New Research Shows Migraines Can Spawn Muscle Tension
If you find that you have neck pain in conjunction with headaches, you are far from alone.
One study from 2010 found that there was actually a more prevalent association between migraines and neck pain than there is between migraines and nausea.
This is surprising, considering that many people associate nausea with migraines, but may not be aware of the link to neck pain.
The link above also refers to an interesting "informal survey" in which the following results were reported:
- 69% of migraine sufferers had a “tight” neck.
- 17% said they had a “stiff” neck.
- 60% said they felt neck pain before a migraine.
Indeed, I have seen a number of references over my years of headache research indicating that muscle tension may be a migraine trigger in some people.
What I have not seen much of however are indications that the situation can be reversed. But today, I found a new study which highlights the possibility that a migraine may actually cause neck pain.
In this article, I will get into this complicated relationship between neck pain and migraines.
But I would also like to underscore the challenges of telling apart one type of headache from another.
Tension-type headaches frequently exist in the presence of stiffness in the neck, shoulders and back.
While tension headaches are usually described as a "tight band around the head," there are anecdotes to suggest that they may exhibit more variety than that.
There is also the matter of cervicogenic headaches. These types of headaches are spawned from problems arising in the structure of the neck. Symptomatically, they are very close to migraines. Telling the two apart may be difficult or impossible.
Further convoluting this topic is the fact that a person may suffer from more than one type of headache.
This used to be referred to as a “mixed tension headache.”
Now however, headache experts are starting to realize that people with “mixed tension headaches" actually may be experiencing both migraines and tension headaches or cervicogenic headaches. These headaches can even occur simultaneously.
Why Might Muscle Tension Cause Migraines?
I've already discussed some evidence that muscle tension (specifically in the neck) may be a contributing factor in some migraine cases.
My chiropractor has also pointed out the tension around the shoulder blades seems to be a common migraine trigger.
My guess as to why muscle tension might trigger a migraine is that both the body and mind are under stress from the tension.
In some cases, the stress might even lead to a tension headache before spawning a migraine.
More research is needed in this area to be sure what is going on. Indeed, researchers still do not seem to entirely be able to agree as to whether muscle tension proceeds from migraines, results from them, or both.
Can Migraines Cause Muscle Tension?
Now we can get into talking about the evidence that migraines may actually result in muscle tension rather than simply being triggered by it.
The study I found today was published in March 2018 in The Journal of Headache and Pain. It is titled, “Altered muscle activity during rest and during mental or physical activity is not a trait symptom of migraine - a neck muscle EMG study.”
The study incorporated data from 102 participants. Thirty-one of them suffered chronic migraines, while 43 suffered episodic migraines. The rest were migraine-free subjects. The researchers used trapezius muscle surface EMG response measurements to monitor tension while subjects were engaged in physical activity or rest. They also checked responses during mental stress.
They found that for the most part, migraine patients and healthy subjects exhibited no significant differences in readings under most conditions.
But they did find that, “for the initial mental stress situation (F (2,56.022) = 8.302, p = 0.001), where controls increased tension by only 4.75%, episodic migraineurs by 17.39% and chronic migraineurs by 28.61%. Both migraine groups returned to resting EMG levels within the same timeframe as healthy controls.”
Based on the results, the researchers concluded, " Neck pain associated with migraine can therefore not be attributed to increased trapezius activity during rest, mental stress and physical activity or prolonged muscle activity and should not be seen as a constantly underlying trigger but rather as an accompanying symptom of migraine.”
The researchers also say, " Our results from this study neither indicate higher levels of neck muscle tension nor increased durations of tension after stressful incidents in patients with frequent episodic or chronic migraine compared to headache-free controls.”
This seems to suggest that a migraine patient with no other headache-related issues should no longer feel muscle tension or pain after an attack is ended.
To me it seems plausible however that a patient with chronic injury or a structural problem could have those issues triggered by migraine-related neck tension, leading to tight trigger points, headaches, and other complications. Of course, this is only hypothetical.
