When Migraine Starts or Stays in Your Neck


Neck pain can be one of the most dreaded symptoms for those of us with migraine. For some, the arrival of neck pain marks the beginning of an attack; for others, it seems like there is always some degree of neck pain. It raises questions: Is the tense, sore neck a trigger for an attack? Is it a sign that an attack is already underway?

How do we know if there’s a structural component causing our pain?

Dr. Sait Ashina, MD, is an assistant professor of neurology and anesthesia at Harvard Medical School, as well as the director of the Comprehensive Headache Center at Beth Israel Deaconess Medical Center in Boston. He is a prolific researcher and is board certified in neurology and headache medicine.


How prevalent is neck pain for those with migraine?

Dr. Ashina:
Neck pain can be independent of migraine or it could be part of it. When it’s part of an attack, it can occur prior to its onset, during the headache itself, or may happen in the postdrome phase after the attack. There are studies showing that up to 70% of people with migraine report neck pain during their attack, while 48% describe neck pain beforehand. There are also conditions that are common with migraine that may result in neck pain, such as rheumatoid arthritis, herniated disc, arthritis in the neck or spine, fibromyalgia, concussion, whiplash injury, and, rarely, Ehlers-Danlos syndrome and hypermobility. All those conditions are very common in patients with migraine.
How do we know whether neck pain is a symptom of the attack, if it’s the trigger, or something else?
Dr. Ashina: What some think are triggers of a migraine attack are not really triggers, but symptoms of the prodromal phase of a migraine that happens before the actual attack occurs. Migraine has many symptoms, such as the headache itself, light and sound sensitivity, or nausea, all of which can respond to treatment. These treatments can also improve neck stiffness and pain. In terms of other conditions, there is cervicogenic headache, which is a secondary headache, in contrast to migraine, where the headache is a primary symptom. It’s a condition caused by a cervical spine problem or its bony component—a disc or tissue elements, and is usually accompanied by neck pain. Occipital neuralgia is another distinct headache condition involving the occipital nerves that run from the top of the spinal cord and through the skull. If injured or inflamed, a person with occipital neuralgia usually feels the pain in the back of the head and the base of the skull. The diagnostic criteria of the International Headache Society can help to distinguish between these different types of headaches. It’s essential to get the correct medical diagnosis.
How might the neck be treated if it’s aggravating or triggering migraine attacks?
Dr. Ashina: There are different treatments, such as physical therapy and massage, and self-care measures like applying hot or cold packs. There are trigger point injections, which are nerve blocks. If there are more structural problems in the cervical spine, like disc herniations or arthritis, then epidural steroid injections, facet joint blocks, and radiofrequency ablations, which use heat generated by radio waves to target specific nerves and temporarily turn off their ability to send pain signals. Some respond to acupuncture, acupressure and dry needling. Weight loss can help neck pain. Finally, many pain psychologists work with biofeedback, behavioral therapy, relaxation techniques, and meditation. In worst cases, surgeries can help the neck pain, as well.
Watch the full interview for answers to:

How prevalent is neck pain for those with migraine?What is the trigeminal cervical complex?What is the difference between primary and secondary headache?How do we know if neck pain is a symptom of a migraine attack or if it’s triggering the attack?What are trigger point injections?What is a cervicogenic headache?What is occipital neuralgia?How can we distinguish between occipital neuralgia and migraine with neck pain?Can Botox help relieve neck pain with migraine?How do we determine whether neck pain is a symptom of a migraine attack or caused by a structural or neurological issue apart from migraine?What types of imaging studies are done for neck pain?What are the treatments for neck pain that may be triggering a migraine attack?What is radiofrequency ablation (neurotomy)?How does posture affect the neck and migraine?Is it better to use heat or ice for neck pain?Which non-medical interventions are helpful for neck pain with migraine?
Watch Dr. Ashina’s interview preview here, or order it as part of the Migraine World Summit package from this page.