Neck pain in migraine: A narrative review and steps to correct evaluation and treatment.

Neck pain is extremely common in people who suffer from migraines, occurring during attacks, between episodes, and throughout all phases of migraine. This comprehensive review examined the complex relationship between neck pain and migraine to help doctors better diagnose and treat these interconnected conditions. Researchers analyzed existing studies covering clinical evidence, imaging, and neurophysiology to understand how neck pain functions in migraine—whether it's a symptom of migraine itself, a trigger that starts an attack, or a separate coexisting condition. The review found that migraine patients frequently show cervical dysfunction, muscle tenderness, and altered posture. The neck and head share overlapping nerve pathways, suggesting they activate pain signals through similar mechanisms. Unfortunately, neck pain in migraine patients is often misdiagnosed as a purely cervical (neck) disorder, leading to inappropriate treatment and missed opportunities for effective migraine care. The researchers found that standard migraine medications like amitriptyline and Botox injections may help reduce neck pain, while non-drug treatments including physical therapy, acupuncture, and behavioral strategies show promise. However, the evidence for neck pain relief specifically remains limited. The review highlights a significant knowledge gap: few studies have examined whether newer migraine treatments, particularly CGRP-targeted medications, help with neck pain. The authors emphasize that accurately identifying whether neck pain is a migraine symptom, trigger, or separate condition is essential for choosing the right treatment approach, and that combining medications with non-drug therapies may offer the best outcomes. If considering acupuncture for migraine-related neck pain, seek a qualified, licensed acupuncturist with experience treating headache disorders.

This narrative review systematically examined the relationship between neck pain and migraine through PubMed-sourced preclinical, clinical, neurophysiological, and imaging evidence. The analysis revealed that migraine patients frequently exhibit cervical dysfunction, tenderness, and postural alterations, with overlapping neuroanatomical pathways between cervical and trigeminal systems suggesting shared nociceptive mechanisms. A critical finding is the frequent misdiagnosis of migraine-associated neck pain as primary cervical pathology, resulting in suboptimal therapeutic approaches. The review proposes a structured clinical assessment protocol and treatment algorithm. Standard migraine therapies including amitriptyline and onabotulinumtoxinA demonstrated potential for neck pain reduction, while non-pharmacological interventions—physical therapy, acupuncture, and behavioral strategies—showed promise but lacked robust evidence. The authors identified a significant research gap: minimal data exists on CGRP-targeted therapies' effects on neck pain. Clinical takeaway: Accurately differentiating whether neck pain represents a migraine symptom, trigger, or comorbidity is essential for treatment selection. Combined pharmacological and non-pharmacological approaches warrant consideration, with future research needed to establish efficacy of newer migraine-specific treatments on cervical symptoms.