Neck Pain: A Missing Piece of the Migraine Puzzle?

Everyone knows about headache, nausea, visual auras – maybe even vertigo or congestion.  These are all possible symptoms of a migraine attack.  And then there are comorbid disorders, such as depression or IBS.

But how often do we talk about neck pain when we talk about migraine?

Of course we talk about it – sometimes.  But a recent study questions whether we should be talking about it a lot more.

Neck Pain and Migraine

Some researchers in Brazil have been probing into the link between neck pain and migraine.  One of their recent studies was published in the Journal Headache.

The question was not whether or not migraine patients have neck pain.  It was more a question of disability.

But let’s go back a step.  In 2010, in a study entitled The Prevalence of Neck Pain in Migraine, researchers discovered that neck pain was actually more likely to accompany migraine than nausea.

As the migraine attack progressed, nausea (if present) tended to increase, but so did neck pain.

Also, the more attacks a person had per month, the more likely they were to experience nausea.  But the neck pain also increased, remaining more common than nausea.

Now, of course, if you’re nauseous and your neck hurts, usually the neck pain will be ignored and the nausea will be treated, because you can function somewhat with neck pain (if it isn’t too severe), whereas nausea can keep you from just about any activity.

Now, back to the more recent study.  The study discovered that not only was neck pain present, but it was disabling.  For some people it was more disabling than others, but 69% of those with episodic migraine had some disability from neck pain, and 92% of those with chronic migraine had some disability from neck pain!

So what have we learned so far?  Neck pain is associated with migraine.  More than a co-morbid condition, neck pain seems to rise and fall with individual migraine attacks.  Neck pain is also worse for those with chronic migraine.

Research over the past few years, including the recent study, are showing not only that migraine and neck pain are related, but that neck pain seems to be a symptom of migraine.  In fact, it may be a very common symptom of migraine.  On top of that, it seems to be a significantly disabling symptom of migraine.

A lot of questions remain, of course.  Is the migraine attack contributing to the neck pain, or vice versa?  Or could the neck pain and migraine rise from a common cause?  The answer may be a mix of all three, and research in Brazil and elsewhere continues to investigate just where this neck pain is coming from and what its characteristics are.

Meanwhile, those of us with migraine need to pay attention to neck pain as a possible symptom of our migraine attacks.  It’s something that should find its way into migraine diaries and discussions with our doctor.

Researchers in 2010 also discovered that patients delayed treating migraine when neck pain was present.  It’s possible that our lack of understanding of the relationship is keeping us from recognizing a migraine attack.  If you pay attention to neck pain symptoms, you may be able to recognize a migraine attack faster and treat it earlier.

What about you?  Do you experience neck pain with migraine attacks?  Tell us about it!

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21 comments… add one
  • Rilla4 Aug 7, 2014

    I am a Chronic Daily and Hemiplegic Migraineur. My chronic migraines are 24/7, and never less than “5” on the pain scale. My first migraine was in 1956 when I was four years old. I don’t remember having any neck pain then, but I definitely did during my thirties and growing progressively worse as I aged. Now as my migraine builds, so does my neck pain. My neck gets stiff, sore, and warm to the touch. I can hear the “crunching, snapping and popping” sound as I turn my head side to side and all around. During my migraine the pain is not only is on one side of my head but whichever side it’s on, it goes down into that side of my neck, upper back, shoulder and arm. It also seems to make my nausea worsen as my neck becomes more painful. My migraines affect every part of my life and health in almost every way possible.

