Can a Chiropractor Help with Migraines?
By Dr. Chris Collins | Axia Chiropractic | Chattanooga, Tennessee
An Honest Look at the Neck-Migraine Connection
If you've been living with migraines for years, you probably don't need another person telling you to drink more water, reduce your stress, or avoid certain foods. You've likely tried all of that and more. What you really want to know is whether there's something you've been missing, and whether it's still possible to get your life back.
I've spent years working with people who have asked those same questions. Some came to me after decades of debilitating migraines, having already tried medications, specialists, and other forms of care. I've watched some of those patients experience remarkable changes, including migraines that became less frequent, less severe, or disappeared entirely.
One of the things I've learned is that the upper neck sometimes deserves a closer look. There's a well-established neurological relationship between the upper cervical spine and the pathways involved in migraine. That doesn't mean every migraine originates in the neck, but it does give us another place to investigate when someone has been struggling to find answers.
Is this article for you?
I wrote this for people who are tired of planning their lives around the possibility of another migraine. Maybe you've tried multiple treatments without lasting relief, or perhaps you've noticed that neck pain, tension, or an old injury seems connected to your headaches.
We'll explore what research tells us about the neck-migraine connection, what I look for when evaluating someone with chronic migraines, and what improvement has looked like for patients in my practice. I'll also share when upper cervical care may be worth considering and when another healthcare professional should be involved.
My hope is that you'll leave with a better understanding of your options and a few new questions worth asking.
Want to get straight to the point? Jump to How I evaluate someone with migraines, What improvement can look like, or Common questions about chiropractic care for migraines.
The overlooked clue: how common neck pain is with migraines
If you live with migraines, there's a good chance your neck hurts too.
A 2022 systematic review published in Cephalalgia examined 24 studies and found that approximately 77% of people with migraines in clinic-based studies experienced neck pain, compared with about 23% of people without headaches. Neck pain was also more common among people experiencing chronic migraines.
Another study found that neck pain occurred during migraine attacks even more frequently than nausea, despite nausea being one of the symptoms most commonly associated with migraine.
That's worth paying attention to.
Some people have neck pain before a migraine begins. Others notice tension building around the base of their skull or across their shoulders during an attack. And some have persistent discomfort even between migraines.
The relationship isn't as straightforward as saying neck pain causes migraines. Neck pain can actually be a symptom of the migraine process itself. Some people with migraines have no neck pain at all, while others have significant neck problems that may be unrelated to their headaches.
But because these symptoms overlap so frequently, I believe the neck deserves consideration when we're investigating someone's migraine history.
Migraine or neck-related headache?
There is a separate type of headache called cervicogenic headache, meaning a headache that originates from structures in the neck.
These headaches can produce pain in the back of the head, around the temples, or behind the eyes. Their symptoms can overlap considerably with migraine, making it difficult to distinguish between the two without a careful history and examination.
A person may also experience both types of headaches.
I mention this not to suggest your diagnosis is wrong, but to explain why I don't take any headache at face value. Two people can describe nearly identical pain and have very different things driving it. Sorting that out is the first job.
Migraine is typically associated with neurological symptoms such as sensitivity to light or sound, nausea, and sometimes visual disturbances. Cervicogenic headaches are more commonly associated with restricted neck movement, pain provoked by certain positions, or discomfort originating in the cervical spine.
Those differences give us useful clues, but symptoms alone don't always tell the whole story.
Why the upper neck may matter
The upper neck is where your head and spine meet. It includes the first two cervical vertebrae, the atlas (C1) and axis (C2), and it's a relatively small area with a tremendous amount happening in and around it.
One reason this region interests me is its relationship with the neurological pathways involved in processing pain and sensation in the head.
Sensory information from the upper cervical spine interacts with pathways associated with the trigeminal nerve, which plays an important role in migraine. This relationship is often described through the trigeminocervical complex, a region of the nervous system where sensory signals from the head and upper neck converge.
Researchers have studied this connection as one explanation for why neck pain and migraines frequently occur together.
Read more about the trigeminocervical complex and migraine.
I don't assume that every migraine is coming from the neck. Migraine is more complicated than that.
What I want to know is whether dysfunction in the upper cervical region is one of the things contributing to that particular person's migraine pattern.
That question becomes especially relevant when someone's history includes a concussion, whiplash injury, persistent neck tension, restricted movement, or other findings that suggest the cervical spine deserves closer attention.
