Why Researchers Believe the Neck Could Hold the Key to Better Migraine Relief
For millions of people, migraine is much more than “just a headache.”
It can disrupt work, family life, sleep, and even simple daily activities.
During an attack, many people experience intense throbbing pain, nausea, vomiting, and extreme sensitivity to light, sound, or smells.
Some also experience dizziness, vision changes, or tingling sensations before the headache begins.
Migraine is a complex neurological condition, and despite significant advances in treatment, many patients continue to experience frequent attacks that reduce their quality of life.
Now, researchers at the University of Queensland (UQ), Australia, are investigating an intriguing question: Can treating problems in the upper neck help reduce migraine attacks in certain people?
A newly launched clinical trial aims to find out whether a targeted physiotherapy program could become an effective addition to conventional migraine treatment. (News)
Unlike many previous studies that looked at general neck exercises, this research focuses on a specific joint high in the neck called the C1/C2 joint, where most head rotation occurs.
Researchers believe improving movement in this area may reduce migraine frequency and lessen its impact in carefully selected patients who also have neck pain.
Migraine Is One of the World’s Most Disabling Neurological Conditions
Migraine affects more than 1.2 billion people worldwide, making it one of the most common neurological disorders.
In fact, global health studies consistently rank migraine among the leading causes of disability, especially in adults under the age of 50.
It affects people during some of their most productive years, resulting in missed workdays, reduced productivity, and substantial healthcare costs.
Unlike a typical tension headache, migraine is caused by abnormal activity within the nervous system.
During an attack, nerve cells become overly sensitive, triggering the release of inflammatory chemicals around pain-sensitive structures in the brain.
This process activates the trigeminal nerve, which plays a major role in migraine pain. (PubMed)
Although medications remain the main treatment, they do not work equally well for everyone.
Some patients continue to experience frequent migraines despite taking preventive medicines, while others stop treatment because of side effects such as fatigue, dizziness, weight changes, or nausea.
This has increased interest in safe, non-drug approaches that could complement medical treatment rather than replace it.
Why Are Researchers Looking at the Neck?
One of the most overlooked features of migraine is neck pain.
Many people assume neck pain occurs simply because they tense their muscles during a migraine attack.
While that can happen, research now suggests the relationship is much more complicated.
Studies show that neck pain is 12 times more common in people with migraine than in people without migraine.
Around 77% of people with episodic migraine and 87% of those with chronic migraine report neck pain during their condition. (DOI)
Researchers have discovered that nerves from the upper neck and the trigeminal nerve meet in the same region of the brainstem, known as the trigeminocervical complex.
To understand this more easily, imagine two roads merging into one highway. One road carries pain signals from the face and head, while the other carries signals from the upper neck.
Because these signals meet in the same “traffic junction,” irritation coming from the neck may influence how migraine pain is processed in some people.
This does not mean that every migraine starts in the neck.
Instead, researchers believe that a subgroup of migraine patients may have neck-related dysfunction that makes attacks worse or more frequent.
That possibility is exactly what the new Australian trial hopes to investigate.
The Upper Neck May Be More Important Than Previously Thought
The current study focuses on the atlanto-axial joint (C1/C2), located between the first and second cervical vertebrae.
This joint is responsible for approximately half of all neck rotation, allowing us to turn our head from side to side.
If movement becomes restricted or uneven, it may alter the sensory information travelling from the neck to the brain.
Researchers believe these altered signals could contribute to migraine symptoms in susceptible individuals.
According to lead investigator Peter Farmer, many patients with migraine and neck pain show uneven movement at this joint during clinical examination.
His physiotherapy approach, developed over more than 20 years of clinical practice, aims to gently restore normal movement while improving neck function through carefully prescribed exercises. (News)
Importantly, the researchers are not claiming that neck treatment cures migraine.
Instead, they hope to identify which patients are most likely to benefit from this specific physiotherapy approach.
A Growing Interest in Drug-Free Migraine Care
Healthcare professionals increasingly recognize that migraine often requires more than medication alone.
Modern migraine management may include:
- Preventive medicines
- Lifestyle modifications
- Sleep optimization
- Stress management
- Exercise
- Education
- Physiotherapy for patients with associated neck dysfunction
Current evidence suggests physiotherapy should be viewed as an adjunct treatment, meaning it works alongside medical care rather than replacing it.
This integrated approach may help reduce disability and improve quality of life in selected patients.
Researchers also point out that many patients prefer having additional non-drug options, particularly when medications alone do not provide adequate relief or produce unwanted side effects.
Why This New Trial Is Receiving Attention
The University of Queensland study stands out because it is not testing generic neck exercises.
