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Migraine Symptoms: Neck Pain

For years, people with Migraine have been asking me about neck pain and Migraines.

They wanted to know if they were alone in having neck pain with their Migraines, if the neck pain could be triggering the Migraines, if triptans (Imitrex, Maxalt, Zomig, etc.) could be causing their neck pain, and more. They were frustrated, and I was frustrated because I didn’t have solid answers for them.

Finally, a group of researchers led by Dr. Anne Calhoun answered some of the questions about Migraine and neck pain.1


Study objective:

“To determine the prevalence of neck pain at the time of migraine treatment relative to the prevalence of nausea, a defining associated symptom of migraine.”1

Migraine and neck painStudy methods:

  • Study participants were recruited from an academic Migraine and headache clinic and the general public.
  • In order to clearly identify neck pain associated with Migraine, patients with fibromyalgia, known or suspected cervicogenic headache, and history of significant cervical trauma or surgery were excluded.
  • Potential participants were examined by Migraine and headache specialists to confirm Migraine diagnosis in accordance with the International Headache Society’s International Classification of Headache Disorders, 2nd Edition (ICHD-II).
  • Study participants recorded details of all Migraines in a daily diary over at least one month and until six Migraines had been treated.

Study results:

  • Study participants recorded a total of 2,411 “headache” days, of which 786 were identified as Migraine days.
  • Neck pain was more prevalent than nausea, regardless of the treatment stage.
  • Neck pain was more prevalent than nausea, regardless of the intensity of the headache pain at the time of treatment.
  • There was a correlation between neck pain and chronicity as Migraines moved from episodic to chronic.

Study conclusions:

Calhoun et. al. concluded:

“Neck pain is a common and integral feature of migraine. In this sample of migraineurs, neck pain was more commonly associated with migraine than was nausea, one of the defining characteristics of the disorder. Greater awareness of neck pain as an associated symptom of migraine may improve diagnostic accuracy and have a beneficial impact on time to treatment.”


Ford and Calhoun also studied the impact of neck pain on Migraine treatment and presented their findings in a research poster at the 52nd Annual Scientific Meeting of the American Headache Society. This research is an extension of the first study, performed with data collected from the same participants during that study.

Study objective:

“This study will examine whether presence of neck pain is associated with a delay in migraine treatment.”2

Study methods:

  • There were 113 study participants whose Migraine frequency ranged from episodic to chronic.
  • Participants were examined by by Migraine and headache specialists to confirm Migraine diagnosis in accordance with the International Headache Society’s International Classification of Headache Disorders, 2nd Edition (ICHD-II).
  • Potential participants with fibromyalgia and cervicogenic headache were excluded.
  • Study participants recorded details of all Migraines in a daily diary over at least one month and until six Migraines had been treated.

Study results:

  • Presence of neck pain in the hour before initial treatment was associated with:
    • Treatment being delayed more than 30 minutes past the beginning of the headache.
    • Treatment being started at a higher headache pain intensity.
  • When neck pain accompanied Migraine, participants with moderate or severe neck pain were more likely to treat the Migraine within 30 minutes of the begging of the headache than participants with mild neck pain.

Study conclusions:

Presence of neck pain was associated with delayed Migraine treatment as indicated by:

  1. higher pain intensity at the time of initial treatment and
  2. longer wait times before beginning treatment.

Ford and Calhoun offered explanations for this delay in treatment:

  1. Migraineurs fail to relate neck pain to their Migraine attacks.
  2. Neck pain is so prevalent in Migraine that Migraineurs have become accustomed to it and ignore neck pain until its severity increases or until the headache pain becomes worse than the neck pain.

Summary and comments:

Neck pain can indeed be a symptom of a Migraine attack. In this study it was, in fact, more common than nausea, which is so commonly associated with Migraine that it’s part of the International Headache Society’s diagnostic criteria for Migraine.

Neck pain during Migraine resulted in delayed treatment possibly because Migraineurs don’t recognize neck pain as a Migraine symptom or because they’ve become so used to it that they ignore it.

Both physician and patient education need to be modified to include neck pain as an acknowledged symptom of Migraine, and the International Headache Society should review their diagnostic criteria for the possible inclusion of neck pain.

Patients who experience neck pain during or near a Migraine should discuss it with their doctors to ensure that it is part of their Migraine and not another unrelated issue.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

1 Calhoun, Anne H., MD; Ford, Sutapa, PhD; Millen, Cori, DO; Finkel, Alan G., MD; Truong, Young, PhD; Nie, Yonghong, MS. “The Prevalence of Neck Pain in Migraine.” Headache 2010;50:1273-1277. doi: 10.1111/j.1526-4610.2009.01608.x. 2 Ford, S.; Calhoun, A.H. “Presence of Neck Pain Delays Migraine Treatment.” Poster Presentation #PO-22. 52nd Annual Scientific Meeting, American Headache Society. Los Angeles. June, 2010. 3 The International Headache Society. “The International Classification of Headache Disorders, 2nd edition.” Cephalalgia 2004; 24 suppl 1:1-160.


