Understanding the Connection Between Headaches, Neck Pain, and Back Pain

Do you have persistent headaches or migraines? Do you experience recurring neck or back pain? Perhaps you also have a sensitive gut. These issues may not be separate problems. At Peek Practice, we focus on understanding what connects them and what that means for their management.

Not All Pain Comes From Damage

Many people assume that pain indicates something is broken, worn down, or part of a disease process. For some patients, this is true — a compressed nerve, a torn structure, or an identifiable injury.

However, a significant group of individuals experiences pain that is disproportionate to any structural finding. They may have pain that recurs across multiple body areas without a single clear cause. For these patients, the better question is not what is damaged, but why is this nervous system generating so much pain despite little or no tissue insult?

Research consistently points toward predisposition. Some nervous systems are inherently more sensitive, making them more likely to generate pain from inputs that would otherwise go unnoticed. This is a biological issue, not a psychological one. The International Association for the Study of Pain has formally named this phenomenon nociplastic pain. This type of pain arises from altered pain processing within the nervous system itself, rather than from injury or tissue damage. In other words, pain can be the condition, not merely 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, which includes the nerves, spinal cord, and brain, does not simply transmit incoming signals. It also regulates them. The brain and spinal cord have built-in mechanisms that either allow or prevent incoming damage signals from becoming a pain experience. Think of it as a volume control that keeps the background noise of daily physical life from overwhelming the system.

Consider the sheer volume of traffic the brain must process moment by moment. We cannot be consciously aware of all the background noise and remain functional at the same time. The brain has a constant system for regulating this traffic, bringing only the most relevant information to our attention based on survival needs.

In some individuals, this control system is loose, allowing more data to reach the higher brain. Minor inputs — such as normal movement, everyday physical load, or even gut movements — can trigger a pain response that a less sensitive system would not register. Researchers refer to this as neuroinhibitory dysfunction, which is a reduced ability of the nervous system to regulate excess noise.

This dysfunction is measurable. A clinical test called conditioned pain modulation assesses how well the nervous system quietens one pain signal in the presence of another. Individuals with migraines, chronic tension-type headaches (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 merely plagued by head pain; they have a hyper-responsive nervous system that struggles to regulate sensory inputs. This includes light, sound, smell, pressure, and mechanical stimuli. Essentially, they are less able to filter incoming signals. Brain imaging research has demonstrated these changes directly. Importantly, these alterations 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 that migraine is not a separate condition existing alongside neck and back pain. It serves as a window into the same underlying system. An individual 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 migraines, 88% of those with tension-type headaches, and 89% of those with both — compared to only 57% in people without headache disorders (Ashina et al., 2015). A systematic review of 14 studies, including over 400,000 participants, 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 diagnosed with migraines upon clinical examination. Most had undergone unnecessary investigations as a result (Viana et al., 2018). A 2022 systematic review confirmed that this pattern of misdiagnosis remains a current clinical issue (Al-Khazali et al., 2022).

What This Means for Management

Recognising this pattern changes the clinical question. The assessment is not solely about identifying which structure is responsible for the current episode. It also involves determining whether multiple, seemingly 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. However, when 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. This may also involve referrals to neurology or pain medicine when appropriate. A Chiropractic Orthopaedist in Auckland is well-positioned to assess both dimensions and develop a comprehensive plan that addresses each aspect.

Treating each episode in isolation misses the point. The question is not only what is structurally wrong. It is also about why this nervous system generates 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 that neck pain occurs in over 75% of people with migraines, 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 simple terms, it refers to a reduced ability of the nervous system to dampen its own pain responses. Instead of quietening after receiving a signal, the system remains reactive, generating pain at a lower threshold than average. This 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 are best managed with this understanding in mind.

What is nociplastic pain?

This term is the formal classification by the International Association for the Study of Pain for pain arising from altered processing within the nervous system, without clear tissue damage or nerve injury to account for it. Conditions such as 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 central components of a pain presentation. When a more pain-sensitive nervous system appears to be a significant contributor, this shapes the management plan and guides referrals when 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.