Instead, participants will undergo detailed physical assessments to identify specific movement problems in the upper cervical spine before treatment begins.
Researchers hope this individualized approach will reveal whether improving movement at the C1/C2 joint can reduce migraine frequency, headache burden, and neck-related symptoms.
If successful, the findings could help physiotherapists better identify patients whose migraines have an important musculoskeletal component.
This would move migraine care closer to personalized treatment, where therapy is tailored to the individual rather than applying the same approach to everyone.
Inside the Australian Clinical Trial and Why Researchers Are Optimistic
After years of treating people with both migraine and neck pain, physiotherapist and PhD researcher Peter Farmer began noticing a pattern.
Many of his patients had difficulty turning their head evenly from side to side, particularly at the very top of the neck.
When this movement improved with targeted physiotherapy, some patients also reported fewer migraine attacks.
These clinical observations eventually led to a formal research program at the University of Queensland (UQ). (7News)
While these early results were encouraging, researchers were careful not to jump to conclusions.
Small pilot studies can only suggest that a treatment might work.
A much larger and carefully controlled clinical trial is needed before doctors and physiotherapists can confidently recommend a new treatment approach.
That is exactly what the UQ research team is now undertaking. (NCBI)
What Is the New Clinical Trial Trying to Find Out?
The main goal of the study is simple:
Can a specialized physiotherapy program that targets movement in the upper neck reduce the frequency and severity of migraine attacks in people who also experience neck pain?
Researchers are not trying to prove that every migraine begins in the neck.
Instead, they want to determine whether there is a specific group of migraine patients whose symptoms are partly influenced by problems in the upper cervical spine.
If that group can be identified, physiotherapy could become an important part of a personalized migraine treatment plan rather than a one-size-fits-all approach. (Taylor & Francis Online)
Who Can Participate?
The trial is recruiting 55 adults aged 18 to 65 years from Queensland, Australia.
To qualify, participants must:
- Have a history of migraine diagnosed according to accepted clinical criteria.
- Experience neck pain alongside migraine.
- Show reduced or uneven movement in the upper cervical spine during examination.
- Meet the study’s medical eligibility requirements.
People with other serious neurological disorders, recent cervical spine injuries, or medical conditions that could interfere with treatment may not be eligible.
These criteria help researchers ensure that the results accurately reflect the effects of the physiotherapy program rather than other health problems.
What Treatment Will Participants Receive?
Unlike general neck exercises that many people find online, the treatment in this study is highly individualized.
Each participant first undergoes a detailed physiotherapy assessment to identify movement problems in the upper neck.
Based on those findings, therapists develop a treatment program tailored to that person’s needs. (Partners and community)
The physiotherapy program includes three main components:
1. Gentle Manual Therapy
The physiotherapist uses carefully controlled hands-on techniques to improve movement at the C1/C2 joint, which is responsible for much of the neck’s ability to rotate.
The treatment is designed to restore normal movement rather than force the neck into extreme positions.
2. Targeted Exercise Therapy
Participants also perform exercises that help improve:
- Neck mobility
- Muscle control
- Coordination
- Stability
- Functional movement
These exercises are gradually progressed according to each patient’s symptoms and progress.
3. Home Exercise Program
Patients continue their rehabilitation at home using exercises prescribed by their physiotherapist.
Home programs are important because regular movement practice helps maintain improvements achieved during clinic visits.
Researchers will also monitor how consistently participants complete their exercises, since adherence often influences treatment outcomes.
Why Focus on the C1/C2 Joint?
Many readers may wonder why researchers are paying so much attention to one small joint near the top of the neck.
The answer lies in anatomy.
The atlanto-axial joint (C1/C2) provides around 50% of the neck’s ability to rotate.
It also contains numerous sensory receptors that constantly send information to the brain about head position and movement.
If movement becomes restricted or uneven, these sensory signals may change.
Researchers believe that in some people with migraine, these abnormal signals could increase the sensitivity of pain-processing pathways inside the brainstem.
Although scientists are still studying exactly how this happens, the theory is supported by growing evidence linking upper cervical dysfunction with migraine-related neck pain.
Earlier Research Produced Encouraging Results
The current clinical trial did not appear overnight.
It was built upon an earlier pilot study conducted by the same research team.
In that study, researchers tested their physiotherapy approach in a small group of migraine patients who also had neck pain and limited upper cervical movement.
The results were encouraging:
- Many participants experienced fewer migraine attacks.
- Several reported improvements in neck movement.
- Participants generally expressed high satisfaction with the treatment.
