/assets/images/provider/photos/2740242.jpg)
Migraine and Neck Pain: Understanding Their Connection
Migraine and neck pain have significant overlap, as they share many neural pathways. Not only can migraine result in neck pain, but neck pain can also trigger migraine headaches. Correctly identifying the interplay between these two sources of pain is crucial, as therapeutic strategies can vary widely.
Migraine and Neck Pain
Migraine is not merely a headache, but rather a state of brain dysfunction, resulting in heightened sensitivity to nerve input. Conceptualizing migraine in this way makes it easier to explain some migraine symptoms, such as nausea, smell sensitivity, light sensitivity, noise sensitivity, and heightened pain sensations (including the headache).
Importantly, this heightened sensitivity occurs at the level of the brainstem, which is the lowermost structure in the brain where it meets the spinal cord. One of the major nerves that ends in the brainstem is the trigeminal nerve, the major sensory nerve innervating the face and forehead.
Additionally, the nerves innervating the upper neck and back of the head also terminate here, and they too become more sensitive during a migraine. These nerves are called the “occipital nerves,” and there are three of them on each side: greater, lesser, and third. These occipital nerves convey pain and touch sensations from the upper neck and back of the head. They converge and enter the spinal cord in the upper cervical spine, specifically at the second and third vertebrae (C2 and C3).
The command center of the trigeminal nerve (also known as the “nucleus,” where the nerve originates) is extensive, extending all the way to the upper cervical spine, reaching the levels of C2 and C3. Consequently, this nucleus makes very tight connections with the nerves landing at those levels, including the occipital nerves.
When the trigeminal nerve becomes sensitized (i.e., easier to excite and more capable of augmenting any signal) due to the migraine attack, these nerves become sensitized as well.
Once this process begins, migraine patients start experiencing pain in their neck on top of their migraines. At times, this pain can be more distracting than the headache pain itself.
Cervicogenic Headache and Migraine
To complicate matters further, it is important to understand that neck pain can be not only the result of migraine but also the cause of it (or the cause of its provocation to be more accurate).
First, let’s discuss what cervicogenic headache (CH) is. Cervicogenic headache essentially means a headache originating from the neck. Neck pain (and pain in the spine in general) is frequently due to joint inflammation (i.e., arthritis). This is more common in the mobile segments of the spine, such as the lower back (the lumbar spine) or the lower neck, while it is not as common in the upper neck and thoracic area.
However, certain factors can also predispose the upper neck joints to arthritic changes, the most common being decelerating injuries such as whiplashes, or non-ergonomic forward neck posture, as seen with prolonged screen time.
When the cervical spine joints at C2/C3 become involved, they may irritate the adjacent occipital nerves, mainly because of their proximity but also due to the muscle tension on them as these muscles become stiffer around these joints.
As a result, when these nerves become tender, they can transmit that irritability to the trigeminal nerve via its connections in the brainstem, and at this point, neck pain may transform into a headache.
However, whether this headache will become a migraine, or remain as referred head pain greatly depends on individual factors, including environment and genetics. It is very common in headache medicine to observe that people with a history of migraine headaches may experience a significant deterioration of their migraines following any serious neck injury or arthritic changes.