How Migraines Can Be a Literal Pain in the Neck

Source: Photo by Keenan Constance on Unsplash

It always starts on the right side of my neck, a single, deep spot that hurts so much that I press on it as hard as I can, thinking that will somehow loosen the knot and ease the pain. People often comment that my head is tilted to the right, that I’m constantly pushing on that area, rubbing it hard, but mainly pressing one or two fingers, hoping for relief. I later learned from my physical therapist that this practice only worsens the problem.

While I have known that the neck pain is somehow connected to my migraine, I didn’t fully realize that this is migraine, often the first stage for me. I’d always thought it was more of a warning that the neck pain could lead to a migraine attack if I weren't conscientious. Often, if I turn my neck wrong or too quickly or bend down in a bad way, the pain gets much worse and can trigger traveling pain along the occipital nerve and explode into an intense throbbing behind my right eye.

In the past, neck pain was thought to be a migraine trigger. A 2018 study from The Journal of Headache and Pain found that “neck pain is actually a symptom of a migraine attack. Unfortunately, it continues to be an overlooked symptom, and many patients mistake it for a neck pain syndrome…that neck pain is usually a symptom of migraine and not a cause.”

According to Sandhya Kumar, a neurologist specializing in headaches, neck pain is often on the same side as the headache. “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.” Kumar also pointed out that neck pain is more common in those experiencing chronic migraine.

I know now I need to take appropriate steps to ward off a full-blown attack. When my neck pain starts, I usually turn to my Cefaly device, often try to make an appointment with my chiropractor, and, too, regularly see my physical therapist who works directly on my neck (Her specialization is working with chronic migraine patients). If I take the first rescue medication at the first sign of pain, I also reduce or even eliminate the pain.

However, in all honesty, I have cervical pain on the right side more days than I don't. If I were to turn to my first rescue medication every time I really needed it, I would run out early in the month, given the small monthly amount the insurance covers.

How Common Is Neck Pain with Migraine?

The Will Erwin National Headache Foundation reported that the 2018 Migraine in America survey uncovered that 69 percent of migraine sufferers surveyed reported dealing with neck pain when they have migraines. Another study published in the Headache journal discovered that among the 113 individuals evaluated, neck pain was more common for migraine patients than nausea. Many people reported that neck pain begins before a migraine, although this precursor lasts through the migraine attack for many. One study showed that in 90 percent of cases where patients thought they had a cervical (neck) pain syndrome, they actually had migraines. (The Will Erwin National Headache Foundation)

What is the Connection?

Some researchers believe that other inputs into the trigeminocervical complex might play a role in aggravating headaches in people with migraine. Musculoskeletal problems in the neck, like migraines, also activate nerves of the upper neck that are part of this trigeminocervical complex.

Kumar pointed out that:

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.

How Can We Treat the Neck Pain?

If I can treat the pain in time (which is not always successful, as the neck pain is what I now consider a low-medium migraine day), I can abort a full-blown attack.

Some of the treatments recommended include:

• Physical therapy
• Chiropractic care
• Cefaly device
• Hot, moist heat
• TENS unit
• Migraine rescue medications
• Nerve Blocks

So, as I catch myself pushing in on that spot halfway down the right side of my neck, even as I work on this post, I know I need to do my neck stretches and grab my Cefaly device for the next hour.