  • Meredith
    3 years ago

    Neck Pain is the most prominent symptom I have and always had since I was a child of migraine. Excruciating neck pain. I feel like I was hung, wish I would die it is so painful. Actual x-rays when I was n my twenties showed my neck and skull looked like I was! Though outward appearance it appeared my neck and head were straight. When barometric pressure drops, it causes soft tissue in my neck and shoulders to twist, setting off migraine.

  • annette
    5 years ago

    I am not sure if anyone in the US is familiar with a relatively new technique from an Australian organisation called the Watson Headache Institute. It involves the stretching of the fine muscles in the neck which affect the spinal joints close to the skull. I have no barrow to push, but after suffering migraines for more than 40 years, I am finally seeing a reduction in their chronic occurrence after stumbling on a local physiotherapist trained in the technique, who has worked on my neck over the past few months. It is the first treatment that has actually made a difference in my life and the severity and frequency of the pain. And it has given me back some power over the migraines as I now have a tool other than drugs with which to stop the headache beginning and progressing.

  • Rhonda Lustig
    6 years ago

    Ive only in the last couple of months have been experiencing the neck migraine. Ive had migraine since age of 40, so 6 years now. It literally feels like a rabid dog has hold of the back of my neck. When nsaids, ice then heat and muscle relaxer (xanaflex) don’t work, then the tryptan (amerge) is the only thing that gets rid of it. Never heard of a neck migraine until now.

  • Teri-Robert author
    6 years ago


    It’s not actually a “neck Migraine.” Neck pain can be a symptom with any kind of Migraine – Migraine with our without aura, hemiplegic Migraine, etc. Have you discussed this with your doctor? Most doctors say that the triptans such as Amerget work best if taken when we first realize we have a Migraine and don’t work nearly as well when taken later. Your doctor may suggest skipping the NSAIDs, ice, heat, and Zanaflex and going straight to the Amerge.

  • Angela Harris
    6 years ago

    My neck is prone to getting uncomfortably stiff and popping very easily just before I get a migraine. Sometimes, I think that if I pop my neck, either intentionally or accidentally, it triggers the attack. My neuro has me on low dose flexoril as needed that I can take in combo with naproxen and my triptan to address the neck issues. I only use it when my neck gets tense, and sometimes, if I recognize the neck tension in time, I can get by with just the naproxen these days.

  • L. Kersten
    6 years ago

    When a migraine is coming, my neck makes a little ‘scratchy’ sound upon turning my head to the left or right.

  • Elaine Gross
    8 years ago

    The occipital area has caused me the greatest pain, followed by my neck. Prior to my stay at Methodist Hospital in Philadelphia for IV infusions I was near suicidal with that occipital pain. When I was in the hospital, Drs. Silberstein and Young came in my room for the first time and said to me “You have a neck problem”. I said that I knew that, but how did they know. They said “head tilt”. Amazing. Botox has really helped that, also the occipital pain. I have pain patches for the back of my neck, and they help a bit. Since Botox has lowered the pain level, nausea has become more troublesome to me. Also numbness, smells, dizziness, and malaise have worsened. Maybe it just seems like it since pain isn’t the worst symptom. Thanks Teri. Good article.

  • Michelle Stewart Lambert
    8 years ago

    I have always had neck pain and never put it together with chronic migraines until very recently.

  • Amanda Lewis
    8 years ago

    Neck pain has been a part of my migraines for as long as I can remember. Sometimes my migraines are only neck pain and no headache. If left untreated, the headache usually follows. Sometimes I try to treat the neck pain as muscle strain, but inevitably a full-blown migraine occurs. So I’ve learned to distinguish my “migraine neck” from muscle strain (like from bending over a computer all day) so I can take a triptan earlier and prevent the fallout.

  • Ter-i
    3 years ago

    Precisely – if the neck gets treated, kind relative gives me massage or i roll over tennis ball, I get migraine much faster and with super intensity. Taking triptans will eliminate also that neck pain! Although im somewhat reluctant take triptans before onset of the “real thing” just for neck pain…hmmm

  • DonnaFA moderator
    3 years ago

    Hi Ter-i! I share some of your experience in this. I find neck position, and any kind of neck treatment will accelerate onset, or exacerbate the attack. You may find Neck Pain interesting as well. Thanks for being part of the community! -All Best, Donna ( team)

  • L. Kersten
    6 years ago

    My story too, exept that I don’t have any meds that work.

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