    • Colleen Aug 7, 2014

      Hi Rilla4, I had a fall off a ladder and injured my neck in 2007 which started chronic migraines which became 24/7. I had a 4 level neck fusion in 2010 and migraines progressed. I have tried every drug possible to relieve the pain and still to this day when I get a migraine. I take Maxalt, ondrestrom for nausea, sumatriptan injections. The one and ONLY thing that I get relief from migraines is getting Botox A injections every 12 weeks (a total of 31 injections from my neurologist. Dr. Schim by the way was 1 of the 2 Doctors who got botox A approved to use for migraines in 2010. I dropped to 97 pounds and was so very ill I never left my house and could not eat anything but jello, yogurt and pudding for 3 months. I was ready & pretty much asking God to let me come to him and just die. I spent about 23 1/2 hours a day in my bed in the dark in severe migraines. I would suggest if these are daily migraines search botox A for migraines and they will tell you who in your area is qualified to give you these injections. If you really want help I would do that since I don’t know what you have taken. Also Elavil taken once a night in evening helps reduce nerve pain in shoulders, neck, and nerves in head which bring on the migraines. Botox is covered by medical insurance if deemed fit which you sound like you do. I have tried 8 different medications and botox finally saved me. Also have you had a MRI on your neck? Do you have numbness in arms, hands, calfs or feet? If you do you probably have a neck cervical injury. During migraines I can not look at TV computer or even take any noise including talking to my sons. I am not a doctor but if you are seriously that bad I would suggest you seeing a neurologist and getting on oral medications and sumatriptan injections for migraines. If you have already done oral medications and injections than get botox A so you can lead a normal life. There is relief out there and it is achievable. Also if you don’t have the money to get the injections every 12 weeks, I would also suggest a new product in Belgium that has produced and manufactured. I have 2 friends that say this does help and only takes 3 minutes to diminish you migraine. You put it on your head that produces electrical shocks and migraine is gone in 3 minutes. I have never used this but they say it works. The product is called Cefay and it only cost $ 299.00 American dollars and is new on market. The FDA has not approved it yet but you can buy it through Canada online but you need your Doctor to fax a Prescription in your name to purchase it . It is available in most countries and that too could also be a cheaper way to take care of your migraines. Also the botox is not only put in your head but also down your neck and shoulders if that is where the pain starts that produces your migraines. I wish you the best of luck to lead a reduced migraine life like I have finally achieved in 2012.

      • Rilla4 Aug 9, 2014

        Colleen, I want to thank you so very much for your reply to me. I do know about Botox and Sumatriptan, but I can not take either. You see, I have a rather long and complicated medical history with many serious health problems. As of the past ten years or so, these conditions have advanced to the point that all of the Preventive Medications are contra indicated for me. I have not tried Cefay, but before I would spend the money on a treatment which only has a “fair” response from many who have tried it, I would like a trail period first. The blocks and surgeries are also contra indicated for me. As for an MRI, I do very much need one. However, under my insurance plan they will not put me under full sedation. With my extreme Claustrophobia, they can’t even put me in the same room with the machine without me going into a seizure and passing out, which also includes the “Open Air” MRI. By the way, those seizures are from migraine induced epilepsy. I also have migraine induced Prinzmetal’s Angina, and with the hemiplegic migraines, I’ve had four migraine induced strokes. They were fairly small strokes, but strokes none the less with deficits. I’m left with the use of Rescue Medicines only. I do take a Calcium Channel Blocker, but it’s for the Prinzmetal’s Angina not my migraines.
        I have had a few things happen to me which undoubtedly had a worsening effect on my migraines. In Junior High, I fell and sustained a severe concussion to the back of my head, and in the early 80’s, I contracted Viral Meningitis, after which I was told by the doctor, that if I had migraines, they would definitely be worse. They were. I also have a shortened, misshapen vertebrae in my neck as well as arthritis. I would like to ask my doctor for muscle relaxer for my neck, back and shoulders. I just never remember to ask her when I see her … even when I write a note to remind me! ; – }
        As far as my sister and I have been able to trace it back, we are third generation migraineurs from both sides of our parents. All four of my children have migraines, and my four year old granddaughter also has migraines, and hers started when she was three. I would also like to get the genetic testing done to see which mutation I have.

        • Charmaine Scott Jul 1, 2017

          You and I have the exact same medical issues. Please message me.

    • Peter S. May 26, 2016

      Hello Cheryl!

      Sorry to hear that. Yes, I’ve the same problem like you. So I get Botox A in several areas of the neck, head and forehead. I know, that this form of migrain is a mixen form of tension headache and migrain. So the goal is to get the tension away so that a migrain attack can be avoided.

