Migraines and Your Musculoskeletal System: Where Does Osteopathy Fit?

by osteopath Carien Boshoff

If you experience migraines, you may also notice neck stiffness, jaw tension or upper back discomfort. So, what might your musculoskeletal system have to do with your migraine?

Migraine is a neurological condition, not simply a result of tight muscles or a stiff neck. However, musculoskeletal symptoms can occur alongside migraine and may be relevant to your overall presentation.

This is where your osteopath may be able to help, by assessing and managing the musculoskeletal components of your symptoms.

What type of migraine do you have?

There are different types of migraine. Two commonly recognised types are migraine without aura and migraine with aura.

Migraine without aura

This involves recurrent attacks of headache, typically lasting 4-72 hours. The headache may be:

• One-sided

• Pulsating or throbbing

• Moderate to severe

• Worse with normal physical activity

You may also experience nausea, vomiting or sensitivity to light and sound.

• 

• 

Migraine with aura

Some people experience neurological symptoms before or during their migraine. This is known as an aura.

Aura can include:

• Visual disturbances such as flashing lights or zigzag patterns

• Tingling or numbness

• Difficulty speaking

• Other temporary neurological symptoms

Some people experience migraine attacks both with and without aura.

If you experience new or unusual neurological symptoms, these should be assessed by an appropriate medical professional rather than automatically assumed to be migraine.

• 

• 

What does your neck have to do with it?

Neck pain and stiffness are commonly reported by people with migraine. Importantly, this does not mean that neck tension is necessarily causing the migraine.

Your osteopath may instead consider whether there are co-existing musculoskeletal factors that could be contributing to your overall symptoms or affecting your comfort.

Your assessment may include:

• Cervical and upper thoracic mobility

• Muscle tension and tenderness

• Jaw movement and surrounding muscles

• Shoulder and upper back function

• Posture and sustained positions

• How your symptoms respond to movement

Your osteopath may also ask about sleep, exercise, work habits and other factors that may influence your musculoskeletal symptoms.

Where does osteopathy fit?

An osteopath can assess whether musculoskeletal symptoms are occurring alongside your migraine, such as neck pain, stiffness or jaw discomfort.

Depending on your individual presentation, management may include:

• Hands-on treatment to relevant musculoskeletal structures

• Joint mobilisation or articulation where appropriate

• Soft tissue techniques

• Individualised exercise and movement advice

• Education and self-management strategies

• Advice around aggravating positions or activities

• Referral to another healthcare professional when appropriate

• 

• 

• 

Take home message

Migraine is a neurological condition, but musculoskeletal symptoms can occur alongside it. Osteopaths aren't treating the migraine itself; they assess the musculoskeletal picture around it. If you experience migraine alongside neck pain, stiffness, jaw tension, or upper back discomfort, your osteopath can assess these areas and determine whether osteopathic care is appropriate for your individual presentation.

References

Headache Classification Committee of the International Headache Society (IHS). (2018). The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 38(1), 1–211. https://doi.org/10.1177/0333102417738202

Rehman, Y., Kirsch, J., Wang, M. Y.-F., Johnston, R., Will, M., Gibson, E., Spencer, D., Garcia, C., & Snider, K. T. (2025). Osteopathic manipulative treatment in the management of headaches associated with musculoskeletal dysfunction: Systematic review and meta-analysis. Journal of Osteopathic Medicine, 126(5), 233–243. https://doi.org/10.1515/jom-2025-0075

Chaibi, A., et al. (2024). Spinal manipulations for migraine: An updated systematic review and meta-analysis of randomized clinical trials. BMJ Open, 14, e079196. https://doi.org/10.1136/bmjopen-2023-079196