Relevant to this subject is another interesting article from Tufts Now.
In the article, the author confers with a Tufts neurologist named Egilius L.H. Spierings, who delves into the role that muscle tension can play in headaches.
The article states, “The more pain the person endures, the more likely she—and women suffer from migraine at about twice the rate that men do—is to store tension in those muscles.”
This is described as a vicious cycle. Spierings explains, “The pain is ultimately caused by the blood vessels widening. But what drives the frequency, I think, is a muscular mechanism.”
Indeed, patients with chronic migraines—but not those with infrequent migraines— have been finding relief with Botox treatments.
Because so much more research is needed into these topics, it is impossible to draw any firm conclusions at this point.
Here is what I get from all this, however:
- Migraines are painful. People who experience frequent pain from migraines or other sources may develop chronic problems involving muscle tension.
- Those who only suffer infrequent migraines are less likely to have muscle tension continue after a migraine attack.
- Those who do develop issues with muscular mechanisms are more likely to go on to develop more frequent migraines.
- Those who are predisposed to muscular issues for other reasons (i.e. structural deformities) may have this issue compounded.
This would explain in part why migraines and tension-type headaches seem to feed off of one another.
It is my belief that this can also happen with cervicogenic headaches and migraines.
Key Point: Researchers still are not overly clearer on the role which muscle tension plays in relation to migraines. There is evidence to suggest that migraines may be triggered by muscle tension or may cause muscle tension. The more chronic one issue is, the more probable it seems that the other will become so.
Recognizing a Migraine
Now you know that there is a complex interplay which may be possible between migraines and muscle tension.
So if you do experience frequent headaches, you might be rethinking the nature of those headaches.
There's quite a bit of variation in how any given type of headache can manifest.
For this reason, headaches cannot be summarized in a one-description-fits-all manner.
But we can still review traits which are common for different types of headaches.
This may help you to figure out whether you are experiencing migraines, tension-type headaches, cervicogenic headaches, or a combination of these types of pain.
Here are some traits which are common with migraines:
- Pain is typically unilateral, but it may occur in any location on the face or head. It is most frequently centered in the temple or around the eye.
- The pain is intense and may throb or pound. This is usually accented if you are physically active.
- It is possible for the pain to switch sides.
- In some cases, the pain may be bilateral.
- Neck pain may accompany a migraine, as discussed.
- Back pain also seems to be associated with migraines, particularly around the shoulder blade.
- You might feel faint or experience dizziness.
- Some people with migraines experience nausea or vomiting.
- You may be sensitive to light and/or sound while experiencing a migraine.
- In some situations, a migraine may not actually involve head pain. Instead, the other symptoms will be present on their own.
- A migraine may last a few hours or it could last for days.
Additionally, there may be patterns in how migraines develop and fade away.
- Many people with migraines report a lead-in stage known as the “prodromal phase.” Some symptoms which are commonly associated with this phase include irritability, and unusual energy levels, hunger or thirst, cravings, increased urination and yawning.
- Following this phase, you may enter a stage called the “aura.” Not everyone gets this. The aura can include vision changes like an arc of light, generally on just one side. The arc will usually have a “jagged” profile. You might also have a blind spot, and some people even hallucinate. Tingling sensations and difficulty concentrating may be involved as well.
- Following the “attack” phase where the head pain generally occurs, there is the “postdromal” phase. This phase is dominated by fatigue and cognitive issues. Some head pain may come and go during this phase, especially with movement.
If all or part of what you read above sounds familiar to you, you may indeed suffer from migraines.
Recognizing a Tension Headache
Migraines are probably the most talked-about type of headache, but tension headaches are actually more prevalent. Also called “tension-type headaches,” they are frequently characterized by the following traits:
- Pain which has a more “dull” quality than that of a migraine.
