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  • Writer's pictureSam Kelokates

What does it mean when you have a migraine and your neck hurts?

Have you ever had a headache that felt like it was taking over your whole head, you just wanted to be in a dark room, and your neck felt stiff and achy all at the same time. If so, you're not alone.

Many people who experience migraine also deal with chronic neck pain. Migraine and a neck spells double-trouble.

You might be surprised to learn how common migraine is, as well as neck pain. Migraine affects around 15% of the population, which means millions of people around the world are dealing with migraine.

And more than 77% of people with migraine report also experiencing neck pain.

Not only does migraine cause a lot of personal suffering, but it also has a big impact on society. Migraine is a leading cause of disability globally, especially among those under 50 years old.

So, What is a Migraine?

Linking Neck Pain and Migraine

What's Happening in Your Neck?

Seeking Help


So, What is a Migraine?

Migraine is not just a simple headache. It's a neurological condition that often comes with some specific symptoms. A headache is just one of the many symptoms that can occur for those suffering from migraine.

These symptoms can include a throbbing headache that is usually on one side of your head and can be intense, but it can be on both sides. You might find that bright lights or loud noises make you feel even worse, this is known as photophobia and phonophobia, respectively. People experiencing a migraine attack may feel nauseous and even throw up.

Now you may be wondering why neck pain is such a common issue in migraine, and what it might mean.

Linking Neck Pain and Migraine

If you're someone who experiences migraine, you might be familiar with neck pain, and wonder if it's causing your headache. The connection between these two conditions might seem puzzling, but it's not as mysterious as it first appears.

Trigeminocervical Nucleus: Where It All Comes Together

At the center of migraine and neck pain is an area of the brainstem called the trigeminocervical nucleus (TCN). It's like a busy super highway where nerve signals from your headache, face, and neck converge. This nucleus is known to be involved in migraine.

This nucleus plays an important role in processing sensory information from the face, head, and neck. It acts as a relay center for transmitting pain signals from these areas to the brain.

The trigeminocervical nucleus plays an important role in both migraine and neck pain due to its location in the brainstem where the trigeminal nerve (cranial nerve V) and upper cervical nerves come together and interact.

In migraine, the activation of the TCN is of particular significance. During a migraine episode or episode, there is often increased activity of the trigeminal nerve, leading to the release of neuropeptides and the initiation of inflammation around blood vessels in the brain.

This series events of a neural activity contributes to the perception of head pain and other characteristic migraine symptoms such as nausea, and sensitivity to light and sound.

Similarly, in neck pain, especially when it is related to issues like muscle strain or tension, the trigeminocervical nucleus can be involved in the processing of pain signals originating from the neck region.

Sensitization of this nucleus can lead to heightened pain perception and may contribute to the onset or exacerbation of both migraine and neck pain.

While the precise mechanisms and interactions within the TCN are still being studied, its role in processing pain signals from the head and neck emphasizes its importance in understanding and treating these conditions.

What's Happening in Your Neck?

When it comes to migraine and neck pain, your neck isn't just a passive bystander; it plays an active role in this complex relationship. So what's happening in your neck.

Cervical Musculoskeletal Impairments

These impairments involve the musculoskeletal structures of your neck. They may include problems with the muscles, ligaments, and joints in this area. While you might think of migraine as primarily related to the heada, it can have a big effect on your neck.

Impairments associated with Neck Pain:

  • Reduced Flexibility: Migraine patients often experience reduced flexibility in their necks, particularly during a migraine attack. This reduced range of motion can contribute to neck pain and discomfort.

  • Trigger Points: Muscles in the neck can develop trigger points, which are tight knots of muscle fibers. These trigger points can refer pain to other areas, including the head and face, contributing to migraine-associated neck pain.

  • Posture Problems: Some migraine sufferers may develop poor posture due to the pain and discomfort they experience during an attack. This can lead to chronic neck pain, which may persist even between migraine episodes.

  • Increased Sensitivity: Migraines can heighten the sensitivity of the nerves in the neck, making you more susceptible to pain. Even the slightest muscle tension or strain can lead to significant discomfort.

Understanding these musculoskeletal impairments in your neck is crucial. They can both contribute to neck pain during migraine attacks, but may also be caused by the frequent migraine episodes.

Differentiating Neck Pain in the Phases of Migraine

Understanding neck pain during migraine is not so straight forward as it may seem. Neck pain can occur at different phases of the migraine attack. Each phase has its characteristics and challenges.

1. Premonitory Symptoms

Before the headache-phase of the migraine attack, many individuals experience premonitory symptoms. These are like early warning signs that something isn't quite right and an attack incoming.

Some patients report onset of neck stiffness, tension, or discomfort during this phase. It's crucial to recognize these symptoms as potential indicators of an impending attack. This would be a time of action.

2. Interictal Neck Pain

The interictal phase is the time between migraine attacks. This is the time between migraine attacks.

During this period, some people continue to experience neck pain or discomfort. It can be a lingering effect from the previous migraine, or a sign that another one might be on the horizon, or a sign of another source of neck pain.

