If you have ever had a migraine, you know it is far more than a bad headache. The throbbing pain, the sensitivity to light and sound, the nausea, the hours or even days lost to it. Migraine is a complex neurological condition that affects roughly 1 in 7 people worldwide, with women affected about twice as often as men (Amiri et al., 2022).
Most people manage their migraines with medication. For many, that works well enough. But for those who experience frequent episodes, are looking to reduce their reliance on medication or find that their current approach is not cutting it, chiropractic care is worth considering.
The neck-migraine connection
One of the reasons chiropractic care can be effective for migraines is the relationship between the upper cervical spine and headache. The upper neck shares neurological pathways with the head and face through the trigeminocervical nucleus, a region in the brainstem where sensory signals from the upper cervical nerves converge with those from the trigeminal nerve (the main pain nerve of the head).
When the joints, muscles or nerves of the upper cervical spine are irritated or restricted, they can sensitise this system and lower the threshold for migraine attacks. This is not a theory. A 2024 study by Jafari and colleagues demonstrated that upper cervical manual therapy produced measurable changes in the blink reflex of migraine patients with neck pain, confirming that treating the neck can directly influence trigeminal nerve processing (Jafari et al., 2024).
Many migraine sufferers also report neck pain and stiffness before or during an attack. This is not a coincidence. The cervical spine is often part of the problem.
What the research says
The evidence base for spinal manipulative therapy (SMT) and manual therapy in migraine management has grown considerably in recent years.
A 2024 systematic review and meta-analysis by Posadzki and colleagues, which pooled data from randomised clinical trials, found that spinal manipulation produced significant reductions in migraine frequency compared to controls (Posadzki et al., 2024).
A 2022 systematic review published in Cephalalgia found that manual joint mobilisation was associated with reduced migraine frequency and pain intensity (Beier et al., 2022). A further systematic review and meta-analysis in 2023 confirmed that physical therapy approaches, including manual therapy, improved outcomes in chronic migraine (Onan et al., 2023).
A pilot randomised controlled trial from Harvard-affiliated researchers tested a multimodal chiropractic approach for migraine. Participants receiving chiropractic care showed reductions in migraine days and improvements in disability scores, supporting the feasibility of chiropractic as part of a migraine management strategy (Rist et al., 2021).
What chiropractic treatment involves
Chiropractic care for migraines typically focuses on:
- Cervical spine assessment and adjustment. Identifying and treating restricted or dysfunctional joints in the upper and mid-cervical spine that may be contributing to migraine through the trigeminocervical pathway.
- Soft tissue work. Addressing tension and trigger points in the suboccipital muscles, upper trapezius and deep cervical flexors that commonly refer pain into the head.
- Thoracic spine mobilisation. A stiff thoracic spine forces the cervical spine to compensate, increasing mechanical stress on the upper neck.
- Postural assessment. Forward head posture and rounded shoulders increase load on the cervical spine. Addressing posture can reduce the mechanical drivers of migraine.
Who benefits most
Chiropractic care tends to be most effective for migraine sufferers who:
- Have neck pain or stiffness as part of their migraine pattern
- Notice that their migraines are triggered or worsened by sustained postures, screen time or stress
- Experience tension-type headaches between migraine episodes
- Want to reduce how often they need medication
- Have not responded fully to medication alone
It is not a replacement for medical management when that is needed. But for many patients, adding chiropractic care to their approach reduces migraine frequency and severity in a meaningful way.
Getting help
If migraines are affecting your quality of life, it is worth having your neck properly assessed. A thorough examination can determine whether cervical spine dysfunction is contributing to your headaches and whether treatment is likely to help.
Book an appointment or get in touch to discuss your situation.
References
- Amiri P, Kazeminasab S, Nejadghaderi SA, et al. Migraine: A Review on Its History, Global Epidemiology, Risk Factors, and Comorbidities. Frontiers in Neurology. 2022;12:800605.
- Jafari M, Bahrpeyma F, Togha M, Hall T, Vahabizad F, Jafari E. Can upper cervical manual therapy affect the blink reflex in subjects with migraine and neck pain? Journal of Manual & Manipulative Therapy. 2024;32(2):190-197.
- Posadzki P, Klimek AT, Ernst E. Spinal manipulations for migraine: an updated systematic review and meta-analysis of randomized clinical trials. Systematic Reviews. 2024;13(1):296.
- Beier D, Callesen HE, Carlsen LN, et al. Manual joint mobilisation techniques, supervised physical activity, psychological treatment, acupuncture and patient education in migraine treatment. A systematic review and meta-analysis. Cephalalgia. 2022;42(1):63-72.
- Onan D, Ekizoglu E, Arikan H, Tasdelen B, Ozge A, Martelletti P. The Efficacy of Physical Therapy and Rehabilitation Approaches in Chronic Migraine: A Systematic Review and Meta-Analysis. Journal of Integrative Neuroscience. 2023;22(5):126.
- Rist PM, Bernstein C, Kowalski M, et al. Multimodal chiropractic care for migraine: A pilot randomized controlled trial. Cephalalgia. 2021;41(3):318-328.