At Axia Chiropractic, our work focuses specifically on this region. We examine the upper cervical spine and use a precise, nonrotational adjustment technique when our findings indicate that an adjustment is appropriate.
If you're unfamiliar with this approach, I've written another resource explaining the anatomy, our examination process, and what makes upper cervical care different.
What Is Upper Cervical Chiropractic?
Axia Chiropractic: Our Services
What does the research say about chiropractic care for migraines?
I want you to have a clear picture of the research, including where it's still unsettled.
A 2019 systematic review of six clinical trials found that spinal manipulation may reduce migraine days and pain intensity. The researchers considered these findings preliminary, however, and recommended larger, more rigorous studies.
A 2024 updated systematic review examined six randomized clinical trials involving 645 people with migraines. It did not find a statistically significant improvement in migraine intensity compared with the treatments or controls studied. The authors rated the certainty of the evidence as very low and concluded that the effectiveness of spinal manipulation for migraines remains unproven.
Upper cervical chiropractic specifically has been studied less.
One 2015 pilot study followed 11 people diagnosed with migraines after receiving a form of upper cervical care known as NUCCA. Participants reported improvements in headache-related outcomes and quality of life. Because the study was small and had no comparison group, the results couldn't establish that the adjustments caused those improvements. The technique studied was also different from the one I use.
So the research isn't settled, and it doesn't yet tell us which migraine patients might benefit most from upper cervical chiropractic care.
What I can speak to is my clinical experience. I've worked with people who have experienced meaningful changes after years of suffering. I've also seen people who responded slowly, people who needed additional support, and people for whom we had to reconsider our approach.
Those experiences are part of why I believe careful evaluation and ongoing reassessment matter so much.
How I evaluate someone with migraines
It starts with their story
We always start with the patient's story.
I really want to understand what life is like for them. That isn't only about connecting and empathizing. Their story can reveal important connections in their health history.
I want to know when the migraines started, what was happening around that time, how often they occur, and what they've already tried. I'm interested in any previous head or neck injuries, but I'm also looking more broadly at sleep, stress, diet, hydration, hormones and menstrual cycles, movement, medications, environmental exposures, and anything else that may be contributing.
I'm also interested in how migraines are changing someone's everyday life. Are they missing work? Canceling plans? Struggling to care for their children? Avoiding activities because they're worried another migraine might begin?
Understanding those things gives us a clearer picture of what meaningful improvement would actually look like.
Then we test
From there, we begin testing.
We use paraspinal infrared thermography to measure temperature patterns along the spine. Skin temperature is influenced in part by autonomic nervous system activity, and research using the Tytron scanner has demonstrated that these temperature measurements can be highly reproducible when collected under consistent conditions.
We also assess posture, cervical range of motion, muscle patterns, and the spine itself to develop a picture of the findings we're seeing. When appropriate, specialized cervical imaging helps us better understand the anatomy and mechanical relationships of the upper neck.
The goal isn't to diagnose someone's migraine from a single scan or X-ray. It's to look for consistent findings that help us determine whether upper cervical chiropractic care is appropriate.
These examinations also establish a baseline that we can revisit throughout care. We want to know whether the objective findings are changing, but just as importantly, whether the person's migraine frequency, severity, duration, and quality of life are improving.
We don't assume that someone needs an adjustment simply because they're in the office. We examine them and make that decision based on what we find.
What change usually looks like
When we find a clear upper cervical pattern and are able to address it, I've seen significant changes in migraine patients. A considerable number of the people I've cared for have experienced substantial improvement, and some have experienced complete resolution.
But change rarely arrives all at once, and it doesn't follow the same timeline for everyone.
Usually, one of the first things patients tell me is that the edge starts to come off. Sometimes they describe feeling less tension, sleeping better, or having a migraine that simply wasn't as severe as the ones they were accustomed to.
A migraine may still come, but it doesn't last as long. Or the recovery that used to take two days now takes less time. For someone whose life has revolved around unpredictable headaches, those can be important changes.
Sometimes we see meaningful improvements within the first month. Other people respond more slowly, and during the first three months they may notice only subtle differences that are difficult to track.
Our objective examination findings help us follow the process, but they don't replace the patient's experience. That's why we perform regular progress examinations and continue discussing how their symptoms and daily life are changing.
