Neck Pain and Migraine

A new study offers a better understanding of neck pain associated with migraine, distinguishing it from cervicogenic headache and other neck issues.

Many people with migraine also experience neck pain and stiffness. But they often wonder which one causes the other. Is their neck pain a symptom? Or is it a separate condition causing their migraine symptoms? New research sheds light on the link between the two. It indicates neck pain is a symptom of migraine instead of a cause.

What Is Cervicogenic Headache?

To better understand this research, it’s helpful to know more about a type of headache that involves neck and head pain called cervicogenic headache. This type of headache starts in the cervical spine (neck region). This means head pain arises from problems in the structures of the neck, including the bones, disks and nerves. It’s these areas that cause the pain that goes from the neck to the head. Though some mistake it as migraine, cervicogenic headache is something different.

Cervicogenic headache causes pain that affects one side of the head. Occipital neuralgia, which causes pain due to irritation of the occipital nerve, may also cause one-sided head pain, and sometimes these conditions occur together.

The occipital nerve is located in the back of the head and is connected to the cervical spine. The greater occipital nerve runs up the back of the head, and the lesser occipital nerve runs towards the ear.

Cervicogenic headache often involves a reduced range of motion of the neck. As a result, the headache is made a lot worse through certain movements. As people get older, cervicogenic headache becomes more common because we experience changes in the cervical spine with age. Some people may have arthritis in their cervical spine or other neck problems that cause irritation of the occipital nerve.

Imaging can show if someone has changes in their neck. By treating the neck pain, their headache should also improve. For cervicogenic headache, the first step in treatment is often physical therapy. Other options include an occipital nerve block or medications such as gabapentin, pregabalin, duloxetine or amitriptyline.

New Research on Migraine and Neck Pain

New research looks into the relationship between migraine and neck pain. We talked to Dr. Rashmi Halker Singh, a neurologist at Mayo Clinic, to learn more about this connection. “Neck pain is a very common symptom of migraine. It’s actually much more frequent than nausea,” she says. “And neck pain is also highly predictive of migraine onset.” She explains that about 70 to 80% of people with migraine will have a prodrome phase at the start of their migraine attacks, which acts as a warning that the headache phase of a migraine attack is coming.

People with migraine often visit their doctor for help with their pain. But it’s not always clear what the root cause is. To look into this issue further, researchers recently studied people with episodic migraine (0 to 14 headache days per month), chronic migraine (15 or more headache days per month), people with no migraine at all and people who have only neck pain. “What they found is that about 89% of people who have migraine have neck pain,” Dr. Halker Singh says. “So it was actually just like we thought—neck pain was commonly associated in people who have migraine.” The study also found that people diagnosed with chronic migraine reported the highest neck pain intensity and the most significant neck disability.

During the study, researchers put each person through a set of tests. They used measures typically used to look for structural neck issues, including neck movement range, joint dysfunction and muscle function.

Most people in the study did not have anatomical issues with their necks. The main takeaway of the study, as Dr. Halker Singh explains it: “Just because you have migraine and you have neck pain does not necessarily mean that there’s something wrong with your neck… It’s part of a migraine.” That being said, she is glad the authors noted that it’s important for people to have a personalized assessment to determine whether there are anatomical causes of their neck pain.

What These Findings Mean for People With Migraine

The study found that migraine of this nature does not necessarily indicate that an individual has problems with their neck muscles, tendons, ligaments, connective tissue, or bones (cervical musculoskeletal dysfunction).

Patients with migraine often see Dr. Halker Singh because of neck pain. In these cases, she looks at the patient’s neck, checking for range of motion and sensitivity. She also asks detailed questions about their neck symptoms before creating an individualized care plan. She says the patient should always be given a unique treatment plan because “while most of the time it is still a single problem, which is migraine, sometimes it’s not.”

Dr. Singh finds that typically, by using preventive or acute treatments, her patients can reduce their migraine attacks. They also find that their neck pain improves. She has research to support the relationship between neck pain and migraine. She sees the power in having that proof. “Most of the time, the neck pain ends up being part of the migraine,” she says. “Just explaining to people that that’s what’s going on, that neck pain is part of the migraine, can be really empowering.”

The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.

Reviewed for accuracy by the American Migraine Foundation’s subject matter experts, headache specialists and medical advisers with deep knowledge and training in headache medicine. Click here to read about our editorial board members.