First, let's go through the international definition of migraine (ICHD-3)
At least two of the following headache characteristics must be present:
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Pain is unilateral
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Pain is moderate or severe
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Pain is pulsating
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Pain is aggravated by or causes avoidance of routine physical activity
At least one of the following associated symptoms must be present:
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Photophobia and phonophobia
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Nausea or vomiting
Note that the location of the pain is not defined. 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 migraines felt in the posterior region to be associated with nausea. With these symptoms, it is indeed a migraine.
So the answer is yes — migraine can be felt in the back of the head or at the base of the skull.
What is causing the pain there?
It is important to differentiate between tenderness of the greater occipital nerve and the muscles attached to the base of the skull.
Tenderness of the occipital nerve specifically indicates 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 indicate the type of 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 located in the brainstem receives input from the nerves coming from the three uppermost cervical vertebrae.
Therefore, migraine can be experienced at the base of the skull and even in the upper neck.
The initial symptoms of a migraine attack often involve increased muscle tension in the neck area.
This should not be mistaken as the cause of the headache if the pain characteristics meet the definition of migraine.
Markku Nissilä, specialist in neurology
Frequently asked questions about migraine at the base of the skull
Can 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, even if it meets the diagnostic criteria for migraine.
What causes the pain?
The area of the greater 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 problem.
Could it be muscle tension?
In migraine, neck muscle tension can increase, but it is a consequence – not a cause. The diagnosis is based on the characteristics of the headache, not muscle sensations.
Why does migraine feel like it's in the neck or at the base of the skull?
Because the trigeminal nucleus also receives nerve input from the uppermost cervical vertebrae, pain can radiate to the area of the base of the skull and the upper neck.
Read more and find natural relief
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