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Neck pain and migraine

"I've developed a stiff neck that's about to drive me insane..." - 'Little' Jimmy Dickens

For many of us with migraine disease, neck pain and stiffness may be a troublesome symptom. Along with neck pain associated with a migraine attack , neck pain and tension may occur with coexistent  disorders such as tension-type headache and cervicogenic headache. You can learn more about tension-type headache and cervicogenic headache in these links to articles from the American Migraine Foundation. In this article, we take a closer look at possible mechanisms and clinical implications of neck pain associated with migraine. Because neck pain often begins in the prodrome phase of a migraine attack, let's have a quick review of this phase.

Prodrome Phase: 

Prodromal symptoms (premonitory) may occur hours or days before the headache phase of a migraine attack, with or without aura. A number of symptoms have been reported, including fatigue (hypoactivity), euphoria (hyperactivity), depression, irritability, food cravings, constipation, neck pain and stiffness, yawning, difficulties with concentration, nausea, blurred vision, bloating, pallor, change in facial expression or body perception, piloerection, and sensitivity to light, sound, and smell (Charles, 2012; ICHD 3rd edition, 2018; Burstein, et al., 2015; Lampl et al., 2015; Maniyar, et al., 2015). In the Burstein article, the authors report premonitory symptoms most commonly described by patients point to the potential involvement of:

  • the hypothalamus, including symptoms fatigue, depression, irritability food cravings, and yawning;
  • the brainstem, including symptoms muscle tenderness and neck stiffness;
  • the cortex, including symptoms abnormal sensitivity to light, sound, and smell; and
  • the limbic system, including depression and anhedonia (p. 6620). 

In addition, both the Charles and Maniyar articles suggest premonitory symptoms may be associated with the hypothalamus and note the neurotransmitter dopamine may play an important role. In the Maniyar article, the authors also report emotional changes and a feeling of tiredness may result from involvement of limbic/frontal areas mediated by the hypothalamus; posterior hypothalamic dysfunction could explain neck discomfort and stiffness; and, involvement of the frontal cortex could explain difficulties in reading, writing, and concentration (p. 611). It is interesting to note that in the Charles article, the author mentions some premonitory symptoms may come and go before the headache phase, others may build up in intensity leading up to the headache, occur during the headache, and persist well beyond the resolution phase (p.413). 

Neck Pain 

It is important for us to know neck pain is commonly reported as a symptom with a migraine attack and may be experienced before (prodrome), during and after the headache phase (postdrome). While not conclusive and further studies are indicated, it is thought that neck pain may be an integral part of the migraine process ( Calhoun et al., 2010Ashina, et al., 2015Maniyar et al., 2015Lampl,et al., 2015). In a population study assessing neck pain in migraine and tension-type headache, (Ashina et al., 2015), the authors report neck pain may play a role in the pathophysiology of migraine and tension-type headache and may arise because of convergent input from the first division of the trigeminal nerve and the upper cervical roots to the trigeminal complex (p. 212). Clinical implications from this study that are beneficial for us to know are: 

  • "Neck pain is highly prevalent in the general population and is more prevalent in individuals with migraine and tension-type headache. 
  • Neck pain has the highest prevalence in coexistent migraine and tension-type headache.
  • Myofascial pericranial tenderness is significantly increased in individuals with neck pain compared to individuals without neck pain.
  • Neck pain may have a shared pathophysiological mechanism with primary headaches. 
  • Neck pain may result in increased disability in headache sufferers and treatment may also be directed to the neck," (p. 218).    

Additionally, we should be aware Maniyar et al., (2015), report "patients with neck stiffness do not respond as well to triptan treatment as patients without neck stiffness during acute migraine headache, suggesting a phenotype-mechanism dissociation" (p. 611). And, Lampl et al., (2015), indicate "prevention and treatment of neck pain could be important in the prevention of future chronic migraine" (p. 6/9). 


For those of us with migraine and neck pain, especially, since we may also experience coexistent tension-type headache and cervicogenic headache, treatment of neck pain is something we need to discuss as individuals with our doctors.  For me, since I went from episodic to chronic migraine with medication overuse headache and back to infrequent episodic migraine, when I do have a migraine, neck pain can be equally disabling as headache pain.  My treatment plan includes ice (some may prefer heat), posture correction, neck exercises I learned many years ago from a physical therapist, regular exercise, biofeedback, meditation, acupuncture, and a prescription compound keto/lido cream. There may be a number of other pharmacological and nonpharmacological therapies that can help you. Talk to your doctor about what is right for you. 


Ashina, S., Bendtsen, L., Lyngberg, A., C., et al., (2015). "Prevalence of neck pain in migraine and tension-type headache: a population study." Cephalalgia. Mar;35(3):211-9.

Burstein, R., Noseda, R., & Borsook, (2015). "Migraine: Multiple Processes, Complex Pathopysiology." The Journal of Neuroscience. April;35(17):6619-6629.

Calhoun, A., H., Ford, S., Millen, C., et al., (2010). "The prevalence of neck pain in migraine." Headache. Sep;50(8):1273-7.

Charles, A. (2013). "The evolution of a migraine attack - a review of the evidence." Headache. Feb;53(2):413-9.

Headache Classification Subcommittee of the International Headache Society. The International Headache Society. "The International Classification of Headache Disorders: 3rd edition. Cephalalgia. 2018;38 (1):1-211 

Lampl, C., Rudolph, M., Deligianni, C., et al., (2015). "Neck pain in episodic migraine: premonitory symptom or part of the attack?" The Journal of Headache and Pain. Sep;16:80.

Maniyar, F.H., Sprenger, T., Monteith, T., et al., (2015). "The premonitory phase of migraine-what can we learn from it?" Headache. May;55(5):609-20.

Sharron Murray MS, RN is an author and coauthor CaMEO Study, "Life With Migraine". Currently, Sharron is active in the migraine community as a writer, advocate, American Migraine Foundation Partner, moderator for the American Migraine Foundation "Move Against Migraine" Facebook Group, and member of the National Headache Foundation Patient Leadership Council. 

Follow Sharron on twitter @murraysharron, her FB page, Sharron Murray, MS, RN

This article is not a substitute for medical advce. If you have specific concerns about your health or nutrition, please contact a qualified professional.

Updated November 28, 2018

Copyright February 26, 2018 Sharron E. Murray

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