PT For Migraine: Neck, Shoulders, & Upper Back

Advanced Treatments | 5 Min. Read
Author: Jacob Boyce, DPT, MS, COMT, CEEAA

Dr. Boyce is a physical therapist and pain specialist.
Reviewed by: Ctrl M Health Medical Directors


  • Stiffness, tightness, and weakness in the neck, shoulder, and upper back can contribute to migraine.
  • Physical therapy can help manage migraine by addressing underlying issues, such as stiff tissues that restrict your neck’s range of motion, chronic muscular tension, muscular imbalance of the neck and shoulders, and of neck structure instability.
  • Self-administered physical therapy techniques are recommended to coax the body into proper balance and form, gradually quelling the pain experience. Therapeutic techniques include tender point self-care to the back of the neck and upper back and shoulders; stretching with relaxation for the neck and shoulders; and cervical and scapular stability exercises. Setting up an ergonomic workstation and your sleep posture are also suggested.
  • Watch the video below for a demonstration of tender point self-care for the back of the neck.

Full Article

Your neck, shoulder, and upper back are layered with a network of muscles that act together to do remarkable things––like holding up your ten-pound head. Just the work of supporting your cervical spine and moving your head requires over 20 different muscles. When working properly, they perform in harmony with the bones, joints, tendons, and ligaments of the musculoskeletal system. Dysfunction in this system, though, can create stiffness, tightness, and weakness that can contribute to migraine.

Physical therapy for migraine can help you manage pain and tenderness by addressing those underlying physical issues. That process might include stretching and relaxing the muscles, calming down trigger points, creating a balanced posture, and strengthening underused muscles. Fortunately, there are many safe physical therapy-based techniques you can gently administer on your own to help manage migraine.

How Physical Therapy For Migraine Works

In migraine management, the techniques of physical therapy commonly address these major underlying issues of migraine and neck pain as well as shoulder pain:

Stiff and tight tissues. Your head is meant to move smoothly and symmetrically as it turns from side to side, nods, looks backward, bends to one side or the other, and rotates in different directions. Tightness in your muscles, ligaments, or tendons can reduce your neck’s range of motion and cause irritation of sensitive structures.

Muscular tension. When the pain centers of the brain are constantly activated by a perceived threat, like chronic stress, muscles bunch up to protect against an expected injury. They then remain clenched––until this sense of threat passes. This extended state of muscle contraction is called guarding, bracing, or splinting. Chronic muscle contractions can become a constant source of irritable signals that alert the brain’s pain centers, creating a vicious cycle.

      • These are automatic processes; they happen without any awareness on our part. 
      • Stress and anxiety can be major underlying factors. Stretches for the neck and stress reduction techniques like relaxation, meditation, and mindfulness––which initiate our parasympathetic response––help reduce chronic muscle tension.

Muscular imbalance of the neck and shoulders. The neck and shoulders have specific muscles meant for head stability and refined neck and arm movements. If these muscles significantly weaken or lose endurance, the bigger neck muscles like the upper trapezius try to take over.  Over time, the overuse of some muscles and the neglect of others worsens the imbalance. The result is tension, guarding, and increased strain and pressure on nerves and other sensitive structures in the neck.

Instability in the structures of the neck. When the stabilizing muscles for the neck and head weaken, they don’t properly support the neck and head. This means that the ligaments, nerves, and other tissues can be too easily irritated, strained, or even injured, and contribute to migraine.

Try This At Home: Therapeutic PT For Migraine Management

Several  therapeutic self-care techniques can help restore balance in the musculoskeletal structures that may otherwise worsen migraine. In fact, self-care is vital to making and maintaining progress in physical therapy, because while these techniques may appear to be a mechanical “fix,” your body is not a machine. It’s made of living tissue that needs to be gradually coaxed into proper balance and form and calming the sensory experience of pain. 

This process of physical therapy for migraine requires time and repetition.

Think of it this way: If your houseplant hasn’t been watered in a month, you wouldn’t “fix” it by dumping a month’s worth of water on it at once. The same principle applies here. Regularly exposing your living tissues to the regimen they need brings your whole system into a more balanced state. 

Therapeutic physical therapy for migraine activities include the following:

Tender point self-care to the back of the neck. Tender points are also called myofascial trigger points or knots. They’re places where the muscles have hardened, and tend to correlate with common acupressure points. Tender points in the back of the neck can contribute to headaches and migraine attacks. Applying gentle, sustained pressure can habituate the receptors and allow the muscles to release.

      • Watch the short video above for a demonstration

Tender point self-care to the upper back and shoulders. Tender points in the shoulders and around the shoulder blades can also contribute to headaches and migraine attacks. Gentle, sustained pressure in these spots can also bring relief.

Stretching with relaxation for neck and shoulders. Gently soften and relax these muscles, incorporating an element of mindfulness through breathing exercises.

 Silhouette of young brunette woman on yoga mat stretching out her neck.Cervical stability exercises. Strengthening the cervical (neck) stability muscles allows excessively tense muscles in the lower neck and shoulders to relax. It also helps support and protect pain-sensitive structures in the neck.

Scapular stability exercises. Scapular muscles attach to and control the positioning of the shoulder blade. Strengthening scapular stability muscles relieve tension in the lower neck and shoulders. It also removes pressure from pain-sensitive structures in the neck.

Setting up your workstation. An ergonomic workstation will prevent back and neck issues by improving your posture.

Setting up your sleep posture. Prevent neck and shoulder tightness by properly supporting the curve of your neck, your arms, shoulders, and your back to increase comfort when you lie down.

You’ll find detailed, full-length videos demonstrating each technique in the Care Tuner app. For best results, practice therapeutic self-care activities two to five times per week until you see improvement, or routinely as a form of prevention. These exercises can become a great asset to your migraine management routine––and they will always be at your disposal, whenever you need them, putting you in control of your care.

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