The MSK Studio - spinal physiotherapy and Clinical Pilates clinic in Adelaide

Migraines

Region affected

Upper cervical spine (C1–C3) / Trigeminal system

Common in

Adults 18–55, women three times more commonly than men

Onset

Episodic or chronic — often lifelong pattern

Related conditions

Cervicogenic Headache, Neck Pain, TMJ Dysfunction

Migraine is a neurological condition characterised by recurrent episodes of moderate to severe head pain, typically one-sided and pulsating in quality, often accompanied by nausea, light sensitivity and sound sensitivity. It is one of the most prevalent and disabling conditions worldwide, yet it remains significantly undertreated — in part because the contribution of the cervical spine to migraine is not routinely assessed.

Research has consistently shown that people with migraine have significantly more musculoskeletal dysfunction in the upper cervical spine compared to people without headaches. The relationship is not coincidental. The C1, C2 and C3 spinal nerves converge with the trigeminal nerve — which supplies the head and face — in a brainstem region known as the trigeminal cervical nucleus. When the upper cervical joints are dysfunctional, this convergence allows pain signals to be referred into the head, sensitising the trigeminal pain pathway in a way that can trigger or amplify migraine episodes.

Addressing the cervical spine as a contributing factor — rather than focusing solely on medication management — may help reduce both the frequency and severity of migraine in people who have a significant upper cervical component. This is the clinical rationale behind the Watson Headache® Approach, a research-validated assessment and treatment method used at The MSK Studio in Adelaide.

What Contribute to Migraines?

Signs and Symptoms

Research (Watson and Drummond (2012)) suggests that upper cervical dysfunction is a significant driver of this sensitisation in a meaningful proportion of migraine sufferers. Contributing factors include:

Migraine presents differently in different people, but characteristic features include:

  • Upper cervical joint stiffness or hypomobility at C1 and C2 — the levels most implicated in migraine provocation
  • Sustained desk, driving or screen postures that load the upper cervical joints over time
  • A history of whiplash or cervical trauma that has left residual dysfunction at the cranio-cervical junction
  • Suboccipital muscle spasm — the obliquus capitis inferior muscle, in particular, has direct connections to brainstem pain centres
  • Jaw clenching, grinding or TMJ dysfunction contributing to upper cervical load
  • Central sensitisation — where the brainstem becomes increasingly reactive to cervical afferent input over time
  • Moderate to severe head pain, typically one-sided and pulsating in quality
    Nausea, vomiting or both
    Sensitivity to light (photophobia) and sound (phonophobia)
  • Aura in some presentations — visual disturbances, tingling or speech changes before or during the headache phase
  • Headaches lasting four to 72 hours without treatment
  • Associated neck pain or stiffness — present in the majority of migraine sufferers and a key indicator of cervical involvement
  • Symptoms triggered or worsened by certain neck movements, sustained postures or physical activity
  • Prodrome and postdrome phases — mood changes, yawning, fatigue or cognitive fog before and after the headache phase

What Contribute to Migraines?

Research suggests that upper cervical dysfunction is a significant driver of this sensitisation in a meaningful proportion of migraine sufferers. Contributing factors include:

  • Upper cervical joint stiffness or hypomobility at C1 and C2 — the levels most implicated in migraine provocation
  • Sustained desk, driving or screen postures that load the upper cervical joints over time
  • A history of whiplash or cervical trauma that has left residual dysfunction at the cranio-cervical junction
  • Suboccipital muscle spasm — the obliquus capitis inferior muscle, in particular, has direct connections to brainstem pain centres
  • Jaw clenching, grinding or TMJ dysfunction contributing to upper cervical load
  • Central sensitisation — where the brainstem becomes increasingly reactive to cervical afferent input over time

Signs and Symptoms

Migraine presents differently in different people, but characteristic features include:

  • Moderate to severe head pain, typically one-sided and pulsating in quality
    Nausea, vomiting or both
    Sensitivity to light (photophobia) and sound (phonophobia)
  • Aura in some presentations — visual disturbances, tingling or speech changes before or during the headache phase
  • Headaches lasting four to 72 hours without treatment
  • Associated neck pain or stiffness — present in the majority of migraine sufferers and a key indicator of cervical involvement
  • Symptoms triggered or worsened by certain neck movements, sustained postures or physical activity
  • Prodrome and postdrome phases — mood changes, yawning, fatigue or cognitive fog before and after the headache phase
  •  

How The MSK Studio Treats
Migraines

At The MSK Studio in Adelaide, migraine assessment begins with a thorough upper cervical examination using Watson Headache® Approach techniques to determine whether the cervical spine is contributing to the patient’s migraine pattern. Not every migraine has a significant cervical component — but where one is identified, targeted manual therapy directed at the relevant upper cervical levels, alongside a home program for the deep cervical flexors and suboccipital muscles, may contribute to reductions in episode frequency and severity for some people over a course of treatment.

See our migraine & headache physiotherapy service below:

Migraine & Headache Physiotherapy
Migraine physiotherapy assessment in Adelaide

Related Conditions

Cervicogenic Headache

Whiplash

Cervical Radiculopathy

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