By 3 months, I generally want us to be talking about a significantly different migraine picture. If someone is still experiencing essentially the same chronic pattern at that point, it doesn't mean there's no hope. It does tell me we need to reevaluate and look more closely at other contributing factors.
That doesn't mean everyone is expected to be migraine-free within three months. It means we need to be able to identify meaningful progress and make thoughtful decisions about what comes next.
Three stories, three different timelines
Erin: why this became personal
My wife, Erin, is the reason I practice upper cervical care.
During my years in chiropractic school, her migraines became so frequent and debilitating that she often couldn't drive or function normally. Watching someone I loved struggle with something so disruptive was difficult, especially as I was learning more about the upper cervical spine and its relationship with the nervous system.
Within six months of starting upper cervical care, her migraines were gone.
Watching that happen changed the direction of my career. It gave me a personal reason to pursue this work and a lasting appreciation for how much someone's life can change when their symptoms improve.
I tell the fuller story of Erin's experience in What Is Upper Cervical Chiropractic?
A pastor with 40 years of migraines
A pastor in his early sixties came to see me while visiting his son, who had heard I worked with migraine patients and encouraged him to make an appointment.
For 40 years, he'd lived with a constant headache and migraine episodes several times a week. He described the sensation as feeling like vice grips around his head, with pressure at the base of his skull and behind his eyes.
Some episodes reached 10 out of 10 in intensity and had sent him to the emergency room. He'd tried medications, massage, physical therapy, and chiropractic care. Through all of it, he kept serving his church and his community.
He was only in town for five days, so I slowed down and gathered as much information as I could.
His X-rays, including views showing how his neck moved, revealed a specific pattern that hadn't been addressed before. Because he carried so much tension, his first adjustment was a little uncomfortable, but he noticed the pressure beginning to lift right away.
I checked him every day he was in town and adjusted him only one more time. By the end of those five days, he noticed a real difference.
His response was unusually fast, and I don't want anyone to expect the same thing.
I share his story because it shows that even after decades, change may still be possible when the right question finally gets asked. He still comes to see me whenever he visits his son.
Karissa: when improvement takes time
When Karissa M. first came to see me approximately six years ago, she was experiencing debilitating migraines four to five times a week.
As she describes it, most days ended with her sick or in bed. Even on the better days, she experienced mental fogginess and the anxiety of wondering when the next migraine might strike.
Karissa was not an overnight success story.
It took about three months before she began to notice meaningful change. During that time, our examination findings were changing, even before she felt a dramatic difference. Those findings were part of the picture we continued to monitor as we assessed her progress.
Eventually, she began noticing that her migraines were becoming less frequent and less disruptive.
Today, she describes her improvement as continual. She still visits the office approximately once a month.
I share her story because not everyone responds on the same timeline. Sometimes meaningful improvement develops gradually, and that's worth knowing when you're evaluating whether a course of care is helping.
These are individual patient experiences, not guarantees of what someone else will experience. Each of them reminds me why it's worth continuing to ask good questions, even when someone has been struggling for years.
Why some people don't respond as quickly
Migraine is complicated. Sometimes we're addressing one important part of the problem while other factors keep reinforcing the migraine cycle.
Medication is one thing I pay close attention to.
Many migraine patients have used some combination of over-the-counter pain relievers, triptans such as sumatriptan (Imitrex), Botox, preventive medications, or other rescue medications for years.
I want to know what they're taking, how often they're taking it, and whether their migraine pattern has changed over time.
One reason is a condition called medication-overuse headache. In some people, frequent use of certain medications intended to relieve headaches can contribute to an increasingly persistent headache pattern.
The International Classification of Headache Disorders recognizes medication-overuse headache as a distinct diagnosis.
That doesn't mean migraine medications are inherently harmful or that patients should stop taking them. Many are important parts of medical migraine management. If someone's medications need to be reconsidered, that's a conversation to have with the physician who prescribed them.
I also pay attention to hormonal medications, consistently poor sleep, dietary patterns, stress, hydration, and other individual factors.
When someone isn't responding the way I expect, my answer isn't simply to keep adjusting them. It's to step back and broaden the investigation.
Beyond the adjustment
I talk a lot with migraine patients about the environment we're asking the nervous system to function within.
We can make a great adjustment, but if someone is sleeping four hours a night, skipping meals, chronically dehydrated, under tremendous stress, or repeatedly running into something they already know is a trigger, we need to talk about those things too.
