If you often have neck pain during a migraine attack, you may wonder if it’s a sign of something more serious, or possibly not a migraine at all.
“Although there can be other underlying reasons for neck pain that comes with a headache, it’s a common symptom of migraine headaches,” says Sandhya Kumar, MD, a neurologist who specializes in headaches at Wake Forest Baptist Health in Winston Salem, North Carolina.
It’s also possible for neck pain to be associated with different types of headache other than migraine, says Dr. Kumar.
If you’re not sure if your neck pain is a related to your migraine attacks, or if the pain is in fact causing your headache, keep reading to find out more about how neck pain and head pain are linked.
Is Neck Pain a Symptom of Migraine?
Neck pain can be one of many symptoms experienced in migraine, and the neck pain is often in the same side as the headache, says Kumar. “So, if a person has a right-sided headache during the migraine attack, they will have neck pain and tightness in the right side of the neck,” she says.
“Neck pain in migraine is especially common in people with chronic migraine,” says Kumar. Chronic migraine is a headache occurring on 15 or more days every month for more than three months, according to the International Headache Society.
“Almost 80 percent of people with chronic migraine will have neck pain as an associated symptom,” says Kumar.
There is some debate about whether neck pain triggers a migraine attack or is a symptom. A study published in 2018 in the Journal of Headache and Pain used electromyography to measure activity in the trapezius muscle (the large back muscle that extends from the back of the head and neck to the shoulders) during rest, mental stress, and physical activity in people with migraine compared with people with other types of headaches. Investigators concluded that neck pain was more likely a symptom of migraine than a trigger.
Neck Pain Can Be Associated With Tension Headaches
Tension-type headaches can be the result of neck and scalp muscles tensing or contracting, according to MedlinePlus. Stress, depression, head injury, anxiety, and any activity where you hold your head in one position without moving can cause the muscle contractions.
In addition to having different causes, there are key differences between tension headache and migraine symptoms: Tension headache pain is a dull, pressure-like pain that’s typically on both sides of the head, whereas migraine pain is often described as throbbing pain on one side of the head.
What Does It Mean if Your Neck Hurts and You Have a Headache?
It makes sense that neck pain would be involved in migraine, because of the disease process in the body, says Kumar. “The trigeminal nerve complex is involved in most migraines, and the nucleus (central part) of the trigeminal nerve is actually located high in the back of the neck, in what we call the c1, c2, and c3 vertebrae, the highest vertebrae in the spine,” she says.
The trigeminal nerve is responsible for sensations in the face and for functions like chewing and biting.
“In migraine, those areas get sensitized; the muscles in the neck can become tense and tight,” she says.
What Does Cervicogenic Headache Feel Like?
“A cervicogenic headache is when the pain is occurring from a source in the neck,” Kumar explains.
It’s different from a migraine with neck pain, because unlike migraine, which is a primary headache, cervicogenic headaches are secondary headaches, according to the American Migraine Foundation.
In a primary headache, the headache itself is the main issue and not a symptom of another underlying disease or disorder. In cervicogenic headaches, the pain is caused by an underlying disorder or injury of the neck, such as a tumor, fracture, infection, osteoarthritis, or rheumatoid arthritis of the cervical spine, or muscle tightness or strain in the neck muscles.
“This type of headache can mimic a migraine headache because they are usually on one side of the head and the pain can go from back of the neck and head to the front of the head,” says Kumar.
There are key differences between the two types of headache, however: “Migraine headaches often have other symptoms, such as visual symptoms and nausea; it gets worse with activity, and migraine pain can have a pulsating quality,” she says.
Cervicogenic headaches, on the other hand, are often accompanied by reduced range of motion of the neck, according to StatPearls.
How Sleep and Posture Can Affect Migraine and Neck Pain
The quality of your sleep and the amount of sleep can impact migraine, Kumar says. “Sleep is important in headaches, especially migraine, and too little sleep and too much sleep can trigger a migraine attack,” she says.
The position that you sleep in matters as well, especially if you have neck pain with your migraine, says Kumar. “You may want to adjust your positioning, especially if you have an additional issue like arthritis of the neck; sleeping with a cervical roll or pillow could help, too,” she says. A cervical roll can improve your posture while you sleep by helping you maintain a normal cervical curve and prevent bending of the neck.
“Posture absolutely matters when it comes to neck pain,” says Kumar. If we’re sitting at a computer and get engrossed in our work, our posture may suffer, which can contribute to neck pain, she says.
A big contributor to poor posture comes from looking down at your phone or computer screen. A study published in Surgery Technology International that looked at “text neck” found that when a person holds their head upright and in line with their shoulders, the head weighs about 10 pounds. For every inch the head tilts forward (from poor posture or looking down at a phone or computer) the amount of weight it places on the spine almost doubles, which places a strain on the neck muscles.
Are There Treatments to Help With Migraine Neck Pain?
Trigger point injections could be helpful to improve migraine neck pain, says Kumar. Trigger points are what we often think of as “knots” in our muscles. In a trigger point injection, a healthcare provider injects a mixture of anesthetic and steroid into the affected area, according to the Cleveland Clinic.
For people who experience headache and migraine that involve more significant neck pain, including people with chronic migraine, occipital nerve blocks are also used, says Kumar. Occipital nerve blocks, which are injected into the back of the head, just above the neck, often contain a long-acting local anesthetic and a steroid anti-inflammatory drug, according to the American Migraine Foundation. The pain-relieving benefits from this procedure can last anywhere from a day to weeks or even months.
Injections of Botox (onabotulinumtoxinA) into the neck muscles is another option for treating neck pain related to migraine.
Physical Therapy, Exercise, and Other Strategies to Improve Neck Pain
Physical therapy is recommended for people with migraine and neck pain, says Kumar. “Physical therapy can help in strengthening the neck muscles and promote overall relaxation. There are physical therapists who specialize in targeting those particular areas of the neck involved in migraine,” she says.
A review published in the July 2016 issue of European Spine Journal found that exercises that focused on the neck and spine were helpful for managing headaches with neck pain.
“Anything that relieves stress can be helpful, including yoga, meditation, and relaxation exercises,” says Kumar.
Many of the same exercises that help with migraine and neck pain can improve other types of headache-related head and neck pain, including cervicogenic headaches. A study published in the Journal of Rehabilitation Medicine found that a yearlong program of isometric, dynamic, and stretching exercises helped decrease headache in women with cervicogenic headache.
The Feldenkrais method can help relieve different types of pain and discomfort, including neck pain, through the practice of gentle exercises and directed attention. This helps retrain the brain and results in people moving with greater ease and less pain. Additional benefits include improved posture, reduced stress, and better flexibility.
“Often when people have migraine, we just start them on a pharmaceutical medication,” says Kumar. When you have migraine and neck pain, especially if you have chronic migraine, using other methods of treatment, such as physical therapy and muscle relaxation, in addition to your medications can be very valuable, she says.
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