- The pain is usually classified as being mild to moderate rather than severe.
- The pain pattern may vary, but it is frequently described as a “tight band around the head.” The front, sides, and back of the head are frequently affected.
- When the pain is at a very low pitch, I have noticed it feels more like a general sense of “malaise”—but that may just be me.
- Tension headaches which are long-lasting may be quite fatiguing.
- Because tension headaches are caused by muscle tension, there may be associated trigger points.
- Successfully relaxing the taut muscles may reduce the pain.
- If trigger points are involved, pain may be more intense.
As you are now aware, tension-headaches and migraines can be co-morbid. So if you have a combination of these symptoms and those discussed in the migraine section, you may be experiencing both types of headache.
Recognizing a Cervicogenic Headache
A third type of headache which gets almost no attention is the “cervicogenic” headache.
In fact, this type of headache is so seldom discussed that the phrase is relatively new to me—even though this is probably the most “correct” description of at least part (if not all) of my head pain.
A cervicogenic headache is classified as a secondary headache. That means that it is the result of another underlying disorder.
In this case, that is a disorder of the spine. As the American Migraine Foundation explains, “Cervicogenic headache is referred pain (pain perceived as occurring in a part of the body other than its true source) perceived in the head from a source in the neck.”
This source may include derangements of the bone and/or soft tissues. The foundation elaborates, “Numerous pain-sensitive structures exist in the cervical (upper neck) and occipital (back of head) regions. The junction of the skull and cervical vertebrae have regions that are pain generating, including the lining of the cervical spine, the joints, ligaments, cervical nerve roots and vertebral arteries passing through the cervical vertebral bodies.”
It needs to be emphasized that not all headaches which involve neck pain are cervicogenic in nature. If a migraine causes neck tension, but is not derived from problems with the structure or tissues of the neck, it is not cervicogenic.
Even tension headaches caused by neck tension are not necessarily cervicogenic. There needs to be an actual physical defect for this classification to be relevant.
The foundation writes, “Such disorders include tumors, fractures, infections and rheumatoid arthritis of the upper cervical spine. There is debate as to whether cervical spondylosis (age-related wear and tear affecting the spinal disks in your neck) can cause cervicogenic headache.”
In my case, I have a deformity of the jaw which pulls my spine out of alignment on a recurrent basis. This in turn leads to extremely tight muscles with trigger points which refer pain back to my head.
I am not positive if this is formally classified as a cervicogenic headache or not; because the only confirmed abnormality in structure is in my jaw, it may not “count.”
For all I know though, there are now abnormalities in my neck as well. The soft tissue has certainly developed chronic problems, and my symptoms are very much a match for typical cervicogenic head pain manifestations.
Here is what cervicogenic pain is typically like:
- Much like a migraine, this type of pain usually occurs on one side of the head and/or face at a time. It can manifest pretty much anywhere on the face or head, and often can make its way down to the eye.
- Being as this is a form of referred pain, it tends to follow familiar referred pain patterns such as those which you can find in these diagrams. If you press on trigger points which are tender, you may feel the pain radiate more strongly.
- Sometimes there is accompanying pain in the neck, shoulders, and back. But other times, you may feel no localized pain at all, simply head pain. This can make it easy to miss the fact that the neck is involved.
- Moving the neck in certain ways, or standing, sitting or lying down in certain postures can make pain better or worse depending on the referral patterns and tissues involved.
- Pain may range from mild to intense. It tends to have a steady quality to it rather than be throbbing quality. But it should not be confused with the mild, steady pain which characterizes a standard tension-type headache. That pain is usually described as “dull,” which is not at all how one would likely describe the pain of a cervicogenic headache.
- Cervicogenic problems can produce additional symptoms as well. Some people feel nauseous with this type of pain. Vision changes, light or sound sensitivity, vertigo, and so on may occur as well.
- Your range of motion may suffer because of cervicogenic issues. This may be because turning your head too far carries consequences, or because your muscles have literally shortened and you cannot move your head that way anymore.
