OsteoVIf you live with migraine, you may also be nursing a stiff neck, sleeping badly and feeling more sluggish than you would like. It is tempting to file each of these under a separate heading, and easy to be sent to a separate person for each one. Often they are threads of the same story, and pulling on one can loosen the others.
Migraine rarely travels alone
Headache medicine has a word for this: comorbidity, meaning two or more conditions that keep company more often than chance would predict. Migraine is unusually sociable in this respect. Neck pain, disturbed sleep, low mood and anxiety all turn up alongside it far more often than they do in people without migraine.
This is important because when your care is split between different clinicians who never compare notes, the connections between these problems can fall through the gaps. You end up managing four things at once with no one looking at how they feed each other.
The neck
Neck pain and migraine are close companions. In clinic-based studies pooled in a 2022 review, around 77 per cent of people with migraine reported neck pain, compared with roughly 23 per cent of people without headache. Neck pain also tends to be more common the more frequent the migraine.
This does not mean your neck is the sole cause of your migraine and it does not mean it is irrelevant. The nerves that carry pain from the upper neck and the nerves involved in migraine share connections in the brainstem, so signals from one can be felt as the other. For many people, tightness and tenderness around the neck and jaw are part of the attack rather than a separate injury. This is useful to know, because the neck is something a hands-on assessment can examine and work with directly and determine whether the neck is actually an issue or a symptom of your attack.
The sleep
Sleep and migraine pull on each other in both directions. Poor or broken sleep can make attacks more likely and being woken or floored by attacks makes good sleep harder to come by. Reviews of the evidence describe this as a two-way relationship, with insomnia recognised as a risk factor for migraine becoming more frequent over time.
The encouraging part is that sleep is one of the more workable pieces of the puzzle. Steadying your sleep and waking times and treating an insomnia pattern properly rather than just enduring it, is one of the few changes that can influence headache frequency rather than only easing a single attack.
The mood
Living with recurring pain takes a toll on mood and mood in turn shapes how pain is experienced. The link between migraine and conditions like depression and anxiety is well established. The American Migraine Foundation notes that people with migraine are around two to five times more likely to experience depression or anxiety than people without it.
None of this means migraine is caused by your mood, or that the pain is imagined. It means the nervous system that produces migraine and the systems that regulate mood and sleep are closely wired together. Anxiety about when the next attack will land can itself keep the whole system on edge, which is worth naming rather than ignoring.
Why joining the dots helps
Seeing these as one connected picture is not about adding more to your mental load. It is the opposite. A proper assessment that looks at the neck, sleep, mood and headache together can often find the thread most worth pulling first, so your effort goes where it is likely to count rather than being spread thinly across four separate appointments and four different specialists.
You have probably sensed this connection for a while, even if no one has said it out loud. Whole-body thinking is not a slogan here. It is simply how these conditions actually behave.
When to seek urgent care
See a doctor promptly, or call 999, if you have a sudden, severe "thunderclap" headache, a headache with fever and a stiff neck, new weakness, numbness or confusion, or a headache after a head injury. New or changing headaches always deserve medical assessment.
If your headaches come bundled with neck pain, broken sleep or low mood, a full assessment can help make sense of how they fit together and where to start. You are welcome to book an appointment or get in touch.
- Al-Khazali HM, Younis S, Al-Sayegh Z, Ashina S, Ashina M, Schytz HW. Prevalence of neck pain in migraine: A systematic review and meta-analysis. Cephalalgia. 2022;42(7):663-673.
- Tiseo C, Vacca A, Felbush A, et al. Migraine and sleep disorders: a systematic review. The Journal of Headache and Pain. 2020;21:126.
- American Migraine Foundation. The relationship between migraine and mental health. americanmigrainefoundation.org
- National Institute for Health and Care Excellence (NICE). Clinical Knowledge Summaries: Migraine. cks.nice.org.uk