Sleep is a big one for me. We also discuss hydration, consistent nutrition, movement, stress and recovery, caffeine, alcohol, screen habits, hormonal patterns, and individual food or environmental sensitivities when they're relevant.
These conversations aren't about asking people to overhaul their lives overnight. Often, we're looking for a few practical changes that can support the work we're doing together.
At the same time, I don't want migraine patients becoming afraid of their lives. I don't want to hand someone a giant list of foods they can't eat and activities they can't do.
The goal isn't to eliminate every possible trigger. It's to identify the factors that genuinely matter for that person, while helping their body become more adaptable and resilient.
When to see a medical doctor
Part of being good at caring for migraine patients is knowing what belongs in my office and what doesn't.
Our history and examination are designed partly to look for red flags, findings that tell me something else needs to be investigated.
Most of the migraine patients who come to me have been dealing with this for months or years. Many have already seen several providers, had imaging, tried medications, or worked with a neurologist.
If their presentation fits their established history and my examination shows they're an appropriate candidate for upper cervical care, I'm comfortable moving forward.
If something doesn't fit, whether that's an unusual neurological finding, significant trauma, signs of a broader illness, or anything else that concerns me, I want the appropriate medical provider involved.
I don't see that as chiropractic versus medical care. It's simply good clinical decision-making. My job isn't just knowing how to make an adjustment. It's knowing when to adjust, when not to, and when someone needs something else.
Seek emergency care right away if you experience a sudden, severe headache that reaches maximum intensity within seconds or a minute (sometimes called a thunderclap headache), a headache accompanied by fever and a stiff neck, or new neurological symptoms such as weakness, confusion, difficulty speaking, or loss of vision.
A new or significantly changed headache following a head injury also requires urgent evaluation. You should see a medical doctor promptly if your headache pattern changes substantially or if you begin experiencing new headaches after age 50.
Learn more about headache warning signs from the American Migraine Foundation.
Common questions about chiropractic care for migraines
Will I have to stop my migraine medication?
No. We never tell patients to stop prescribed medication. If a medication may be contributing to someone's headache pattern, that's a conversation to have with the physician who prescribed it.
How long before I notice a difference?
It varies. Some people notice changes within the first month, while others take about three months or longer.
We perform regular progress examinations throughout care, generally after every 12 visits. By approximately three months, I want us to be able to identify meaningful progress. If we're not seeing it, we reevaluate what may be contributing and whether our approach needs to change.
Do I need neck pain for my neck to be involved?
Not necessarily. Neck pain is common with migraines, but it isn't required, and it doesn't prove the neck is contributing. That's why we rely on a detailed history and examination rather than symptoms alone.
Is a neck adjustment safe if I have migraines?
The adjustment I use is a precise upper cervical toggle-recoil adjustment, not a twisting or rotational manipulation of the neck.
We examine each patient, use specialized imaging when appropriate, and decide whether an adjustment is indicated before making one.
A large 2026 retrospective study found no increased risk of cervical artery dissection following chiropractic cervical spinal manipulation compared with a group receiving an ibuprofen prescription for neck pain or headache. That's reassuring, although no procedure is entirely without risk, and the study did not specifically investigate toggle recoil.
You can read more about our approach in our dedicated resource on Upper Cervical Chiropractic.
What if I've already tried chiropractic care and it didn't help?
Many of our migraine patients have tried chiropractic and it didn't help, including the pastor whose story I shared above and my wife.
Chiropractic approaches vary widely. Upper cervical care is very specific, and that specificity may be worth exploring when previous approaches haven't produced the results someone hoped for.
A careful examination can help us determine whether there are findings that warrant a different approach.
Can chiropractic care completely resolve migraines?
I've worked with patients who have experienced complete resolution of their migraines following upper cervical care. Others have experienced substantial improvement without their migraines disappearing entirely.
I can't promise which outcome someone will experience. But if you're still suffering after trying other treatments, I believe it's reasonable to investigate whether the upper cervical spine might be contributing to the problem.
Start with a conversation
If you've been living with migraines and feel like you've tried everything, I'd be glad to talk with you.
We'll listen to your story, look at the full picture, and help you decide whether upper cervical care makes sense for you.
You don't need to arrive knowing whether your neck is part of the problem. That's one of the questions we're here to help investigate.
Axia Chiropractic
315 N. Market St., Suite 107
Chattanooga, TN 37405
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