Neck pain, muscle tension and jaw problems are extremely common in migraine and can feed the cycle ^1,2. The musculoskeletal pillar addresses them, using the right therapy at the right time.

Why timing matters

Dr. Harcourt teaches that manual therapies can be the best, or the worst, treatment for a person with migraine depending on the stage. During a sensitized phase, when the nervous system is on high alert, firm pressure or aggressive techniques can backfire ^3,4. Gentle, well-dosed care tends to work better, with intensity increased as the nervous system calms.

Spinal manipulation and manual therapy

• Systematic reviews suggest manual therapies, including spinal manipulation, massage and physiotherapy, may be as effective as some preventive medications for migraine ⁵.
• A high-quality placebo-controlled trial found that both chiropractic manipulation and a sham (placebo) treatment reduced migraine days compared with usual care, which highlights how much expectation and the nervous system’s response matter ⁶.
• Other reviews have been more cautious about spinal manipulation ⁷.
• Osteopathic manipulative treatment has shown benefit in a controlled trial ⁸.
• Many people with migraine already use manual therapies ⁹.

In Dr. Harcourt’s framework, joint adjustments are used if and when appropriate, for example when they have helped you during a previous attack, not as a default.

Massage

Massage reduced migraine frequency and improved sleep in a randomized trial ¹⁰. It can also lower the overall stress load.

Trigger points

Tender spots in neck and shoulder muscles can refer pain to the head. Manual trigger point therapy has shown benefit for headache in a systematic review ¹¹.

Exercise

• Aerobic exercise reduced migraine burden in a randomized trial of people with migraine and neck pain ¹².
• High-intensity interval training reduced migraine days more than moderate continuous exercise in a randomized trial ¹³.
• Neck and core strengthening: people with migraine often have weaker neck muscles ¹⁴.
• Physical activity is also helpful for people with medication overuse headache ¹⁵.

Exercise is introduced gradually and progressed as you tolerate it, so it relieves the bucket rather than adding to it.

Acupuncture

Acupuncture reduces migraine frequency compared with usual care and is comparable to some preventive drugs ^16,17. Brain imaging suggests it influences pain-processing areas such as the thalamus and brainstem ^18,19.

Research cited on this page

1. 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
2. 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
3. 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
4. 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
5. Chaibi A, Tuchin PJ, Russell MB. Manual therapies for migraine: a systematic review. J Headache Pain. 2011;12(2):127-33. PubMed 21298314 · DOI
6. Chaibi A, Benth JŠ, Tuchin PJ, et al. Chiropractic spinal manipulative therapy for migraine: a three-armed, single-blinded, placebo, randomized controlled trial. Eur J Neurol. 2017;24(1):143-153. PubMed 27696633 · DOI
7. Posadzki P, Ernst E. Spinal manipulations for the treatment of migraine: a systematic review of randomized clinical trials. Cephalalgia. 2011;31(8):964-70. PubMed 21511952 · DOI
8. Cerritelli F, Ginevri L, Messi G, et al. Clinical effectiveness of osteopathic treatment in chronic migraine: 3-Armed randomized controlled trial. Complement Ther Med. 2015;23(2):149-56. PubMed 25847552 · DOI
9. Moore CS, Sibbritt DW, Adams J. A critical review of manual therapy use for headache disorders: prevalence, profiles, motivations, communication and self-reported effectiveness. BMC Neurol. 2017;17(1):61. PubMed 28340566 · DOI
10. Lawler SP, Cameron LD. A randomized, controlled trial of massage therapy as a treatment for migraine. Ann Behav Med. 2006;32(1):50-9. PubMed 16827629 · DOI
11. Falsiroli Maistrello L, Geri T, Gianola S, et al. Effectiveness of Trigger Point Manual Treatment on the Frequency, Intensity, and Duration of Attacks in Primary Headaches: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Neurol. 2018;9:254. PubMed 29740386 · DOI
12. Krøll LS, Hammarlund CS, Linde M, et al. The effects of aerobic exercise for persons with migraine and co-existing tension-type headache and neck pain. A randomized, controlled, clinical trial. Cephalalgia. 2018;38(12):1805-1816. PubMed 29333870 · DOI
13. Hanssen H, Minghetti A, Magon S, et al. Effects of different endurance exercise modalities on migraine days and cerebrovascular health in episodic migraineurs: A randomized controlled trial. Scand J Med Sci Sports. 2018;28(3):1103-1112. PubMed 29161767 · DOI
14. 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
15. Mose LS, Pedersen SS, Debrabant B, et al. The role of personality, disability and physical activity in the development of medication-overuse headache: a prospective observational study. J Headache Pain. 2018;19(1):39. PubMed 29802536 · DOI
16. Linde K, Allais G, Brinkhaus B, et al. Acupuncture for the prevention of episodic migraine. Cochrane Database Syst Rev. 2016;2016(6):CD001218. PubMed 27351677 · DOI
17. Musil F, Pokladnikova J, Pavelek Z, et al. Acupuncture in migraine prophylaxis in Czech patients: an open-label randomized controlled trial. Neuropsychiatr Dis Treat. 2018;14:1221-1228. PubMed 29785113 · DOI
18. Gu T, Lin L, Jiang Y, et al. Acupuncture therapy in treating migraine: results of a magnetic resonance spectroscopy imaging study. J Pain Res. 2018;11:889-900. PubMed 29740217 · DOI
19. Li Z, Zeng F, Yin T, et al. Acupuncture modulates the abnormal brainstem activity in migraine without aura patients. Neuroimage Clin. 2017;15:367-375. PubMed 28580293 · DOI