However, because the pilot study involved only a small number of participants and did not include a large comparison group, researchers stressed that the findings should be interpreted cautiously.
They concluded that the results justified conducting a larger randomized clinical trial. (PubMed)
Media reports about the pilot study also noted that around eight out of ten participants reported fewer migraines, with some saying they could interrupt an attack earlier than before.
While promising, these findings still need confirmation in a larger, well-controlled trial before firm conclusions can be drawn. (7NEWS)
How Will Researchers Measure Success?
The team is not simply asking participants whether they “feel better.”
Instead, they will collect detailed clinical data throughout the study.
Researchers will assess:
- Number of migraine attacks
- Frequency of headache days
- Migraine severity
- Neck pain intensity
- Neck mobility
- Daily disability
- Overall quality of life
- Response to treatment over time
Using standardized outcome measures helps ensure the results are scientifically reliable and can be compared with other migraine research around the world.
Why This Study Is Different from Earlier Physiotherapy Research
Physiotherapy has been studied for migraine before, but many earlier trials treated all migraine patients in the same way.
This study takes a different approach.
Instead of assuming everyone with migraine needs the same treatment, researchers first identify patients who have a specific physical problem in the upper neck.
Only then do they provide targeted treatment aimed at correcting that dysfunction.
This reflects the growing trend toward personalized medicine, where treatments are matched to the characteristics of each individual rather than the diagnosis alone.
Researchers Urge Caution
Despite the excitement surrounding the trial, the research team has been careful not to overstate its significance.
The study is still recruiting participants, and no final clinical results have been published yet.
Even if the findings are positive, they will need to undergo peer review and may require confirmation by additional studies before influencing international migraine treatment guidelines.
For now, researchers view this trial as an important step toward understanding whether carefully selected migraine patients can benefit from targeted physiotherapy, rather than suggesting that physiotherapy is a cure for migraine.
What This Means for Patients, Physiotherapists, and the Future of Migraine Care
The University of Queensland trial has generated excitement because it explores a question that many clinicians have been asking for years:
Can treating neck dysfunction help reduce migraines in the right patients?
While researchers are hopeful, they also stress that the answer is not yet known.
The trial is still underway, and its results have not been published.
However, the study is built on years of research suggesting that the neck and the brain communicate more closely than previously thought. (news.uq.edu.au)
What Does Previous Research Tell Us?
Physiotherapy is not a new treatment for migraine, but the evidence has been mixed.
Over the past decade, researchers have studied a range of physiotherapy techniques, including:
- Manual therapy
- Strengthening exercises
- Posture correction
- Motor control training
- Stretching
- Neck mobility exercises
- Aerobic exercise
- Education and self-management
Some studies found meaningful improvements in headache frequency, neck pain, and quality of life, while others showed little or no benefit.
One major reason for these inconsistent findings is that many earlier studies treated all migraine patients as though they had the same underlying problem.
Researchers now believe that migraine is a highly individual condition and that different patients may respond to different treatments. (Liang Z, Castaldo M. Musculoskeletal Science and Practice, 2025.)
A recent review suggested that people with migraine who also have clear signs of neck dysfunction may respond better to physiotherapy than those without neck-related problems.
This idea forms the foundation of the new Australian trial. (Farmer P, et al. Journal of Manual & Manipulative Therapy, 2026.)
Could Physiotherapy Reduce the Need for Medication?
Researchers are not suggesting that physiotherapy should replace migraine medication.
Instead, they believe it may become an additional treatment option for selected patients.
For example, someone taking preventive migraine medication may still experience frequent attacks triggered by neck stiffness or prolonged desk work.
If physiotherapy successfully improves neck function, it could potentially reduce the overall burden of migraine, allowing medical treatment and rehabilitation to work together.
This combined approach is already common in other chronic pain conditions such as low back pain, osteoarthritis, and neck pain,
where exercise and rehabilitation complement medication rather than replace it. (American Headache Society guidance; The Journal of Headache and Pain.)
Why This Research Matters to Physiotherapists
For physiotherapists, the study highlights an important message:
Not every patient with migraine needs neck treatment, but some might benefit significantly from it.
If the trial confirms its hypothesis, physiotherapists may need to place greater emphasis on detailed cervical spine assessments instead of simply prescribing general neck exercises.
This could include evaluating:
- Upper cervical rotation
- Joint mobility
- Muscle control
- Neck muscle endurance
- Movement patterns
- Head posture
- Functional limitations
Treatment could then be tailored to the individual’s physical findings instead of following a standard exercise program for everyone.
This represents one of the biggest shifts occurring in modern rehabilitation: moving from diagnosis-based treatment to person-specific treatment.
