Migraine, Persistent Headache, and Recurring Neck and Back Pain — Why They Often Travel Together

Nigel Peek, MSc Chiro (SA) | DIANM, Chiropractic Orthopaedist | PGDip HealSc Pain & Pain Management — Dist. (Otago) | Peek Practice, Grey Lynn, Auckland

Do you have persistent headaches or migraine? Recurring neck or back pain? Perhaps a sensitive gut as well? These may not be separate problems. At Peek Practice, the focus is on understanding what connects them — and what that means for how they are managed.

Not All Pain Comes From Damage

Most people assume pain means something is broken or worn down or some disease process. For many patients, that is true — a compressed nerve, a torn structure, an identifiable injury. Find it, treat it, resolve it.

But a significant group of people experience pain that is out of proportion to any structural finding, or that recurs across multiple body areas without a single clear cause. For them, the better question is not what is damaged — but why is this nervous system generating this much pain despite little or no tissue insult.

The research points consistently toward predisposition. Some nervous systems are simply more sensitive from the outset — more likely to generate pain from inputs that would pass through unnoticed in someone else. This is biology, not psychology. The International Association for the Study of Pain now has a formal name for this: nociplastic pain — pain that arises from altered pain processing within the nervous system itself, rather than from injury or tissue damage. In other words, pain is the condition, not a symptom of something structural happening elsewhere in the body.

The Nervous System Has Its Own Off-Switch — and in Some People, It Is Weaker

The nervous system (nerves, spinal cord and brain) does not simply transmit incoming signals. It also regulates them. In other words, the brain and spinal cord has its own built-in mechanism that either allows or prevents incoming damage signals before they become a pain experience. Think of it as a volume control keeping the background noise of daily physical life from overwhelming the system. The thing to consider here is the sheer volume of traffic the brain has to consider on a moment to moment basis. We cannot be consciously aware of the background noise and be functional at the same time. The brain has a constant system of regulating this traffic and only bring what is absolutely relevant to your attention when appropriate on the basis of survival needs.

In some people, this control system is loose, allowing more data to gain access to the higher brain. Minor inputs — normal movement, everyday physical load, even gut movements — can trigger a pain response that a less sensitive system would not register. Researchers call this neuroinhibitory dysfunction: a reduced ability in the nervous system to regulate excess noise.

This is measurable. A clinical test called conditioned pain modulation assesses how well the nervous system quietens one pain signal in the presence of another. People with migraine, chronic tension-type headache (CTTHA), fibromyalgia, and recurrent spinal pain consistently show a weaker response on this test.

Migraine and Persistent Headache — A Window Into the Whole System

Migraine and tension type headache sufferers are not simply plagued by head pain, they have a hyper-responsive nervous system that struggles to regulate sensory inputs — light, sound, smell, pressure and mechanical stimuli, in other words, they are less able to hold back incoming signals. Brain imaging research has demonstrated this directly. Importantly, these changes are present between migraine and headache attacks, not only during them. The migraine nervous system does not fully reset between episodes.

This matters because it means migraine is not a separate condition sitting alongside the neck pain and back pain. It is a window into the same underlying system. The person with migraine, chronic neck pain, and recurrent low back pain is not dealing with three separate problems. In many cases, they are experiencing three expressions of one predisposed nervous system.

Migraine, Persistent Headache, and Neck Pain — What the Numbers Show

Neck pain occurs in 76% of people with migraine, 88% of those with tension-type headache, and 89% of those with both — compared to 57% in people with no headache disorder (Ashina et al., 2015). A systematic review of 14 studies, one including over 400,000 people, confirmed a clear association between persistent low back pain and primary headache disorders (Vivekanantham et al., 2019).

One study found that 91% of patients who believed they had a neck pain problem were actually found, on clinical examination, to have migraine — and most had undergone unnecessary investigations as a result (Viana et al., 2018). A 2022 systematic review confirmed this misdiagnosis pattern remains a current clinical problem (Al-Khazali et al., 2022).

What this Means

Recognising this pattern changes the clinical question. The assessment is not only about finding which structure is responsible for the current episode. It is about whether multiple, apparently unrelated pain conditions share a common root — a nervous system that is less efficient at quietening pain signals than it should be.

Where a structural problem exists, it is diagnosed and managed directly. Where a more sensitive nervous system is a significant part of the picture, management includes explaining the mechanism, a graduated return to activity, and strategies that help the nervous system gradually re-learn to regulate itself — alongside referral to neurology or pain medicine where appropriate. A Chiropractic Orthopaedist in Auckland is well placed to assess both dimensions and build a plan that accounts for both.

Treating each episode in isolation misses the point. The question is not only what is structurally wrong. It is why this nervous system is generating pain at this level of input in the first place.

FAQS

 

Why do my migraines, neck pain, and back pain all seem connected?

They may share a common root — a nervous system that is less efficient at quietening pain signals. Research confirms neck pain occurs in over 75% of people with migraine, and a systematic review of 14 studies found a clear association between persistent low back pain and primary headache disorders. These are not coincidental numbers.

What is neuroinhibitory dysfunction?

In plain terms, a reduced ability in the nervous system to turn down its own pain responses. Rather than quietening after receiving a signal, the system stays reactive — generating pain at a lower threshold than average. It is a biological characteristic, not a psychological one.

Is chronic tension-type headache the same as migraine?

They are distinct diagnoses. In chronic presentations, both involve an over-reactive nervous system that amplifies incoming signals well beyond what tissue irritation alone would explain. Both reflect a weaker-than-normal off-switch, and both are best managed with that understanding in mind.

What is nociplastic pain?

The formal International Association for the Study of Pain category for pain arising from altered processing within the nervous system, without clear tissue damage or nerve injury to account for it. Migraine, chronic tension-type headache, fibromyalgia, and chronic low back pain are all recognised within this category.

Can a Chiropractic Orthopaedist help with this kind of pain?

Yes. A full Chiropractic Orthopaedic assessment at Peek Practice, Grey Lynn, Auckland evaluates both the structural and the central components of a pain presentation. Where a more pain-sensitive nervous system appears to be a significant contributor, this shapes the management plan and guides referral where appropriate.

REFERENCES

Woolf CJ. (2011). Central sensitization: implications for the diagnosis and treatment of pain. Pain. 152(3 Suppl):S2-S15.

Harriott AM, Schwedt TJ. (2014). Migraine is associated with altered processing of sensory stimuli. Curr Pain Headache Rep. 18:458.

Mainero C, Louapre C. (2014). Migraine and inhibitory system. Curr Pain Headache Rep. 18:426.

Vecchia D, Pietrobon D. (2012). Migraine: a disorder of brain excitatory-inhibitory balance? Trends Neurosci. 35(8):507-520.

Ashina S, et al. (2015). Prevalence of neck pain in migraine and tension-type headache: a population study. Cephalalgia. 35(3):211-219.

Ashina S, et al. (2018). Increased pain sensitivity in migraine and tension-type headache coexistent with low back pain. Eur J Pain. 22(3):474-484.

Viana M, et al. (2018). When cervical pain is actually migraine: an observational study in 207 patients. Cephalalgia. 38(2):383-388.

Vivekanantham A, et al. (2019). The association between headache and low back pain: a systematic review. J Headache Pain. 20:82.

Al-Khazali HM, et al. (2022). Prevalence of neck pain in migraine: a systematic review and meta-analysis. Cephalalgia. 42(7):663-673.