3. Ictal Neck Pain

The ictal phase is when you're actively experiencing a migraine attack. Neck pain during this phase is a hallmark feature for many people with migraine. It's often described as a throbbing or aching sensation in the neck and may even involve the shoulders and upper back as well.

The Challenge of Distinguishing Between Them

One of the challenges with neck pain and migraine is distinguishing which phase it's associated with.

Premonitory symptoms can sometimes be mistaken for tension or stress-related neck pain. Interictal neck pain may blend with everyday discomfort, making it difficult to link to migraines.

And during a full-blown attack, it's easy to attribute all discomfort to the migraine itself.

The Importance of Keeping a Migraine Diary

To better understand and manage your migraine-related neck pain, keeping a migraine diary or journal can be beneficial. Recording the time of onset, how long it lasted, and the intensity of your neck pain, along with any associated symptoms or triggers.

This can assist you in pinpointing which phase the pain occurs, but also provide important information that can be shared with your doctor or other healthcare provider. They can use this information to customize your treatment plan more effectively.

By recognizing the different phases of neck pain in migraine, you can take proactive steps to manage and alleviate your discomfort, improving your overall quality of life.

Seeking Professional Help

When it comes to managing migraines and neck pain, you don't have to go it alone.

Healthcare providers can play a crucial role in helping you understand, treat, and find relief from these challenging symptoms.

The Role of Healthcare Providers in Migraine & Neck Pain

Your first step in addressing migraine and neck pain should be consulting a healthcare provider. They can help confirm your diagnosis, rule out other potential causes, and create a personalized treatment plan.

Here are the healthcare professionals that should be on your team:

  • Primary Care Physician: Your primary care doctor can assess your symptoms, provide initial guidance, and refer you to specialists if necessary.

  • Neurologist: A neurologist specializes in conditions affecting the nervous system. Ideally a neurologist who is a Headache Specialist is preferred as they are best-suited to diagnose and manage migraine.

  • Pain Management Specialist: For more severe or chronic neck pain, a pain management specialist can offer advanced treatments and interventions.

  • Physical Therapist: Physical therapists are experts in musculoskeletal and neurologic conditions. We can help address neck pain and migraine through exercise and other techniques.

Physical Therapy and Rehabilitation

Physical therapy can be an invaluable part of your treatment plan for migraine with neck pain. A skilled physical therapist can:

  • Assess your musculoskeletal function to identify areas of weakness, impaired mobility, increased areas of sensitization, and motor control issues.

  • Develop individualized treatment programs to improve neck and shoulder strength and flexibility.

  • Teach relaxation techniques and postural adjustments to reduce strain on your neck.

  • Provide manual therapy as appropriate to decrease pain and improve function.

Read more here: Physical Therapy for Migraine

How to Find the Right Specialist for Your Needs

Finding the right specialist for your migraine and neck pain can help with effective management. Here are some steps to help you find the right healthcare provider:

  • Ask for Referrals: Start by asking your primary care physician for referrals to specialists who have experience with migraines and neck pain.

  • Research and Reviews: Look for providers online, read reviews, and check their credentials. Online reviews and recommendations from trusted sources can provide insight into a provider's reputation.

  • Consultation: Schedule consultations with potential specialists to discuss your condition, treatment options, and their approach to care. This will also help you assess your comfort level with the provider.

  • Patient Advocacy Groups: Consider reaching out to migraine and headache patient advocacy groups for recommendations and resources.

Seeking professional help is a significant step toward effectively managing your migraines and neck pain. With the guidance of healthcare providers and the potential benefits of physical therapy, you can work towards finding relief and improving your quality of life.


  • Common Occurrence: Neck pain is a common companion to migraines, affecting many individuals who experience this debilitating headache disorder.

  • The Migraine Impact: Migraine can significantly impact the lives of those who suffer from attacks, often causing not only head pain but other extremely debilitating symptoms.

  • Musculoskeletal Impairments: Musculoskeletal impairments in the neck area can contribute to neck pain during migraine, making it essential to address both aspects of the condition.

  • Differentiating Neck Pain Phases: Migraine can manifest with neck pain during various phases. These include the premonitory phase, interictal phase, and ictal phase.

If you're someone who experiences migraine with neck pain, please know that you don't have to suffer in silence.

Reach out to healthcare professionals who can help you understand and manage your condition effectively. There's a wealth of resources and treatments available to improve your quality of life.

Remember, you're not alone in this journey, and there's hope for better days ahead. By seeking help, staying informed, and taking an active role in your healthcare, you can work towards finding relief from migraines and neck pain.

About Me: Hi, my name is Sam Kelokates, PT, DPT. I am a licensed physical therapist and owner of Kelos Physical Therapy. Located in Philadelphia, PA and King of Prussia, PA. I specialize in the non-pharmacological management of headache and migraine disorders.

Disclaimers: This blog post is for informational purposes only and should not replace professional medical advice or treatment. Always consult with a qualified healthcare provider for personalized guidance and recommendations. **I may earn commissions for purchases made through the links in this post**

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