When Migraine is an Actual Pain in the Neck

What’s worse than the pain of migraine pain? Migraine pain accompanied by other uncomfortable symptoms!

An example: neck pain. Your head pain can become extra-uncomfortable if your shoulders and the back of your neck are suddenly tense and achy as well. 

If you experience neck pain with your migraine, you’re not alone — they’re related symptoms for many people. According to Dr. Rashmi Halker Singh, a neurologist at Mayo Clinic, neck pain with migraine is even more common than nausea.

Data from several studies has shown that 70-90% of people with migraine experience some type of neck pain as well, particularly people who live with chronic migraine (15 or more episodes per month). Although most migraine-related neck pain occurs in the upper neck, it may also radiate to the lower neck and/or shoulder. 

Until recently, researchers questioned whether neck pain was typically the cause of a migraine attack…or rather, part of the migraine episode itself. A study published in 2018 found that neck pain tends to be more an actual symptom of migraine than a trigger, and is often felt on the same side as the migraine itself. 

Succeeding research had very similar findings — but data varies on when the neck pain begins and how long it lasts. 

• In a study of 487 people with episodic migraine, 32% began feeling neck pain up to 48 hours before their head pain, during their migraine’s prodrome stage. For another 54%, neck pain came during the headache stage itself. No one reported neck pain post-migraine. 
• In a 2020 study of 50 people with migraine, 89% reported that their head and neck pain often occurred together, beginning and ending at the same time.
• Another recent study found that 32% of participants claimed that neck pain occurred prior to headache; 89%, during migraine; and 28%, after migraine was resolved, during the postdrome stage.

So while a connection between neck pain and migraine is well established, when it occurs can vary from person to person. For some, neck pain is a precursor to their migraine headache; for others, it accompanies head pain or may even follow it.  

‍Common Misdiagnoses

Because neck pain can often precede migraine by a day or two, some people may mistake it for cervical (neck-related) pain syndrome, or for a completely separate head-pain issue like tension headache. One study showed that, in 90% of cases where patients thought they had cervical issues, they were actually experiencing migraine. 

To make things even more complex, true cervical dysfunction has many symptoms in common with migraine, including nausea, dizziness, and weather-related triggers. And, like migraine, it’s sometimes hereditary.

Migraine-related neck pain can also be misinterpreted as a tension headache, as both neck and scalp muscles contract. Typically, however, there’s a fairly distinct difference between tension headache — a dull sensation of pressure on both sides of the head — and migraine — a throbbing headache, often one-sided. And, unlike tension-type headaches, migraines may be amplified by physical activity.

Because neck pain can often precede migraine by a day or two, some people may mistake it for cervical (neck-related) pain syndrome, or for a completely separate head-pain issue like tension headache.

‍Causes of Neck Pain with Migraine

So what causes migraine-related neck pain? While the exact cause is still elusive, possible factors include:

• The trigeminocervical complex: The term is a mouthful but essentially refers to a bundle of pain nerves located within the face and upper neck. It appears that these nerves might be activated during a migraine headache, causing pain to radiate to the upper neck as well. Musculoskeletal issues of the neck and spine can further aggravate this nerve bundle, worsening migraine and triggering more frequent neck pain.

• Joint disease: Age-related wear and tear on neck joints can stimulate pain nerves that travel to the head. And conversely, migraine itself can stimulate these same nerves, leading to neck pain.

• Posture: Poor posture can place strain on the neck and increase tension on shoulders and back. Postural issues are often connected with an individual’s work or lifestyle — gazing at a computer screen or down at a cellphone all day, for example. A study of posture and head positioning determined that a head held upright with good posture weighs about 10 pounds. But, if poor posture causes the head to tilt forward, inch by inch it increases the weight placed on the spine, until that weight almost doubles. This imbalance can put significant strain on neck muscles. 

Poor sleep posture can also aggravate neck pain before, during, or after a migraine episode. Research indicates that sleeping on one’s back or side is best to minimize spinal pressure and position the neck most naturally for rest.  

Treating Neck Pain

Perhaps not surprisingly, the best way to treat your neck pain with migraine is to treat the migraine itself. An effective combination of preventive and acute treatment can help reduce the frequency and lessen the pain of migraine, and will likely also relieve any neck pain that comes with it.

Also, depending on the individual, certain alternative approaches — acupuncture, massage therapy, CBT, relaxation techniques, and physical therapy — may help strengthen neck muscles and promote overall relaxation. Cervical pillows and hot/cold compresses could help relieve a sore neck as well.

For a more severe case of neck pain, your health care professional might recommend trigger point injections. An anesthetic/steroid mixture is injected into muscle knots caused by acute or repetitive trauma and stress on muscle fibers. For people with chronic migraine with intense neck pain, occipital nerve block and Botox injections may be indicated.

To help your physician find the best line of treatment for you, be sure to track triggers or patterns in your migraine-related neck pain. Ask yourself:

• When does my neck pain begin in relation to other symptoms of migraine?
• Does this pain spread throughout my entire neck and head? Or does it affect a single area of my neck?
• How long do my neck pain and/or other migraine symptoms last?
• Does my current migraine treatment relieve my neck pain as well? How well? How quickly is the neck pain resolved?  

Individualized Treatment

The optimum way to manage your migraine — and soothe uncomfortable symptoms like neck pain that accompany it — could be treatment individualized to your unique migraine history and DNA.

Mable’s DNA test can provide valuable information about the genetic causes of your migraines, and suggest the treatments most likely to ease your symptoms. This may save you months experimenting with treatments that ultimately can’t or won’t work for you. Mable offers you telehealth access to a doctor who will carefully review your DNA results and prescribe medication based on them.

For now, the customized approach you’ll get with Mable may be the closest to a migraine “cure” for you — your most informed, most effective treatment. Ready to get started? Take the Mable quiz.

Questions about Mable? Visit our Help Center.