Many people feel their migraine “starts in the neck.” Research shows why.

The neck-head connection

Nerves from the upper neck feed into the same brainstem area as the trigeminal nerve, which carries head and face pain. That means irritation in the upper neck can be felt as head pain, and migraine can be felt as neck pain ¹.

What the research shows

• People with migraine have more neck dysfunction on clinical tests, including reduced mobility in the upper neck, than people without migraine ².
• Muscles of the head and neck show different activity patterns in migraine ³.
• People with migraine can have weaker neck muscles ⁴.
• Degenerative neck changes (cervical spondylosis) are associated with a higher risk of migraine ⁵.
• Neck and shoulder pain, along with other factors, can predict who does not improve with standard care ⁶.

Trigger points and sensitization

Tender spots in muscles can refer pain to the head. People with migraine are often more sensitive to pressure across the body, a sign of central sensitization ^7,8,9. This is why the same massage pressure that feels great to one person can be too much for someone in a sensitized phase.

The jaw

Temporomandibular disorders (jaw joint and muscle problems), clenching and grinding are linked to migraine ¹⁰. Jaw tension can be another drip in the bucket.

Back pain

Migraine and back pain often occur together, part of a broader pattern of pain conditions ¹¹.

Posture and movement

Long hours at a computer, forward head posture and lack of movement add load to the neck. Dr. Harcourt evaluates posture, neck motion, muscle tone and the jaw as one of the four pillars. See Musculoskeletal care.

Research cited on this page

1. Goadsby PJ, Holland PR, Martins-Oliveira M, et al. Pathophysiology of Migraine: A Disorder of Sensory Processing. Physiol Rev. 2017;97(2):553-622. PubMed 28179394 · DOI
2. Szikszay TM, Hoenick S, von Korn K, et al. Which Examination Tests Detect Differences in Cervical Musculoskeletal Impairments in People With Migraine? A Systematic Review and Meta-Analysis. Phys Ther. 2019;99(5):549-569. PubMed 30690564 · DOI
3. Janani AS, Pope KJ, Fenton N, et al. Resting cranial and upper cervical muscle activity is increased in patients with migraine. Clin Neurophysiol. 2018;129(9):1913-1919. PubMed 30005219 · DOI
4. Tolentino GA, Bevilaqua-Grossi D, Carvalho GF, et al. Relationship Between Headaches and Neck Pain Characteristics With Neck Muscle Strength. J Manipulative Physiol Ther. 2018;41(8):650-657. PubMed 30573197 · DOI
5. Lin WS, Huang TF, Chuang TY, et al. Association between Cervical Spondylosis and Migraine: A Nationwide Retrospective Cohort Study. Int J Environ Res Public Health. 2018;15(4). PubMed 29587400 · DOI
6. Aguila MR, Rebbeck T, Pope A, et al. Six-month clinical course and factors associated with non-improvement in migraine and non-migraine headaches. Cephalalgia. 2018;38(10):1672-1686. PubMed 29199431 · DOI
7. Toriyama T, Horiuchi T, Hongo K. Characterization of migraineurs presenting interictal widespread pressure hyperalgesia identified using a tender point count: a cross-sectional study. J Headache Pain. 2017;18(1):117. PubMed 29285568 · DOI
8. Florencio LL, Giantomassi MC, Carvalho GF, et al. Generalized Pressure Pain Hypersensitivity in the Cervical Muscles in Women with Migraine. Pain Med. 2015;16(8):1629-34. PubMed 25929269 · DOI
9. Castien RF, van der Wouden JC, De Hertogh W. Pressure pain thresholds over the cranio-cervical region in headache: a systematic review and meta-analysis. J Headache Pain. 2018;19(1):9. PubMed 29374331 · DOI
10. Song HS, Shin JS, Lee J, et al. Association between temporomandibular disorders, chronic diseases, and ophthalmologic and otolaryngologic disorders in Korean adults: A cross-sectional study. PLoS One. 2018;13(1):e0191336. PubMed 29385182 · DOI
11. Badley EM, Millstone DB, Perruccio AV. Back Pain and Co-occurring Conditions: Findings From a Nationally Representative Sample. Spine (Phila Pa 1976). 2018;43(16):E935-E941. PubMed 29462062 · DOI