Neck musculoskeletal dysfunction in patients with chronic primary headaches

To compare cervical musculoskeletal findings in chronic forms of migraine, tension-type headache, cluster headache, and healthy controls and identify which variables were most strongly associated with headache frequency, neck disability and impact in each headache group. Single-blinded cross-sectional study with a non-probabilistic sample. A blinded physiotherapist assessed 129 participants: chronic migraine ( n = 35), chronic tension-type headache ( n = 30), chronic cluster headache ( n = 34) and headache-free controls ( n = 30). Psychosocial and cervical musculoskeletal variables (head posture, total cervical active range of motion, flexion–rotation test, motor control, symptom reproduction and resolution) were compared. Backward linear regression analyses were performed to explore associations between cervical variables and headache frequency. neck disability and headache-related impact. Compared to controls, chronic cluster headache showed reduced total cervical active range of motion [F(3,128) = 8.8; p = 0.001, d = 0.75], retraction [F(3,128) = 4.66; p = 0.007, d = 0.70], protraction [F(3,128) = 7.77; p = 0.017, d = 0.73] and flexion–rotation [F(3,128) = 3.68; p = 0.014, d = 0.72]. While sex confounded total active range of motion ( p = 0.009); neither variable influenced protraction or retraction (all p ≥ 0.26). Familiar head pain was evoked more in chronic migraine (68.6%) and tension-type headache (72.4%) than controls (23.3%) [χ²(1) = 20.85; p = 0.008; χ²(1) = 29.99; p = 0.0003]. Erector spinae activity was negatively associated with cluster headache frequency (Adjusted R²=0.25; β=−0.65; p = 0.02), cervical retraction was negatively associated with migraine frequency (Adjusted R²=0.11; β=−1.58; p = 0.03), and no significant associations were found for tension-type headache. This study provides the first comprehensive assessment of cervical musculoskeletal function in chronic cluster headache and directly compares it with the main chronic primary headaches and free-headache control group. Chronic cluster headache showed reduced cervical range of motion and impaired flexion–rotation versus controls; Although some differences between headache groups were observed, cervical musculoskeletal impairments were broadly present across chronic headache populations, without a clearly distinctive disorder-specific pattern. Neck musculoskeletal findings were not associated with headache frequency or impact.