Migraine (Neck-Related & Tension-Type Headache)

Overview

Migraine is a neurological condition that causes repeated attacks of moderate to severe headache, often throbbing and on one side, lasting from a few hours to a few days. Many people also feel sick, become sensitive to light, sound or smell, and need to lie down in a quiet room. Some notice warning signs before an attack, such as visual disturbance or tingling, known as an aura. Migraine is common, affects more women than men, and often starts in the teens or twenties, which is why many of the students we see know it well.

We want to be clear about our role. Migraine is diagnosed and managed medically by your GP or a neurologist, and we do not cure it. What we can do is treat the musculoskeletal factors that frequently sit alongside migraine and may make attacks more frequent or more intense: stiff upper neck joints, tight suboccipital and shoulder muscles, forward-head posture, jaw clenching and the physical load of stress and poor sleep. For many people, neck symptoms are part of the migraine picture itself, and the boundary between migraine, cervicogenic headache and tension-type headache can be blurred.

Treatment therefore works best as a partnership. Your GP handles diagnosis and any medication; we address the neck, posture and muscle tension. Outcomes vary from person to person, but many people find that easing these contributing factors may help reduce how often attacks come and how hard they hit.

Causes and risk factors

• Family history: migraine often runs in families
• Hormonal changes, particularly around the menstrual cycle
• Irregular sleep, skipped meals, dehydration and caffeine changes
• Stress, and the "let-down" period after a stressful stretch such as exams
• Upper neck joint stiffness and tight neck and shoulder muscles
• Prolonged screen time with the head held forward
• Jaw clenching or teeth grinding, often linked to stress
• Certain foods, strong smells, bright or flickering light in some people

How we may be able to help

Assessment comes first. We take a detailed headache history to understand your pattern and help you tell migraine apart from cervicogenic headache and tension-type headache, which can coexist and are treated differently. We examine the movement of your upper neck joints, test the deep neck muscles, feel for trigger points in the suboccipital, upper trapezius and jaw muscles, and look at your posture. If you have not yet had a medical diagnosis, or your pattern has changed, we ask you to see your GP first and can arrange an online private GP consultation if that is quicker. If anything in your history suggests a medical cause, we refer you on straight away.

Treatment is tailored to what we find and aims to reduce the musculoskeletal load that may be feeding into your attacks. It may include hands-on mobilisation of the upper neck, chiropractic spinal manipulation by our chiropractor where assessment shows it is suitable, and dry needling or acupuncture for trigger points in the neck, shoulder and jaw muscles. A 3D posture scan can show how far forward your head sits, and interferential therapy may help settle neck pain and muscle spasm during a flare. We then build a programme of deep neck strengthening, posture work and relaxation strategies, and help you plan around known triggers. Treatment is scheduled between attacks rather than during one, and we work alongside, never instead of, your GP's care.

What you can do at home

• Keep a headache diary noting sleep, meals, stress, neck stiffness and screen time around each attack
• Aim for regular sleep and meal times, and stay hydrated
• Set your screen at eye level and take a short movement break every 30 to 45 minutes
• Do gentle chin tucks, upper-neck stretches and shoulder rolls a few times a day
• Notice daytime jaw clenching and let the teeth rest apart with lips closed
• During an attack, rest in a dark, quiet room; a cool pack on the forehead or a warm pack on the neck may help
• Discuss attack frequency and medication options with your GP, and attend any neurology follow-up