Pain beyond the head: clinical implications of body pain in migraine and tension-type headache in a population-based study

Abstract Background Body pain significantly affects the quality of life. However, the relationship between headache and pain across broad body regions remains unclear. This population-based cross-sectional study aimed to investigate the prevalence and impact of body pain in migraine and tension-type headache (TTH). Methods We analyzed baseline data from 2,548 participants in the Korean population-based Circannual Change in Headache and Sleep study. Participants were classified into migraine (n = 145), TTH (n = 805), and no-headache (n = 920) groups. Body pain was assessed across 19 regions using the Widespread Pain Index (WPI). Multivariable analyses adjusted for age, sex, and psychiatric symptoms were performed. Results Body pain was more widespread in the migraine and TTH than in the no-headache group, showing a gradient of migraine > TTH > no-headache (P < 0.001). Migraine was most strongly associated with neck pain (odds ratio [OR] 2.84, P = 0.008), whereas TTH showed the strongest association with upper back pain (OR 2.74, P = 0.008). Higher WPI and body-pain intensity were associated with higher headache intensity, more monthly headache days, more monthly severe headache days, and higher HIT-6 scores, as well as poorer quality of life and greater depression, anxiety, and insomnia (all P < 0.001). Axial body pain was associated with higher monthly headache days in migraine, whereas upper body pain was associated with higher monthly headache/severe headache days in TTH. Conclusions Body pain is more prevalent and widespread in patients with migraine and TTH and is associated with a greater disease burden, potentially reflecting central sensitization. Distinct patterns of regional pain, particularly neck pain in migraine and upper back pain in TTH, may provide clinically relevant insights into underlying nociceptive mechanisms. Graphical Abstract