      Botox can relax muscles because the nerven that do the tension be disabled. The therapy must be repeated every four month.

      Hope that could hell you. Thank you for sharing your story and yes: Migrain can be triggern from neck pain.

      Sincerely Peter

  • Carol H. Aug 7, 2014

    Yes, neck pain ALWAYS with migraine. When I was first diagnosed with migraine by a neurologist, he had an MRI done which showed advanced degenerative disc disease. (I was 52 years at the time)
    I never have neck pain without the migraine, and it is chronic migraine. Rarely do I have a couple of days symptom free.
    I’ve become quite “disabled” by these migraines.

    Thank you for this blog James. I’ve learned more from it than anywhere else. The doctors are pretty much no help except for prescriptions. I’ve tried almost everything but draw the line at botox.

    I’ve tried hyperbaric oxygen treatment for 40 sessions with no affect except the one symptom of “smelling burning plastic” ceased and hasn’t returned in the 1 year since treatments ended.

    • Colleen Aug 7, 2014

      Carol H. If you wish to read what I just wrote to Rilla4 I think you will find the information that I have provided to here in a reply helpful. If you can not read her reply I will copy and paste it to you.

      • Carol H. Aug 7, 2014

        Colleen: Thank you for all the info. I’m wondering about the Cefay. I will have to get back to the neurologist and see about another course of action.
        You’ve given me much to look at in your reply to Rilla4.
        I appreciate all of that. Looks like many with migraine have been through so much. Thank you again!

  • Peter S. Aug 12, 2014

    Hello together!

    First the neck has cold sweat and ends up with neck pain. The neck pain also begins to pulsate. If it is pulsating then its going to
    the back of the head on the left side. It feels like a hammer which is beating the occiput. After a short time the pulsating is reaching the left temple.

    Boom! The migrain is there. It’s almost on the left side, somtimes on the right or in the middle of the head or between the eyebrows.

    Somtimes it starts also with a prickling on the occiput and short after that the neck pain is starting. If the neckpain started then
    the migrain started like the describing above.

    This is the symptoms that I have before a migrain starts.


    Peter S.

  • denise Aug 14, 2014

    I absolutely suffer with severe neck pain with migraines almost every single time which makes it that much harder to function! I also get sharp shooting pain on right side of my head that goes to my face (near my ear) and neck and when that happens i’m a goner for a minimum of 3 to 4 days 🙁

  • Trish Aug 21, 2014

    I have been receiving IMS… a deep form of acupuncture in my neck and back for several months. In the two years of keeping stats on my sumitriptan use, it has made a significant reduction in the number of migraines.
    I am a lifelong migraineur, with a history of neck trauma and I am particularly subject to barometric effects, being more accurate than the Meteorologists in predicting
    rain etc 48 hrs in advance. My Physiotherapist/Acupuncturist also
    put “seeds” in my ears on the French acupuncture “Weather spot”
    so I have successfully averted migraine by applying pressure to
    the base of my skull, neck and these “ear seeds.”

  • Cyndi wilkins Aug 28, 2014

    I have been a chronic migraine patient since the age of twelve. These attacks were frequent ( 2 or more a month) and severely debilitating throughout my youth. Fortunately, as I have gotten older and take a low dose cardiac drug daily,the frequency and severity of these attacks has diminished over the years.
    I struggled with the effects of pain meds for years, only to discover they did nothing to manage these attacks and they incapacitated me even further.
    Since beginning therapy with the cardiac drug (over 15 years ago), I have had continued success in managing them.
    Neck and shoulder pain seem to be a constant for me now, (even low back pain, but I’m not sure it is related.) I prefer that over a migraine any day!

  • Karen Dec 22, 2014

    My son and I both get migraines, as do many people in our family. We go to a chiropractor once a week and it really helps to reduce muscle tension from migraines and prevent them too. Insurance has covered it so far.

    I have no underlying neck issues other than chronic muscle tension and a few cases of whiplash that got better. My son had a mild concussion but I don’t think that’s a factor in his migraines.

