Migraines are a complex neurological disorder that involves far more than simply a severe headache. A common symptom reported by those who experience migraines is pain and stiffness that originates in the neck and shoulders. This discomfort is highly prevalent, with estimates suggesting that between 70% and 80% of migraine sufferers experience neck pain either before or during an attack. Understanding the connection between the neurological event of a migraine and the musculoskeletal discomfort in the upper body is a powerful step toward more effective treatment.
The Bidirectional Connection
The relationship between migraines and neck/shoulder pain is complicated because it can flow in two directions. In many cases, the migraine attack itself is the cause, producing pain that radiates into the neck as a secondary symptom. This is often the case when the neck pain is experienced during the headache phase or lingers afterward.
The reverse is also true; existing tension or a structural issue in the neck can act as a trigger, lowering the threshold for a full-blown migraine attack. This duality means that a person may experience neck pain as a warning sign, a symptom of the attack, or both. Clinicians must determine whether the neck issue is a result of the neurological event or an initiating factor.
How Migraine Activity Generates Neck and Shoulder Pain
The primary mechanism linking a migraine to neck and shoulder pain is the shared network of nerve pathways in the brainstem. This convergence zone is known as the trigeminocervical complex (TCC). Pain signals from the head and face are primarily carried by the trigeminal nerve.
The TCC is located in the upper cervical spinal cord, where the sensory fibers of the trigeminal nerve physically connect with the afferent nerves from the upper neck vertebrae, specifically C1, C2, and C3. When a migraine begins, the trigeminal nerve system becomes highly sensitized. This heightened electrical activity is amplified and then shared with the connected cervical nerves.
This sharing of hyper-sensitized signals causes referred pain, where the brain interprets the neurological activity as physical discomfort in the neck and shoulder area. Even though the problem originated in the brain, the pain is genuinely felt in the muscles and joints of the upper body. This process can lead to central sensitization, making the TCC hypersensitive and more easily activated by future stimuli.
Neck pain is a common feature of the postdrome phase, the period immediately following the headache phase. The lingering stiffness and soreness in the upper neck and shoulder muscles are likely due to this residual sensitization in the shared nerve pathways. Many people mistake this lingering discomfort for a simple muscle strain, when it is actually a residual neurological symptom of the attack.
When Muscle Tension Acts as a Migraine Trigger
While migraines can cause neck pain, pre-existing muscle tension can also initiate a migraine attack. Sustained tension in key muscle groups, such as the trapezius, sternocleidomastoid, and suboccipital muscles at the base of the skull, can irritate the cervical nerves. This irritation sends pain signals toward the brainstem.
When these signals reach the TCC, they can activate the same pain pathways that start a migraine. This process essentially “primes” the neurological system, lowering the migraine threshold and making a person more susceptible to a full attack. Postural stress, such as prolonged computer use or “text neck,” is a common contributor to this type of tension.
For many individuals, neck stiffness or a dull ache is a symptom of the prodrome, the warning phase that can occur hours or days before the main headache begins. This early discomfort is a sign of the nervous system already becoming activated. Addressing this tension early can sometimes prevent the full progression of the migraine.
Targeted Management Strategies
Managing migraine-related neck and shoulder pain requires a dual approach that targets both the neurological cause and the muscular symptom. For acute relief during an attack, applying cold or ice packs to the back of the neck can help to numb the area and reduce local inflammation. Gentle stretching exercises, such as neck rotations or shoulder rolls, may help release tension, but should be performed only if they do not worsen the head pain.
For prevention, physical therapy and focusing on proper ergonomics are highly beneficial. A physical therapist can help identify and correct poor posture that strains the upper cervical muscles. Techniques like massage, trigger point therapy, and dry needling can be used to release hyperirritable spots in the trapezius and suboccipital muscles, thereby reducing the input of pain signals into the TCC. Stress management and consistent sleep hygiene are also important preventative measures, as they reduce the overall muscle tension that can act as a trigger.