Neck Pain as a Migraine Symptom

Neck pain is common in migraine. It is estimated that 42% of individuals with episodic migraine experience neck pain as a migraine symptom. Furthermore, 67% of those with recurrent migraines also have neck pain that isn’t necessarily associated with the timing of their migraines.

The combination of neck pain and migraines can have adverse effects on your quality of life—migraine and coexisting neck pain often lead to decreased physical activity and a low sense of well-being. 

If you have migraines, you might be concerned about whether your neck pain is part of your migraine episodes or if it’s the sign of another problem. Sometimes, neck pain is a signal that your migraine is starting, and this pattern is noted in adults as well as children. 

Talk to your healthcare provider about your neck pain so you can get to the root of the cause and get started on the right treatment for it.

Neck Pain With Migraine 

If your neck pain is due to your migraines, you might begin to notice a pattern, especially in terms of the timing of your symptoms.

Most often (over 80% of the time), neck pain that’s part of a migraine begins at the same time as other migraine symptoms (such as head pain, photophobia, dizziness, and nausea). But the neck pain can begin a few days before your other migraine symptoms, or it may last after your other migraine symptoms have resolved. 

Features of migraine-associated neck pain include:

• If your neck pain is associated with your migraines, it might only come on when you have your migraines. However, you may also have frequent or constant neck pain, and it can worsen when you have your migraines.
• Migraine associated neck pain typically feels like an aching muscle soreness and tenderness at the base of the neck and upper shoulders.
• While migraines tend to cause pain on one side of the head, the associated neck pain can affect one side, or it can involve both sides.
• The pain might be worsened with certain positions, but it is unlikely to completely resolve in response to any change in your body position. 

Neck pain in migraine is often dull and achy—it is not normally associated with severe, sharp pain. Neck pain that is associated with migraine should not involve weakness, numbness, tingling, or other sensory changes.

This type of migraine pain is considered to be associated with the migraine pain process, and it shouldn’t cause neurological abnormalities.

Diagnosis 

Neck pain is common, and you can have more than one cause of neck pain. Your evaluation will include a medical history, physical examination, and possibly diagnostic tests.

Before you see your healthcare provider, try to track the frequency, duration, and severity of your pain. Also, be sure to note the timing of factors that could also contribute to your neck pain—such as long hours in a position that strains your neck.

Using a pain diary for a few weeks or longer can help you and your healthcare provider see if there is a trend or an identifiable pattern when it comes to your migraines and your neck pain. In addition to talking with you about your medical history and your pain/headache diary, your healthcare provider will also examine you.

Your healthcare provider will check whether you have tenderness, tightness, or stiffness of your neck muscles and will look for any signs of an injury. Your physical examination may also include a full neurological examination and an eye examination.

If your symptom history suggests a strong pattern of neck pain associated with migraine, and your physical examination does not suggest a neck problem, then your healthcare provider may consider your neck pain to be a part of your migraine, rather than a separate problem.

People who have neck pain as a symptom of migraine may have stiffer neck muscles in between migraine episodes, but this is not associated with other abnormalities that are typically signs of neck problems (like abnormal reflexes, weakness, or sensory changes of the arm).

Tests you might need include:

• Cervical spine imaging: Imaging tests, such as X-ray, computerized tomography (CT), or magnetic resonance imaging (MRI) can be used to assess your bone, soft tissue, and muscle structure.
• Electromyography (EMG) or nerve conduction studies (NCV): If there is a concern that you could have nerve involvement, such as due to inflammation, a pinched nerve, or nerve disease (like neuropathy), you may need these tests to determine whether you have nerve damage.
• Blood tests: Issues like inflammation or infection may be accompanied by abnormal blood tests.

Treatment

Rest assured that having neck pain as part of your migraines does not make your migraines more severe or more difficult to manage with treatment. Often, treatment with migraine medication can reduce your migraine-associated neck pain.

Your healthcare provider may recommend that you try over the counter (OTC) medication, like Tylenol (acetaminophen), Excedrin (aspirin, paracetamol, and caffeine), or a non-steroidal anti-inflammatory (NSAID) like Advil (ibuprofen). OTC treatments can be effective for many people with migraine. 

If OTC treatment is not helping your migraines, you might be given a prescription for a migraine treatment like Fioricet (acetaminophen, butalbital, and caffeine), Zomig (zolmitriptan), or Ajovy (fremanezumab-vfrm).

In addition to medication, other approaches that can be helpful in managing migraine-associated neck pain include stretching exercises, cold packs, and heating pads. 

If you have another cause of your neck pain besides your migraines, you might need other treatment. For example, if your pain is caused by arthritis, you may need a prescription for a long-acting anti-inflammatory medication. And if you have a pinched nerve, you may need medication and individualized physical therapy—and rarely, surgery. 

A Word From Verywell

Neck pain is among the most common symptoms associated with migraine. If you have neck pain with your migraines, you are likely to feel relief when you take your migraine medication.

If your neck pain persists in between your migraine episodes, you should discuss it with your healthcare provider—because you could also have another issue causing your neck pain. Getting an accurate diagnosis and starting treatment can alleviate your neck pain and prevent it from getting worse.