Physical Therapy for Migraine: Neck, Shoulder, Upper Back

Exploring Solutions | 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 instability of neck structures.
  • 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 to the 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 along 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 can help you manage migraine through addressing those underlying physical issues. That process might include stretching and relaxing the muscles, calming down trigger points, creating balanced posture and strengthening underused muscles. Fortunately, there are many physical therapy-based techniques you can safely and gently administer on your own to help manage migraine.

How physical therapy helps manage migraine

In migraine management, the techniques of physical therapy commonly address these major underlying issues of the neck and shoulders:

  • Stiff and tight tissues. Your head is meant to move smoothly and symmetrically as it turns from side to side, nods, looks backwards, 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 due to a perceived threat (like chronic stress), muscles react by bunching up to protect against an expected injury – then remain clenched, until this sense of threat passes. This extended state of muscle contraction is called guarding, bracing or splinting
    • This often turns into a vicious cycle because chronic muscle contraction can itself become a source of irritable signals that alert the brain’s pain centers.
    • These are automatic processes; they happen without any awareness on our part. 
    • Stress and anxiety can be major underlying factors. Stretches for the neck, in addition to stress reduction techniques like relaxation, meditation and mindfulness – which initiate our parasympathetic response – are helpful for this type of 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 become significantly weak, or lose endurance, the bigger neck muscles like the upper trapezius try to take over. Over time, the overuse of some muscles, along with the neglect of others, creates a worsening imbalance. The result is tension, guarding, and increased strain and pressure on certain nerves and other sensitive structures in the neck.
  • Instability in the structures of the neck. When the stabilizing muscles for the neck and head become too weak, they are unable to properly support the neck and head as we move around in gravity and change directions. 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 self-care for migraine management

Plenty of therapeutic self-care techniques can help restore balance in the musculoskeletal structures that can otherwise worsen migraine. In fact, self-care is highly important for 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. When that happens, the sensory experience of pain can also be gradually calmed. This process will require 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. Same principle applies here. Exposing your living tissues to the regimen they need, on a regular basis, allows your whole system to come into a more balanced state. 

Therapeutic self-care activities for migraine management include the following:

  • Tender point self-care to the back of the neck. Tender points are also commonly called myofascial trigger points or knots. They’re places where the muscles have hardened and they tend to correlate with common acupressure points. When tender points develop in the back of the neck, they 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, and can also be relieved with gentle, sustained pressure.
  • Stretching with relaxation for neck and shoulders. Gently soften and relax these muscles, incorporating an element of mindfulness through breathing exercises.
  • 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 Ctrl M Health app. For best results, do any 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 own care.

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