Migraine is a neurovascular brain disorder that affects about 15% of the population and is the number one cause of disability in adults under the age of 50.  Neck pain has been estimated to be twelve times more likely to occur in migraine patients than in healthy subjects.  Similarly, migraineurs with neck pain report more frequent and disabling headaches, as well as increased sensitization in the trigeminocervical complex where sensory input from the face and neck converge. However, there is debate on the nature of the relationship between neck pain and migraines.

On one hand, some experts feel migraines cause increased brain or central sensitization, which causes neck pain. On the other hand, there are experts who suspect sensitization mechanisms resulting from neck pain contribute to migraine. To address this “chicken or the egg” debate, an August 2023 study compared migraine patients with and without neck pain to observe the differences in clinical characteristics.

In the study, 44 migraine patients without neck pain, 64 migraine patients with neck pain, and 54 pain-free control subjects underwent physical examinations and completed multiple questionnaires to identify characteristics about their headache symptoms, neck pain/disability, and the effect of these conditions on their mental health and quality of life. As expected, both treatment groups had more positive findings than the control group. However, those in the migraine-with-neck-pain group had worse headache characteristics, more pronounced cervical musculoskeletal impairments, enhanced signs and symptoms related to sensitization, and worse psychological burden than the migraineurs without neck pain. In another 2023 study, researchers found that migraine patients with impaired balance—which may be due to altered proprioception caused by dysfunction in the cervical spine—had weaker neck muscles, more frequent migraine episodes, and more intense neck pain.

Findings such as these have led researchers to opine that migraine patients should be sub-grouped into those with or without co-occurring neck pain for the purpose of both research and formulating treatment guidelines. For those with neck pain and migraines, treatment addressing musculoskeletal impairments in the neck may be the most beneficial approach. Doctors of chiropractic are well-equipped to evaluate patients with migraines and neck pain and to provide care to address musculoskeletal conditions that may be contributing to or possibly causing the patient’s condition.