What Should Patients Know?
The researchers encourage people with migraine to remain realistic about the study.
At this stage:
- The treatment is still being investigated.
- It has not been proven to work for everyone.
- The trial results are not yet available.
- Patients should continue following advice from their neurologist, physician, or headache specialist.
However, people who regularly experience neck pain, stiffness, or difficulty turning their head during migraine attacks may wish to discuss these symptoms with their healthcare provider or a physiotherapist experienced in headache management.
A thorough assessment can help determine whether neck dysfunction is contributing to their symptoms.
Lifestyle Still Plays a Major Role
Even if targeted physiotherapy proves effective, it is unlikely to be a complete solution on its own.
Migraine is influenced by many factors, including:
- Poor sleep
- Stress
- Hormonal changes
- Dehydration
- Certain foods and drinks
- Irregular meals
- Physical inactivity
- Excessive screen time
- Medication overuse
Current migraine guidelines continue to recommend
a combination of healthy lifestyle habits, appropriate medication, education, and individualized treatment rather than relying on a single therapy. (International Headache Society; The Journal of Headache and Pain.)
Strengths of the University of Queensland Trial
Experts believe this study has several strengths that could make its findings more clinically useful than many previous physiotherapy studies.
1. It targets the right patients.
Instead of including everyone with migraine, researchers are focusing on people who also have measurable upper neck dysfunction.
2. It uses individualized treatment.
Each participant receives treatment based on their clinical assessment rather than following the same exercise program.
3. It measures multiple outcomes.
Researchers are evaluating migraine frequency, neck pain, disability, quality of life, and physical function instead of looking at headache frequency alone.
4. It builds on previous pilot research.
The trial was designed after encouraging findings from earlier studies, increasing the likelihood that the treatment approach is worth investigating further.
Limitations to Keep in Mind
Like all research, this study has limitations.
First, it is still ongoing, so no conclusions can be drawn until the final results are published.
Second, the participants are being recruited from one region of Australia.
Larger international studies may eventually be needed to determine whether the findings apply to people from different backgrounds and healthcare systems.
Finally, migraine is a complex neurological condition.
Even if the treatment proves effective, it is unlikely to help every patient.
Researchers expect that only a subgroup of people with migraine and neck dysfunction may benefit.
What Happens Next?
Once recruitment is complete, researchers will analyze the results and submit them for publication in a peer-reviewed scientific journal.
If the findings are positive, they could influence future migraine rehabilitation research and potentially encourage larger international trials.
Over time, this may help healthcare professionals better identify which patients are likely to benefit from targeted physiotherapy, leading to more personalized care.
A Physiotherapist’s Perspective
For years, physiotherapists have observed that some people with migraine also have restricted neck movement and muscle dysfunction.
Until recently, however, there has been limited high-quality evidence to explain whether treating these problems could influence migraine itself.
The University of Queensland trial represents an important step toward answering that question.
If the results are positive, physiotherapists may gain stronger evidence to support carefully targeted cervical assessment and rehabilitation as part of multidisciplinary migraine care.
If the results are negative, they will still provide valuable information by helping clinicians understand which treatments are less effective and where future research should focus.
Either outcome will improve our understanding of migraine.
Final Thoughts
The relationship between migraine and neck pain has puzzled researchers for decades.
The new University of Queensland clinical trial is not claiming that migraines originate in the neck or that physiotherapy is a cure.
Instead, it is investigating whether a carefully selected group of patients with both migraine and upper neck dysfunction could benefit from a specialized physiotherapy program.
This patient-centered approach reflects a broader shift in healthcare toward personalized treatment rather than one-size-fits-all solutions.
Until the study is completed, people living with migraine should continue following evidence-based medical advice while viewing targeted physiotherapy as a promising area of ongoing research, not yet a proven standard treatment.
Editorial note
One factual point in the original news reports deserves clarification. Some media articles highlighted that about 80% of participants in an earlier pilot study reported fewer migraines. While encouraging, that pilot involved a small number of participants and was not designed to prove effectiveness. The current randomized controlled trial was launched specifically to test those preliminary findings more rigorously before any changes to clinical practice are recommended. This distinction is important to avoid overstating the current evidence.
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Medical Disclaimer!
This article has been reviewed and written under the guidance of our Head Physiotherapist, Dr. Kruti Raj (PT, MUHS,CPT,CMPT). The information shared is intended for educational purposes only and should not be considered a substitute for personalized medical advice, diagnosis, or treatment.
Please consult us or any other qualified healthcare professional before beginning any exercise program, especially if you are experiencing pain, recovering from injury, or managing a medical condition.
