Lisa Brackett, 59, from Lake Worth, Florida, knows she’s in for trouble when her neck starts to hurt. “It feels like a white-hot golf ball at the base of my skull,” she says. “It’s a sickening and very distracting pain that can stop me in my tracks.”
For Brackett, that’s a sign a migraine attack is looming. “Neck pain is really common in people who have migraine,” Elizabeth W. Loder, MD, chief of the headache division at the neurology department at Brigham and Women’s Hospital in Massachusetts, tells SELF. One recent review found that about 77% of people with this complex neurological condition also experienced an achy neck before or during an episode.
But there’s also another type of neck-triggered problem, known as a cervicogenic headache, which is a different beast altogether. To correctly treat your symptoms, it helps to figure out exactly what’s going on. “The challenge is to try to distinguish if [someone has] migraine with neck pain that’s part of their migraine attack, or whether they have neck pain for some other reason,” says Dr. Loder. Here are some ways to tell the difference and what to do about them.
How to tell if your achy neck is something more
Brackett’s symptoms are part of her prodrome, or the “preheadache” phase that occurs a few hours or days before migraine’s official start. Nikki S., 32, from Chicago, feels like her neck problems actually cause her attacks, which is the case for some people. “Neck pain can frequently trigger migraine attacks for me,” she says. “I feel tightness and tingling sensations in my neck and it spreads up to my head. I sometimes feel like my head is too heavy for my neck to support and I need to lie down.”
Cervicogenic headaches, on the other hand, are due to neck problems but aren’t considered part of migraine—and can have a different treatment approach. With this condition, the bones, discs, nerves, and soft tissues of your neck or the very top of your spine are usually to blame. The pain “is primarily in the back of the head and neck,” says Shayna Y. Sanguinetti, MD, assistant professor of neurology at Hofstra Zucker School of Medicine. “This usually develops in relation to…some sort of cervical disorder or lesion, such as injury, degenerative spine disease, or muscle spasm.” Other possible causes include fracture, infection, or even rheumatoid arthritis.
And while a neck ache can be a guest star with either ailment, it can feel a little different depending on the condition. Dr. Loder notes that cervicogenic headaches are more likely to occur suddenly and feel lightning bolt-like. While the pain may feel like it’s coming directly from the back of your head or neck, “it can radiate forward,” Dr. Loder says, and may affect the top of your head. Unlike with migraine, moving your neck or adding pressure to the area might make it feel worse, she says, and you might also experience one-sided pain or difficulty moving your neck.