    My son, who is 12, uses the Cefaly headband. I think it does help cut down on his migraines. It does not give you a shock. It’s more like a vibration. It works best if you use it regularly, and it does not stop migraines for most people but it cuts down on the frequency.

  • Peter S. Dec 22, 2014

    Hello Karen!

    A neurologist tells me, that neckpain is comorbid with migraine

    If it is muscle tension you can try hot packs. It relax the muscle tension or you can use a salve which contains capsaicin the hot component of chilly. Be careful to use it. It’s better to use a pair of gloves to rub it onto the neck and schoulders. Do stretching exercises regular. In the cold time in winter use a scarf to wrap it around your neck. Keep the neck as warm as possible.

    Hope it’ s help you to prevent muscle tension in the neck shoulder area.

    Sincerely Peter S.

  • Cheryl Dec 28, 2014

    My neck helps signal a migraine coming. I can trigger a migraine by rubbing the occipital nerve in my neck. I started taking gabapentin 6 months to try to prevent/reduce my chronic headaches. Jury is still out on its effectiveness. Accupuncture helped but I am too sensitive to the energy it stimulates. Accupressure does not seem to help. Had these headaches for nearly 60 years and they continue to get worse. Have tried straight oxygen, chiropractors, meditation, all the migraine drugs. The only thing I can count on is ibuprofren at the first sign of the headache and resting. And, there are times that does not work either (sigh).

  • Bonnie K. Dec 29, 2014

    I have the hypermobility form of Ehlers-Danlos Syndrome, a genetic collagen disorder that causes a hyper-laxity of the joints and tissues.

    I got my first migraine at about 6 yrs. of age. I am now in my 50s. They have varied in frequency and severity through the years, but the worst was a period of seven years after a fall down the stairs in 2007 during which time I had migraine 15-25 days/month. Neck pain always preceded or accompanied these migraines. I needed anti-epileptic drugs and both preventative and abortive drugs to deal with them. After much research I came across an article on cervicogenic headaches which led me to seek out an Upper Cervical Chiropractor. After a few years of treatments with this type of chiropractor, I now get 1 migraine every month or two and am off most of the migraine drugs.

    I know this info will not apply to everyone with neck pain/migraine, but this is worth a bit of investigation if you think you may be loose jointed and have problems with subluxation of the neck vertebrae. My greatest problem is in the C-1/C2 vertebrae just beneath the skull.

    Please always be very careful to do a thorough interview before trying this type of treatment and make sure they are knowledgeable about EDS before treatment if you have the syndrome.

    There are also some people with EDS who have Chiari Malformation Syndrome in which the brain stem sinks down and protrudes into the upper vertebrae and can cause neck pain and migraine.

    Just another possible avenue of research for those of us who are dealing with this.

  • Amber Dec 30, 2014

    Just the last few years have I begun to connect neck pain or neck strain with a migraine. I can cause a migraine to come on by looking up for more than 2-3 minutes. Once it comes on, and if I don’t take medication early, the migraine can last for days. My migraines were periodic and not debilitating for about 20 years, then all of a sudden they blew me away and I had one continually for 6 months. I could not work or function and wanted to die. The neurologist and I were able to get the migraines down to one or two a week with a handful of pills, some daily and some when the migraine came on. Acupuncture helped me get off the daily medication, but I still take midrin and indomethicin when a migraine comes on. I also get nauseated with them. The head pain feels like an ice pick above my left temple. A very deep tissue massage helps sometimes. I’ve also been diagnosed with colitis which I’m now reading there is believed to be an association between gut problems and migraines. What a life we lead! Thank you for all your helpful information.

  • Patricia Mar 22, 2015

    It seems I have had migraines since the age of 12. I never associated migraines and neck pain until recently. Couple of weeks ago my neck was hurting so bad. It hurt to move it or lay my head on a pillow. I also had a migraine. When I took an Imitrex for the migraine, my neck pain went away. I thoght it was a coincidence until I took Imitrex again for a migraine (had neck pain too). The pain went away. Wow. I’m so happy to discover a way to stop my severe neck pain.

