Let’s first review the international definition of migraine (ICHD-3)
At least two of the following headache characteristics must be met:
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The pain is unilateral
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The pain is moderate or severe
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The pain is pulsating
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The pain is aggravated by, or causes avoidance of, physical activity
At least one of the following associated symptoms must be met:
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Photophobia and phonophobia
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Nausea or vomiting
Note that the location of the pain is not specified. In other words, pain that feels pulsating at the back of the head or base of the skull and worsens with exertion meets the criteria for migraine.
It is very common for migraine felt in the posterior region to be accompanied by nausea. With these symptoms, it is a migraine.
The answer is therefore yes — a migraine can be felt at the back of the head or at the base of the skull.
So what is aching there?
It is important to distinguish the tenderness of the greater occipital nerve and the muscles attached to the base of the skull from other structures.
Tenderness of the occipital nerve is specifically indicative of migraine.
It is common for muscle attachment points to also be somewhat tender during a migraine attack, but that does not change the diagnosis.
The characteristics of the headache define the headache — not the state of the muscles.
(Even tension-type headache cannot be diagnosed solely by palpating the muscles.)
The lower part of the trigeminal nucleus in the brainstem receives input from nerves coming over the three upper cervical vertebrae.
This is why migraine can be experienced at the base of the skull and even in the upper neck.
The initial symptoms of a migraine attack often include increased muscle tension in the neck area.
This should not be mistaken for the cause of the headache if the headache's characteristics meet the definition of a migraine.
Markku Nissilä, Specialist in Neurology
Frequently asked questions about migraine at the base of the skull
Can a migraine be felt at the back of the head?
Yes, it can. Migraine pain can localize to the back of the head or the base of the skull while still meeting the diagnostic criteria for migraine.
What causes the pain?
The area of the occipital nerve and the muscles attached to the base of the skull can be tender during a migraine attack. This is part of the nervous system's reaction, not a separate muscle ailment.
Could it be muscle tension?
In migraine, neck muscle tension can increase, but it is a consequence — not the cause. The diagnosis is based on the characteristics of the headache, not muscle sensations.
Why is migraine felt in the neck or base of the skull?
Because the trigeminal nucleus also receives nerve input from the upper cervical vertebrae, pain can be referred to the area of the base of the skull and the upper neck.
Read more and find natural relief
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