Because cervicogenic headaches and migraines share so many features in common, they can be very challenging to tell apart.
Additionally complicating the matter, a person who has cervicogenic headaches could also have migraines and/or tension headaches.
As discussed previously, it seems like neck problems and migraines may feed into each other in a cyclical fashion.
If you are migraine-prone, and you have an aberration of the spine, the issues with your neck may trigger more migraines.
If you get a lot of migraines, this increases your neck tension, which in turn can trigger your cervicogenic issues to worsen.
Should you determine you do have cervicogenic headaches, it is important to understand that treatment must be focused around the derangements of the neck which are causing the pain.
Is your spine out of alignment? Seeing a chiropractor can help.
If muscles have become tight, you will need to treat the trigger points to get them to loosen up again. This can be very challenging, as muscles seem to remember their recent habits, and can become maladaptive and stubborn.
What if there are other culprits such as arthritis or a tumor? You will need to take additional steps to deal with these issues.
Treat All Your Headache Types to Get Relief
You now are more aware of some of the different types of headaches you can get, and how the neck may be implicated in each of them.
You will need to determine to the best of your ability which types of headaches you are most likely to be suffering from.
Should there be more than one type of headache plaguing you, failure to treat both or all three will hold back the overall success of your treatment plan.
So let's quickly go over some treatments you can try for each type of headache.
- If your migraines are frequent or intense enough, you may be able to get a prescription medication to help manage them. There are two main types of treatments—those that seek to prevent migraines, and thos which seek to support them.
- If you prefer to go a natural route, there are herbal supplements you can try to treat migraines. Some common herbs for migraines include boswellia, butterbur, Vitex, ginger, and feverfew.
- Another popular natural treatment for migraines is therapeutic doses of magnesium.
- Vitamin D may be helpful in reducing migraine frequency and duration, as might vitamin B12.
- Common over-the-counter medications which can help to provide migraine pain relief include ibuprofen, aspirin, and acetaminophen.
- Many people find that caffeine helps with migraines, so a cup of coffee may reduce your symptoms.
- Staying well-hydrated and eating healthy meals abundant in nutrition is important to preventing migraines.
- Quite a few people report that exercise is helpful in regulating migraine pain. This seems to be most helpful as a regular preventative.
- For some people, sexual activity can help reduce migraine pain.
- Getting on a regular sleep schedule can help to prevent migraines.
- Some people find that acupuncture, dry needling, massage, or chiropractic work can help to alleviate migraines. It is possible that this has to do with relieving associated neck, shoulder, and back tension.
- Cognitive therapy, meditation, and other psychological work can help some people to manage their migraines.
- Cold therapy can help to combat migraine pain.
- Also important is to identify your migraine triggers. Once you are able to avoid them more effectively, you may have fewer and less intense migraine episodes.
Treating Tension-Type Headaches
- As with migraines, over-the-counter medications such as acetaminophen, aspirin, and ibuprofen can help to reduce tension headache pain.
- Prescription medications may be given for tension headaches.
- While cold therapy can help with migraines, heat can be applied to tense muscles to reduce tension headache pain.
- Massage therapy, acupuncture, dry needling, and chiropractic may all help to reduce tension headaches.
- Magnesium may be helpful in reducing muscle tension which causes head pain. You can take magnesium by mouth, or you can try taking a warm bath in Epsom salts. You also can consider magnesium spray.
- Be aware of your posture throughout the day. Try to avoid non-ergonomic positions. Vary your posture regularly. Sitting in one position for a long time, particularly if it is not ergonomic, can easily lead to a tension headache.
- Stretching and other exercises may help to loosen up tight muscles.
- Staying hydrated and eating a nutritious diet may help to prevent tension headaches as well.
- As with other types of pain, tension headache pain may be helped sometimes by practicing relaxation techniques, meditation, cognitive therapy techniques, and so on.