    • Kristin Apr 28, 2017

      I too have found that imitrex helps my neck pain. It does something that no muscle relaxers or pain killers could ever do for my neck. I’m not sure if it’s because my neck pain is associated with migraines or if it’s because it feels like it does something to my muscles. I take it when my neck pain is bad and not necessarily when there’s head pain associated.

  • Wendy Harrison Mar 23, 2015

    I’ve had neck pain with migraine for several years now but only mad the link when my migraines went from being episodic to chronic 2 years ago. Sometimes I get one-sided neck pain before the migraine starts, sometimes it happens during the migraine and sometimes after. First of all my neck feels stiff then the pain starts; it feels like toothache in my neck and the muscle between my neck and shoulder tightens up. Often the pain radiates down my shoulder and arm to my wrist. I’ve been told I have moderate arthritis in my neck and wonder if there’s a link BUT the pain I get from an arthritis flare-up is completely different from the neck pain I have when I have migraine – which makes me think they’re two separate things. It’s good to know that other people experience neck pain with migraine, as it isn’t often mentioned as a symptom.

  • Dr. Cheryl Garrett May 24, 2016

    Hello everyone. I just discovered this site and this one: which is EXACTLY what I experience. I now live and teach university in China so Imitrex is unavailable to me but they have another triptan drug which is somewhat effective. I had been being treated by a neurologist at home after completing my PhD in 2012 in the UK with a daily medication (as I have a migraine right now at work I can’t remember what it was called but it started with a ‘t’ and helped reduce my migraine attacks) and 100 mg of Sumaptriptan (Imitrex) as needed. I was getting up to 10 per month but they seem to be reduced to about 4-5 per month here in China as I am sleeping on a very hard bed even without the daily medication. I’ve also only got one pillow as I find if I prop up my neck at a weird angle for too long, I WILL get a migraine. Sleeping on my side naturally is a problem for this as well.
    I have always known that the pain originated in my neck – several neck injuries over the years including an extremely abusive ex-husband who slammed a Mason jar into the L side of my head and a bad fall in 1994 at age 30 which resulted in me being unconscious and a severe concussion – along with other more minor blows to the head at times). At any rate, I am *so glad* that this issue is finally seeing the light of day. It used to be that if I mentioned neck pain to the doctor they would say it wasn’t a migraine so I stopped even discussing the neck pain. Such fools doctors can be until ‘one of their own’ publishes something peer-reviewed. As an historian, I get abused all the time by the so-called ‘knowledgable public’ who honestly don’t know squat about what I do or know but why, oh why, don’t medical doctors/professionals listen more to their patients who know more about their own bodies and lives, and what is causing the problems usually? I have been treated like I was ‘seeking drugs’ and/or like an idiot for seeking attention for pain.

    Thank you, thank you, thank you and I am thrilled to see that FINALLY the medical community is making the connection to neck pain and migraines after what I ahve known about them for nearly 20 years! I mean, yes, I am obviously intelligent but come on…. I am no doctor. I just knew that I had severe neck pain, and that a triptan drug would work for me. So what if the migraines were triggered by neck pain? If the medication works – give it someone who needs it for goodness sake!

    BTW – I started getting migraines whilst still an undergraduate in the late 1980’s after giving birth to my daughter which was very hard on my back from the awful bed in which I had to sleep. I suspect this is when the neck pain/etc really began as it seems like where my neck and back join – the bottom of C7/top of T1 is constantly, in my case, painful to the touch. This also seems to be a difficult spot for chiropractors to manipulate for some reason. Massage helps a great deal but I have a difficult with self-massage and it is all I can do not to scream at my Chinese students who need my help when I am suffering as I am today.

    Thank you for reading (if you did) and allowing me to get this off my chest. I am so thrilled this is finally becoming ‘a thing’ that we don’t need to hide anymore. It’s about time medical professionals made this connection!

    Best Wishes to all my fellow migraine sufferers worldwide.

    Dr. Cheryl L. Garrett
    ICB at CAU, Beijing

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