A review of 14 studies found that people
with persistent headache or back pain
were twice as likely to experience the
other disorder as well.

New research finds a strong association between
headaches and lower back pain.

Chronic headaches and persistent back pain are
both debilitating conditions. New findings suggest a
link between the two, potentially charting a new
course for more effective treatment.

Chronic headaches and back pain both appear in
the top five causes of years lived with disability.

Healthcare professionals often treat the conditions
separately, but there is a theory that in some
people, they appear together. Therefore, treating
both as one disorder may provide better results.

Up to 4% of individuals in the global adult
population have headaches on 15 or more days of
every month, according to the World Health
Organization (WHO).

Meanwhile, about 80% of adults experience low
back pain at least once in their lifetime, according
to the National Institute of Neurological Disorders
and Stroke, and approximately 20% of these people
go on to develop chronic low back pain.

In 2013, a German study found a link between low
back pain and both chronic migraine and chronic
tension-type headaches.

Now, researchers from the University of Warwick,
United Kingdom, appear to have found an even
stronger association.

Double the odds
Appearing in the Journal of Headache and Pain, their
review involved 14 studies with a range of sample
sizes. The smallest study included 88 participants,
while the largest involved 404,206 individuals.

One type of headache and a particular back pain
disorder were the focus: chronic headaches and
persistent low back pain. The team notes the
definitions of these conditions, describing the
former as headaches that occur on the majority of
days for a minimum of 3 months and the latter as
pain "between the bottom of the rib cage and the
buttock creases" for the same period.

The review found that all the studies shared a
similar positive association between the two
conditions. However, the odds of experiencing both
conditions varied widely between the studies from
less than twice as likely to eight times as likely.
This meant that the researchers were unable to pool
the data in a combined statistical analysis.

However, Prof. Martin Underwood notes, "[i]n most
of the studies, we found that the odds were about
double — either way, you're about twice as likely to
have headaches or chronic low back pain in the
presence of the other."

For people experiencing migraine ⁠— the third most
prevalent illness in the world ⁠— the link was even
stronger.

A few limitations exist, namely that inconsistent
study designs and populations and varying
definitions of the disorders may have weakened the
quality of the results.

Still, the findings are "very interesting," notes Prof.
Martin Underwood, from Warwick Medical School,
"because typically these have been looked at as
separate disorders and then managed by different
people."

"But this makes you think that there might be, at
least for some people, some commonality in what
is causing the problem."

Combining treatments
The researchers are not yet sure of the potential
shared cause, but they have some theories. One,
explains Prof. Underwood, is that there may be "an
underpinning biological relationship" in some people
with headaches and back pain.

"There may be something in the relationship
between how people react to the pain," he says,
"making some people more sensitive to both the
physical causes of the headache, particularly
migraine, and the physical causes in the back, and
how the body reacts to that and how you become
disabled by it."

Such a cause could be a target for treatment. In
fact, the team thinks that a joint approach may be
best.

Right now, drugs are available to treat chronic
headaches. Some people try a range of holistic
remedies too. 

Back pain, meanwhile, may require a
combination of exercise and psychological therapy.
Ensuring that people with both disorders receive
appropriate support and management techniques
could well help their quality of life.

 A combined
treatment method could also provide a financial
benefit by reducing the number of medication
prescriptions.