Treating Cervicogenic Headaches
- If there is an underlying issue which can be successfully treated or even cured, it is important to try to do so. For example, if there is a tumor which can be removed without causing harm, this might be sufficient to restore function.
- Regular chiropractic treatments can help bring the spine back into proper alignment, reducing the structural issues that cause pain.
- Some people manage pain using nerve blocks or injections. Note that this can be quite expensive.
- Physical therapy may assist with treating cervicogenic headaches.
- Both over-the-counter and prescription medications can help relieve cervicogenic headache pain.
- Strategic use of heat or cold may reduce muscle and nerve pain feeding into cervicogenic headaches.
- Electrodes connected to a TENS unit which are strategically placed near the sites in the neck which are referring pain may help to cut off the pain from reaching the head.
- Trigger points must be dealt with (see below).
Treating trigger points is complicated, so it deserves a little extra discussion. Trigger points are often described as "knots" in the muscles, and they do sometimes feel like this. Their presence however is more often characterized by "taut bands” of muscle.
The trigger points themselves however are specific spots. Many people get trigger points after injuries or over-exertion or bad posture, but usually they go away quickly. If yours become chronic, the condition is usually referred to as "myofascial pain."
If you do believe that you have trigger points, here are some tips for deactivating them:
- Your first step is to locate the trigger points. This fabulous site can help you figure out which trigger points cause which pain patterns. My experience with the site has been that it is spot-on accurate with most of the sensations that I feel. Treating the trigger point is almost always going to be far more effective than treating the location where you actually feel the pain.
- Trigger points are usually quite stubborn, and will not react swiftly to the conservative measure like heat. That being said, a warm shower or heating pad may still help to reduce the broader tension caused by the trigger points, and may help to soften them up a bit.
- Both acupuncture and dry needling are often suggested for treating trigger points. While these two practices are similar, the approaches used are different.
- Massage therapy can help to deactivate trigger points, especially when performed regularly.
- A TENS unit can be helpful in treating trigger point pain and reducing the degree to which it refers. You can also try EMS.
- Certain over-the-counter and prescription medications may be helpful. Inflammation tends to be high in trigger points, so taking an anti-inflammatory drug can do more than just alleviate pain.
- While an indirect method, chiropractic treatment can do a lot to help reduce trigger points. When you correct spinal alignment issues, you relieve some of the unnatural load being put on certain muscles.
- I have found gua sha to be supremely useful in treating trigger points. While this treatment looks painful, it actually produces rapid pain relief in many cases, and it can break up the trigger points. You can do it yourself at home using a ceramic spoon.
- Stretching can reportedly help to deactivate trigger points. This also may return muscles gradually to their proper lengths.
- It is often reported that compressing a trigger point for a few seconds and then releasing it may help to soften it. There is some contention about how long to press and how hard to press.
While trigger points are commonly associated with cervicogenic headaches, they may show up in conjunction with migraines or tension headaches as well since both can involve severe or frequent muscle tension.
One final note regarding trigger points: it is important to note that they come back again and again when they flare. It is not unusual to need to treat them aggressively for weeks or months before you see improvements that last.
Nonetheless, you should make sure that you do not over-treat them. I have discovered that it is possible to irritate them to an extreme degree if one is not careful, which can actually slow the healing process.
Headache Sufferers Wade Through a Complex Ecosystem of Pain Which Often Can Involve the Neck
You now should understand a bit better the complex interplay of headache factors involving the neck.
Migraines, cervicogenic headaches, and tension headaches can all involve tension and/or pain in the neck.
Problems with the neck can lead to headaches of various types, and various types of headaches can lead to continuing problems with the neck.
So whatever types of headaches you experience, try to figure out whether your neck is playing a role, and if so, what role that is.
Make sure that you are treating your headaches and the issues with your neck. This will give you the best chance of alleviating pain with respect to both acute episodes and your overall condition.