Let's first go through the International Definition of Migraine ( ICHD-3 )
At least two of the following characteristics of the headache must be present:
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The pain is on one side.
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The pain is moderate to severe.
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The pain is throbbing.
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Pain worsens with exertion or causes avoidance of exertion
At least one of the following associated symptoms must be present:
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Sensitivity to light and sound
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Nausea or vomiting
Note that the location of the pain is not specified. That is, pain that feels like a throbbing pain in the back of the head or at the base of the skull and worsens with exertion meets the criteria for migraine.
It is very common for a migraine in the back area to be accompanied by nausea. These symptoms are migraines.
So the answer is yes — a migraine can be felt in the back of the head or at the base of the skull.
What hurts there then?
It is important to distinguish between tenderness of the greater occipital nerve and the muscles attached to the skull base structures.
Pain in the posterior tibial nerve is specifically indicative of a migraine.
It is common for muscle attachment points to also be somewhat tender during a migraine attack, but this does not change the diagnosis.
The characteristics of the headache give the name to the headache – not the condition of the muscles.
(Even a tension headache cannot be diagnosed by simply feeling the muscles.)
The lower part of the trigeminal nucleus, located in the brainstem, receives input from the nerves that come from above the three upper cervical vertebrae.
Therefore, migraines can be experienced at the base of the skull and even in the upper neck.
The initial symptoms of a migraine attack are often accompanied by increased muscle tension in the neck area.
This should not be considered the cause of the headache if the characteristics of the pain meet the definition of migraine.
Markku Nissilä, neurology specialist
Frequently asked questions about migraines at the base of the skull
Can a migraine be felt in the back of the head?
Yes, you can. Migraine pain can be localized to the back of the head or the base of the skull, even if it meets the diagnostic criteria for migraine.
What causes the pain?
The area of the posterior cranial nerve and the muscles that attach to the base of the skull may become tender during a migraine attack. This is part of the nervous system's reaction, not a separate muscle problem.
Could it be muscle tension?
In migraines, neck muscle tension may increase, but this is a consequence – not a cause. The diagnosis is based on the characteristics of the headache, not muscle sensations.
Why is a migraine felt in the neck or base of the skull?
Because the trigeminal nucleus also receives nerve supply from the upper cervical vertebrae, pain can be reflected to the base of the skull and upper neck area.
Read more and find natural help
Many factors contribute to migraines – including neck muscle tension and stress.
Discover the Atlas Care neck stretcher , which relaxes the muscles of the skull base and relieves the symptoms of migraine and tension headaches.