Plain Language Summary Publication: Characterizing neck pain during headache among people with migraine: Multicountry results from the Chronic Migraine Epidemiology and Outcomes – International (CaMEO‐I) cross‐sectional study

Main Findings: In a large, multinational web survey, neck pain with headache (NPWH) occurred in more than two-thirds of people with migraine compared with about one-third of people with non-migraine headache. Among people with migraine, those with NPWH had greater disability, depression symptoms, anxiety symptoms, and allodynia, diminished quality of life, and reduced work productivity. Motivation (Problem): We sought to determine how frequently people with migraine and people with non-migraine headache had NPWH and to examine the association of neck pain with migraine disease burden. We also considered the possibility that NPWH could be used as a diagnostic feature or a measure of disease burden and treatment benefit in clinical trials. Methods: We conducted a web-based study in a representative sample of the general population of six countries: Canada, France, Germany, Japan, the United Kingdom, and the United States. About one-quarter of those with headache had migraine; three-quarters had other headache types. Results: In people with migraine, those with NPWH were 1.7 times more likely to have moderate-to-severe headache-related disability and had 1.7 times more lost productive time at work. Those with NPWH were also more likely to have depression and anxiety symptoms and were less likely to respond well to their usual acute treatments in every country but Japan. When asked to identify the symptoms that bothered them the most, 28.4% of respondents with migraine and NPWH reported neck pain as their most bothersome symptom. While NPWH was associated with substantial burden in all countries, Japan had the lowest rate of moderate-to-severe disability among respondents with NPWH (35.6% compared with 42.7%–55.3% in other countries). Implications (for the future): NPWH is more common in migraine than in other headache types and is associated with higher levels of disability and more lost productive time at work. More than a quarter of people with migraine and NPWH find neck pain to be their most bothersome symptom. Including neck pain as a diagnostic feature of migraine could improve migraine diagnosis, and measuring neck pain in clinical trials could make these studies more patient centered. We hypothesize that the strikingly lower impact of NPWH observed in Japan may be related to cultural differences in attitudes toward pain that influence symptom reporting, although additional data are needed. Study concept and design: Dawn Buse, Richard B. Lipton, and Katherine Sommer. Acquisition of data: Kristina M. Fanning, Michael L. Reed, and Katherine Sommer. Analysis and interpretation of data: Kristina M. Fanning, Richard B. Lipton, Michael L. Reed, and Katherine Sommer. Drafting of the manuscript: Manjit Matharu, Zaza Katsarava, Dawn C. Buse, Katherine Sommer, Michael L. Reed, Kristina M. Fanning, and Richard B. Lipton. Revising it for intellectual content: Manjit Matharu, Zaza Katsarava, Dawn C. Buse, Katherine Sommer, Michael L. Reed, Kristina M. Fanning, and Richard B. Lipton. Final approval of the completed manuscript: Manjit Matharu, Zaza Katsarava, Dawn C. Buse, Katherine Sommer, Michael L. Reed, Kristina M. Fanning, and Richard B. Lipton. Manjit Matharu, MD, serves on the advisory board for Abbott, AbbVie, Eli Lilly, Lundbeck, Medtronic, Pfizer, Salvia, and Teva and has received payment for the development of educational presentations from AbbVie, electroCore, Eli Lilly, Novartis, and Teva. Zaza Katsarava, MD, has been a speaker and/or consultant and/or received research support from Allergan, Amgen/Novartis, Eli Lilly, Merck, and Teva. Dawn C. Buse, PhD, has received grant support and honoraria from AbbVie, Amgen, Biohaven, Collegium, Eli Lilly, Lundbeck, Teva, and Theranica and serves on the editorial board of Current Pain and Headache Reports. Katherine Sommer, PhD, was an employee of AbbVie at the time this study was conducted and may hold AbbVie stock. Michael L. Reed, PhD, is managing director of Vedanta Research, which has received research funding from AbbVie, Allay Lamp, Dr. Reddy's Laboratories, Eli Lilly, and GlaxoSmithKline via grants to the National Headache Foundation. Vedanta Research has received funding directly from AbbVie for work on the CaMEO and CaMEO-I Studies. Kristina M. Fanning, PhD, is managing director of MIST Research, which has received research funding from AbbVie, Allay Lamp, NYC Langone Health, Juva Health, and GlaxoSmithKline via grants to the National Headache Foundation. Richard B. Lipton, MD, reports support for the present study from AbbVie; research support paid to his institution from the Czap Foundation, National Headache Foundation, National Institutes of Health, S&L Marx Foundation, and US Food and Drug Administration; and personal fees from AbbVie/Allergan, American Academy of Neurology, American Headache Society, Amgen, Biohaven, Biovision, Boston, Dr. Reddy's (Promius), electroCore, Eli Lilly, GlaxoSmithKline, Grifols, Lundbeck (Alder), Merck, Pernix, Pfizer, Teva, Vector, and Vedanta Research. He holds stock/options in Axon, Biohaven, CoolTech, and Manistee.