Having to deal with back pain along with migraine may feel like a stroke of bad luck. “Bad lower back pain, as usual, along with a migraine. Very fatigued and frustrated,” one MyMigraineTeam member wrote.

These conditions often feel like two separate issues. But if they show up together often, it might make you wonder if your migraine attack could be causing your back pain or vice versa.

Back pain is a common problem that affects many people, including those with migraine. Although the American Migraine Foundation doesn’t consider back pain to be a common symptom or trigger of migraine, many people with migraine deal with back pain. In fact, one study noted that about 82 percent of people with chronic headaches (15 or more per month) and 80 percent of those with fewer headaches experienced back pain.

The relationship between migraine and back pain can be complex. Overlapping influences like disrupted sleep, stress, and muscle tension can sometimes lead these conditions to occur together. But understanding the link between migraine and back pain and noting when you experience each may help you identify which of these mechanisms is at work in your body.

Below we’ll take a look at the ways in which migraine and back pain can be linked.

What Can Cause Both Migraine and Back Pain?

Migraine and back pain often show up together. A 2019 review found that people living with primary headache disorders — migraine and tension-type headaches — had between 1.55 and 8 times higher risk of low back pain than people without headaches.

This higher chance of back pain among people with migraine headaches is linked to several shared risk factors and biological pathways.

Trigger Points

People with back pain can experience dull, sharp, or shooting sensations as well as tight muscles. These stiff muscle knots that can be felt through the skin are called myofascial trigger points.

Myofascial trigger points are often present in people with migraine and tension headaches. Some researchers have found that people with migraine tend to have more active muscle knots, especially in the shoulders and the neck, than those without the headaches. How big of a role these knots play in headaches and how exactly they trigger migraine is still being studied.

Muscle knots can be caused by:

• Poor posture
• Injury (like muscle strains)
• Tension from stress
• Sitting too much

Studies have reported that specific trigger points — those found in the muscles near the cervical spine (neck), the base of the skull, and the shoulders — are more common in people with migraine than those without.

Therapies targeting these trigger points, such as ischemic compression, dry needling, and positional release, can reduce migraine frequency, intensity, and the need for medication, with effects lasting weeks to months. However, more research is needed on these therapies and their effectiveness for migraine treatment.

Neck Pain

Lower back pain is the most common type of back pain, but pain anywhere from the top of your butt up to the base of your neck counts as back pain. Neck pain can cause headache pain that’s similar to migraine. This is called cervicogenic headache.

Cervicogenic headaches start in the neck and occur due to structural issues within the bones, discs, or nerves of the spine. The pain then travels upward — often to one side of the head — and may also lead to neck stiffness. Although neck pain can contribute to these headaches, it’s also a common symptom of a migraine attack.

“Extremely stressful eight-hour work day. Came home with back pain between my shoulder blades, lower back pain, stiff neck, and a migraine building,” one MyMigraineTeam member shared.

Stress

Stress can cause tension in the muscles of the back. It also plays a big role in migraine. In fact, the American Migraine Foundation lists stress as the most common migraine trigger. One study found that the majority of people with migraine — 50 percent to 70 percent — noted a significant link between their daily stress and migraine activity.

Being stressed can also impact your sleep. It can lead to insomnia (trouble falling or staying asleep) or disrupted sleep with frequent awakenings. Management often involves stress-reduction techniques like mindfulness and physical therapy.

Sleep Disruptions

Irregular sleep patterns are the second most common migraine trigger after stress. This is because sleep is essential for repairing and renewing the body, including the brain and the muscles of the back. If your brain doesn’t receive quality sleep, it can increase your risk of migraine. Meanwhile, sleep issues have also been shown to raise the risk of chronic back pain as well as worsen symptoms of chronic pain.

In addition, close to half of migraine attacks hit in the early morning hours — between 4 a.m. and 9 a.m. This timing can disrupt sleep and contribute to the development of sleep disorders. “Woke up with a migraine and lower back pain,” one MyMigraineTeam member wrote.

It’s important to aim for seven to nine hours of sleep nightly.

Shared Nervous System Pathways

Pain from the back and neck can also contribute to headaches due to shared nerve pathways. Nerves from the upper cervical spine and those from the head meet in an area of the brainstem called the trigeminocervical complex. This allows pain from tight back muscles or neck strain to be processed along the same pathway as head pain. Through this channel, neck and upper back tension can be translated into migraine pain.

Over time, repeated pain signals can cause nerve cells in the trigeminocervical complex to become more sensitive — a process called sensitization, which involves the neurotransmitter calcitonin gene-related peptide (CGRP) in both migraine and back pain. When this happens, migraine symptoms can be triggered from even mild tension in the upper back and neck. Extra sensitive nerves in the head and neck can lead to strong, throbbing pain in the head that worsens when you bend over, cough, or hold your breath. As pain signals travel through different parts of the brain, you may also notice a tender scalp or increased sensitivity to touch.

Keeping Track of Your Back Pain

There are many causes of back pain. The most common — muscle, tendon, or ligament injuries — can have nothing to do with migraine at all. But some people with migraine may notice a link between their headaches and back pain.

If you feel like your back pain is related to your migraine attacks but aren’t sure, try keeping a headache journal. Write down as much information as you can about your migraine attacks and back pain. The more details you compile, the more likely it is you and your healthcare provider will be able to notice any patterns that connect your back pain to your headaches.

Helpful details to write down for each headache and episode of back pain include:

• The date and day of the week
• The time symptoms began and how long they lasted
• Intensity on a scale of one to 10
• Location of the pain
• Whether you have any other migraine symptoms, like dizziness or pain elsewhere in your body
• Other information, such as how you slept, your stress and physical activity levels, hormonal changes, and medication use

You can also note whether you have any back pain or muscle tension during your attack or before it starts. Having all this information in one place can help you and your doctor better understand the link between your migraine headaches and back pain. You might find no noticeable pattern, which can mean your back pain is happening independently from your migraine.

Signs That Back Pain Isn’t Related to Migraine

Many instances of back pain are caused by factors or conditions other than migraine. Other signs and symptoms may also point away from migraine.

Possible signs that your back pain isn’t related to migraine include:

• Severe, worsening, or sudden back pain
• Back pain radiating to the legs/buttocks (sciatica) or arms
• Back pain that lasts longer than one week
• Sudden or significant weight loss along with back pain
• Back pain with progressive weakness, such as foot drop
• Other symptoms alongside back pain, such as cloudy or bloody urine (pee), pain while peeing, bowel or bladder incontinence, pain in the groin, chest or back pain triggered by coughing
• Back pain with severe symptoms, such as fever, intense pain in the abdomen, nausea, vomiting, muscle weakness, feelings of numbness or tingling in the pelvic area, or issues using the bathroom or walking

It’s important to remember that there are many potential causes of back pain. If you feel like your back pain is related to your migraine, talk to your healthcare provider.

With the help of a headache journal, you should be able to identify whether your back pain is connected to your headaches or not. Then you can work with your doctor on a treatment plan, which might include physical therapy or chiropractic care, to help relieve your back pain.

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