Migren ve Boyun Ağrısı İlişkisi
Özet
Migren, tekrarlayan orta-şiddetli baş ağrısı atakları ile otonomik ve duyusal belirtilerle seyreden, ICHD-3 ölçütleriyle sınıflandırılan yaygın bir nörovasküler hastalıktır; kortikal yayılan depolarizasyon, trigeminovasküler aktivasyon, CGRP aracılı sinyalizasyon ve santral sensitizasyon patofizyolojisinin temelini oluşturur. Boyun ağrısı ise toplumda en sık görülen kas-iskelet yakınmalarındandır. İkisi arasındaki ilişki hem epidemiyolojik hem nöroanatomik düzeyde belgelenmiştir: boyun ağrısı migrenli bireylerin %76'sında, baş ağrısı olmayan kontrollerin ise yalnızca %23'ünde bildirilmekte; oran kronik migrende %87'ye ulaşmakta ve atakların yaklaşık %40'ına eşlik etmektedir. Prospektif günlük çalışmalarında atak öncesi boyun ağrısı veya sertliği %42-50 arasında saptanmıştır. C1-C3 dorsal kök ganglionlarından gelen duyusal girdilerin trigeminal afferentlerle trigemino-servikal komplekste birleşmesi, yansıyan ağrının anatomik zeminini oluşturur; suboksipital ve üst trapezius bölgesindeki miyofasiyal tetik noktaların palpasyonu migren benzeri ataklar provoke edebilmekte, büyük oksipital sinir blokajı ise ağrı şiddetini ve ağrılı gün sayısını azaltmaktadır. Boyun ağrısı bu nedenle bazı hastalarda atağın erken evresine ait bir belirti, bazılarında ise eşlik eden gerçek servikal kas-iskelet disfonksiyonudur. Öykü, servikal muayene, kırmızı bayrak taraması ve engellilik ölçekleri birlikte değerlendirilmeli; tedavi baskın mekanizmaya göre farmakolojik yönetim, fizik tedavi, egzersiz ve nöromodülasyon seçenekleriyle planlanmalıdır.
Migraine is a common neurovascular disorder of recurrent moderate to severe headache attacks with autonomic and sensory features, classified by ICHD-3 criteria, and underpinned by cortical spreading depolarisation, trigeminovascular activation, CGRP-mediated signalling and central sensitisation. Neck pain is among the most frequent musculoskeletal complaints in the general population. The link between them is documented at both epidemiological and neuroanatomical levels: neck pain is reported by 76% of people with migraine but only 23% of headache-free controls, rises to 87% in chronic migraine, and accompanies roughly 40% of attacks. Prospective diary studies detect pre-attack neck pain or stiffness in 42-50% of cases. Convergence of sensory input from the C1-C3 dorsal root ganglia with trigeminal afferents in the trigeminocervical complex provides the anatomical basis for referred pain; palpation of myofascial trigger points in the suboccipital and upper trapezius regions can provoke migraine-like attacks, while greater occipital nerve blockade reduces pain intensity and headache days. Neck pain therefore represents an early-phase symptom of the attack in some patients and genuine comorbid cervical musculoskeletal dysfunction in others. History, cervical examination, red-flag screening and disability measures should be evaluated together, with treatment matched to the dominant mechanism through pharmacotherapy, physical therapy, exercise and neuromodulation.
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