Musculoskeletal impairments associated with migraine in young adults: a case-control study

Migraine is common among university students and is frequently associated with neck pain, postural alterations, and musculoskeletal dysfunction. Cervical musculoskeletal impairments may be clinically relevant because nociceptive input from the upper cervical region can converge with trigeminal pathways within the trigeminocervical complex, potentially contributing to pain sensitization in some individuals with migraine.

To examine the association of core muscle endurance, cervical muscle endurance, and craniovertebral angle with migraine in university studentsand to determine whether these musculoskeletal variables remained associated with migraine status after accounting for age, sex, and body mass index.

In this case-control study, 140 university students aged 18-28 years were recruited, including 70 with neurologist-confirmed migraine based on the International Classification of Headache Disorders, 3rd edition (beta version), and 70 headache-free controls. Core muscle endurance was assessed using the McGill endurance tests. Cervical flexor and extensor muscle endurance, as well as craniovertebral angle, were also measuredusing standardized procedures. Baseline characteristics were compared between groups. Between-group comparisons were performed using independent-samples t tests, and adjusted analyses were performed with age, sex, and body mass index entered as covariates. Predictors of migraine status were explored using logistic regression.

Compared with controls, the migraine group demonstrated significantly lower core muscle endurance across all McGill tests (all p < .001), lower cervical muscle endurance (cervical flexors: 22.46 ± 15.54 vs 48.37 ± 16.82 seconds; cervical extensors: 49.80 ± 28.86 vs 72.23 ± 36.41 seconds; both p < .001), and a smaller craniovertebral angle (45.37 ± 3.07° vs 51.57 ± 2.06°, p < .001). In multivariable analysis, cervical flexor endurance and craniovertebral angle remained independently associated with migraine status. In the demographic-adjusted sensitivity model, cervical flexor endurance (odds ratio = 0.855, p = .012) and craniovertebral angle (odds ratio = 0.201, p = .001) remained significant predictors of migraine status. The model showed excellent apparent discrimination, with an area under the receiver operating characteristic curve of 0.99.

University students with migraine exhibited reduced core and cervical muscle endurance, along with greater forward head posture, compared with headache-free controls. These findings suggest that migraine in young adults is associated with measurable musculoskeletal impairments, supporting the inclusion of postural alignment and muscle endurance assessment in physiotherapy evaluation and providing direction for future research on targeted rehabilitation strategies. However, because this was a case-control study, the findings should be interpreted as associations rather than causal effects.