Neck pain: symptom or trigger of #migraine?

I’ve lived for nearly 30 years with the beast that is regular migraine attacks, and I’ve never had any problem with my neck. Until now.

There is quite a lot of literature around neck pain and migraine. Googling neck pain and migraine will get you a whole lot of quacks saying they can ‘cure’ your migraine, which isn’t helpful. But, there is good recent research on the subject, most of which concludes neck pain is a symptom of migraine, and not an unrelated condition or trigger for migraine attacks. One study found more than half of all migraine patients report neck pain during their migraine attacks, and they also had increased stiffness and pain in their neck between attacks (Hvedstrup et al, 2020).

Most research indicates people with migraine often feel the pain in their neck first, which makes it seem as if the neck pain has triggered the migraine attack. In reality, the neck pain is often the first warning sign that a migraine attack is imminent. This is a bit like the deal with chocolate… many people record in their diaries that they ate chocolate before the onset of symptoms, so blame the chocolate as a trigger, when in actuality the craving of chocolate or other high-sugar foods is a warning symptom that an attack is brewing.

Where the relationship with neck pain and migraine gets tricky is the debate about the Watson Headache Approach. This is a method used by physiotherapists which, in simple terms, involves manipulating the neck to recreate head pain, and then focused treatment targeting whichever bit of the neck caused pain when pressed. Why is this controversial? Well it’s a headache thing, not a migraine thing, but often heavily marketed to migraine patients. It does works for some, but not for others, and (a bit like botox) the practitioners encourage patients to persist with treatment for months with no response… which, due to the exorbitant fees charge by some – but not all – practitioners results in people feeling like it’s a rip off.

At a fundamental scientific level, for me, the rationale for the Watson approach falls over as a migraine treatment on two fronts: the assertion that the cause of migraine is a problem in the upper cervical spine (no mate, it’s genetic) and treating the neck pain as a trigger rather than a symptom. That said, if it works for you, go for it.

Watson and Botox are both useful tools to consider if you do have a lot of headache. If you’re someone like me for whom headache isn’t a significant issue, they are (usually) a waste of money. But physio generally is a very important part of the care team for lots of people with migraine. For example, my hemiplegic muscle weakness causes all kinds of issues physios can help with. For those with vestibular migraine, a great vestibular physio can be more important than a great neuro in helping to manage the condition. The blurring of migraine and headache is where things get confusing, so be assertive on what symptom or issue you’re trying to address to make sure you get the right treatment.

So with this recent occurrence of neck pain, part of me wants to go running back to the doctors, and part of me wants to stay calm. New symptoms of migraine I usually like to get checked out… and I’ve never had neck pain before. How do I know it’s migraine-related pain and not just an injury to my neck? Simple… I can feel the Aimovig working. When an attack is triggered, I still get nauseated or some other prodrome symptoms, then the Aimovig kicks in, my feet get hot (yes, strange I know) and the symptoms just fade away… like magic 🙂 The neck pain I have been experiencing is nearly always accompanied by my feet getting hot – so there’s little doubt for me it’s a migraine symptom.

Personally, I’m remaining optimistic this recent issue with my neck is more stress than anything else, and it will soon pass. I will work on it with my physio and do my stretches and whatever else they tell me to do, but no Watson for me.