The Problem with Definitions
One of the puzzles in migraine care is how the role of the neck is often discussed and just as frequently dismissed. Many health professionals agree that neck problems can “influence” migraine, but then quickly add that they cannot be a cause. Why? Not because of strong scientific evidence, but because of how migraine is defined.
Circular Reasoning at Work
By definition, migraine is a “primary headache disorder”, which means there is no recognised cause. So, if neck dysfunction is present in someone with migraine, the reasoning goes: “It can’t be the cause, because migraine has no cause.” This logic is a classic example of circular reasoning. The definition itself becomes the explanation, which shuts the door to other possibilities.
Labels Are Not Explanations
This rationale creates another problem: mistaking a label for an explanation. “Primary” doesn’t mean there is no cause; it simply means that the underlying cause remains unknown. We now know that the upper neck can directly affect a key pain centre in the brainstem, the very same area involved in migraine. This fact makes the neck far more than a bystander.
Why This Matters in Real Life
The consequences of this thinking are very real. If neck involvement is assumed to be trivial, why would it be skilfully assessed, researched, or included in treatment guidelines? The result is a loop: the definition discourages investigation, which limits new evidence, which then reinforces the belief that the neck is irrelevant.
Asking the Right Question
A better question to ask at this juncture is not “Does the neck cause migraine?” but “Can the neck contribute to migraine?” Reframing this question opens up more helpful ways of understanding migraine, ones that allow for multiple factors working together. It also means that careful assessment and treatment of the upper neck could be a vital part of care for some people living with migraine, not just an optional extra.
Moving Forward
Progress depends on being open-minded. Instead of drawing battle lines between “neurological” and “neck-related,” health professionals need to work together. “Neurological” and “neck-related” are not mutually exclusive; “neurological” and “neck-related” are inextricably linked. Just because migraine is considered a “primary” headache, it doesn’t mean it will forever be mysterious. By rethinking old assumptions, we may finally give the neck the attention it deserves in solving the migraine puzzle; these assumptions do a disservice to those living with migraine.
