persistent low back pain and chronic headache disorders. People with ongoing back pain or long-standing headaches are roughly twice as likely to experience both conditions concurrently.

Source: University of Warwick

Persistent Low Back Pain and Chronic Headache: New Evidence of a Strong Link

A new systematic review from the University of Warwick reveals a significant connection between persistent low back pain and chronic headache disorders, including migraine. Published in the Journal of Headache and Pain, the study pooled data from multiple populations and suggests that patients with one of these conditions are substantially more likely to have the other. The findings point toward shared mechanisms and potential opportunities for combined treatment approaches.

Researchers at Warwick Medical School, funded by the National Institute for Health Research (NIHR), examined 14 studies encompassing a total of 460,195 participants. These studies investigated the relationship between ongoing low back pain—defined as pain experienced day after day—and chronic primary headache disorders, defined as headaches occurring on most days for at least three months. Across the reviewed studies, having persistent low back pain roughly doubled the odds of also having chronic headaches, and vice versa. The association appeared especially pronounced among people with migraine.

Persistent low back pain and chronic headache disorders are among the leading causes of disability worldwide. Prevalence estimates indicate roughly 20% of people live with ongoing back pain, while approximately 3% live with chronic headaches. Based on these figures and the study’s findings, researchers estimate that well over 500,000 people in the UK may be affected by both persistent low back pain and chronic headaches.

Professor Martin Underwood, of Warwick Medical School, explained that most reviewed studies reported odds that were approximately doubled. “Either way, you’re about twice as likely to have headaches or chronic low back pain when the other condition is present,” he said. “Historically these problems have been treated separately by different specialties, but our findings suggest there might be shared causes for at least some patients.”

“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.”

Possible explanations for the link include differences in how people perceive and respond to pain, central nervous system sensitization that amplifies pain signals, and psychological or behavioural responses that increase disability. For example, individual variation in the brain’s interpretation of sensory input could cause the same physical stimulus to be experienced more intensely by some people, contributing to both migraine and chronic back pain.

Current treatments differ between conditions. Migraine and other chronic headaches have medication options targeted to headache mechanisms, while persistent low back pain is commonly managed with exercise, manual therapy, cognitive behavioural strategies, and psychological support when disability is severe. The researchers suggest that behavioural and self-management approaches developed for chronic musculoskeletal pain may also benefit people with chronic headache disorders, particularly when both conditions are present.

Professor Underwood added that an integrated clinical approach may be appropriate. “There are effective specific treatments for migraine, and we use supportive, rehabilitative management for chronic back pain to help people live better with pain. Developing combined support and advice programmes for people with both problems could improve care. Clinicians should routinely ask about both back pain and headache when one is present and consider tailoring treatment accordingly.”

Source:
University of Warwick
Media contacts:
Peter Thorley – University of Warwick
Image source:
The image is in the public domain.

Original research:
Open access — “The association between headache and low back pain: a systematic review”. Arani Vivekanantham, Claire Edwin, Tamar Pincus, Manjit Matharu, Helen Parsons, Martin Underwood. Journal of Headache and Pain. DOI: 10.1186/s10194-019-1031-y.

Abstract summary

The review searched five electronic databases for case-control, cross-sectional and cohort studies that compared people with persistent low back pain and primary chronic headaches to groups without these conditions. Fourteen studies met inclusion criteria, with sample sizes ranging from 88 participants to a large international survey of 404,206 people. Reported odds ratios for the association between persistent low back pain and primary headache disorders ranged from about 1.55 to 8.0. Study heterogeneity prevented formal meta-analysis, and only two studies used standard International Classification of Headache Disorders criteria for chronic headache. Overall, the review identified a positive association between persistent low back pain and chronic primary headache disorders, while noting limitations due to diverse populations, varied study designs, and inconsistent definitions of headache and back pain.

Trial registration:
PROSPERO 2018 CRD42018086557.