Migraine is typically treated as a neurological problem – a chemical and electrical event in the brain that triggers pain, light sensitivity, nausea, and sometimes visual disturbances. That framing isn’t wrong. But it’s incomplete for a significant subset of migraine sufferers, and the missing piece is structural. At Draper Spinal Care, one of the most consistent patterns among patients who come in with chronic headaches is that their neck has never been seriously evaluated as a contributing factor – even when they’ve been managing migraines for years.
The connection between upper cervical dysfunction and recurring headaches isn’t new or fringe. It has a body of peer-reviewed literature, a recognized clinical category, and a mechanism that, once understood, makes intuitive sense. What’s missing for most patients is a provider who’s looking for it.
The Neck’s Role in Migraine: More Than Muscle Tension
Most people understand that tight neck and shoulder muscles can cause tension headaches. The upper cervical migraine connection is different and goes deeper than that.
The upper cervical spine – specifically the atlas (C1) and axis (C2) vertebrae – is neurologically dense in a way no other spinal region matches. The brainstem, which regulates basic physiological functions and processes pain signals from the head and face, passes directly through and just below the atlas. The trigeminal nerve, which is centrally implicated in migraine pathophysiology, has a descending nucleus that extends down into the upper cervical spinal cord – creating a convergence zone where signals from the head and signals from the upper neck are processed together. This area is called the trigeminocervical complex, and it’s why dysfunction in the upper cervical spine can produce or amplify headache patterns that feel nothing like a stiff neck.
The vertebral arteries, which supply blood to the posterior brain and brainstem, also pass through the transverse foramina of the upper cervical vertebrae on their way to the skull. When atlas alignment is off, the mechanical relationship between the bone and the vessels passing through it changes – a factor that has been studied in relation to migraine and basilar-type headache presentations.
None of this means the cervical spine is the only cause of migraines. Migraines are multifactorial, and the contributions of genetics, hormonal factors, sleep, stress, and dietary triggers are real. But for patients with recurrent migraines that include neck pain or stiffness, headaches that consistently begin at the base of the skull, or patterns that haven’t responded predictably to standard migraine medications, the upper cervical spine is a plausible and often overlooked contributor.
What Atlas Misalignment Does to the System
The atlas is uniquely positioned and uniquely mobile. It supports the full weight of the skull – roughly ten to twelve pounds – and rotates more than any other vertebra in the spine. That mobility, combined with the absence of an intervertebral disc above or below it, makes it vulnerable to misalignment from relatively minor forces: a car accident years ago, a slip or fall, sustained postural stress, or sometimes no identifiable event at all.
When the atlas shifts from its optimal position, even slightly, several things change. The muscles attached to the upper cervical spine compensate asymmetrically, creating chronic tension patterns on one side that postural adjustment alone can’t resolve. Dural tension – stress on the covering of the spinal cord and brain – can increase when the upper cervical alignment is disrupted, a factor studied in relation to both headache and other neurological symptoms. Cerebrospinal fluid flow through the foramen magnum, the opening at the base of the skull through which the brainstem descends, may also be affected by atlas position, though this mechanism is still being actively researched.
The clinical result of these combined effects, in patients with relevant sensitivity, is often a headache pattern that mirrors migraine in its character but has a structural component that pharmacological treatment doesn’t address. Triptans and preventive medications work on the chemical cascade of a migraine episode – they don’t change the structural environment that may be contributing to the threshold at which those episodes occur.
The Research Connecting Upper Cervical Care and Migraine Relief
A study published in the Journal of Upper Cervical Chiropractic Research documented significant reductions in migraine frequency and intensity following atlas correction in patients with chronic migraine. A case series published in the same journal reported patients with previously intractable migraine patterns experiencing resolution or near-resolution of episodes after sustained NUCCA care.
The 2007 study in the Journal of Human Hypertension – which found that atlas correction produced statistically significant reductions in blood pressure comparable to two antihypertensive medications, without medication – demonstrated the systemic reach of upper cervical correction in a way that drew mainstream attention to the connection between atlas alignment and brainstem-mediated physiology. While that study addressed blood pressure rather than migraine, it illustrated that the atlas-brainstem relationship has measurable systemic effects beyond what most clinicians expect from a spinal adjustment.
Research from the Upper Cervical Research Foundation has examined CSF flow changes following atlas correction using upright MRI, with findings suggesting that misalignment affects fluid dynamics in ways that correction can normalize. This line of investigation is ongoing, but the early imaging findings are consistent with what practitioners observe clinically.
A Cochrane review of spinal manipulative therapy for migraine found evidence of benefit comparable to commonly used migraine prophylactics, with the important difference that spinal care doesn’t carry the side effect profiles that accompany medications like topiramate or amitriptyline – side effects that cause a meaningful percentage of patients to discontinue prophylactic treatment.
The research base for upper cervical care in migraine is not as extensive as the pharmaceutical literature, and it’s worth being straightforward about that. But the mechanistic rationale is sound, the clinical observations are consistent across practitioners, and for patients who’ve been managing migraines primarily through medication without adequate relief, there’s a legitimate case for adding a structural evaluation to the treatment picture.
Why Medications Alone Often Aren’t Enough
The migraine medication landscape has expanded considerably in recent years. CGRP antagonists – a newer class of migraine preventives including rimegepant and atogepant – have shown meaningful efficacy for some patients. Triptans remain the most effective acute treatment for many people. For patients with frequent or severe migraines, these medications can be genuinely life-improving.
They also don’t work the same way for everyone, and they don’t work for everyone at all. Roughly 40 percent of migraine patients report inadequate response to triptans. Preventive medications require consistent daily use, often involve weeks to months before efficacy is established, and carry side effects that range from tolerable to prohibitive. And for patients whose migraines have a structural contributor – an atlas that’s been out of alignment since a car accident a decade ago, perpetually maintaining the upper cervical system in a state of irritation – no amount of pharmacological management addresses that underlying condition.
The patients who tend to benefit most from upper cervical care at Draper Spinal Care are those with cervicogenic features in their headache pattern: pain that originates at the base of the skull or radiates from the neck forward, headaches that are consistently worse or triggered on one side, stiffness or restriction in cervical rotation, or a history of head or neck trauma that predates the onset of chronic headaches. These patterns suggest a structural component worth evaluating, and atlas correction is the most direct way to address it.
What an Upper Cervical Evaluation for Migraine Looks Like
Patients who come to Draper Spinal Care for headache evaluation start with a thorough clinical history that specifically addresses headache characteristics, onset patterns, prior trauma, and medication history. The physical examination includes cervical range of motion testing, postural analysis, and neurological screening.
If the examination suggests upper cervical involvement, precision X-rays are taken to measure atlas alignment in three dimensions. These films aren’t standard cervical spine X-rays – they’re taken in specific positions and analyzed using NUCCA measurement protocols that reveal the degree and direction of atlas misalignment. That measurement is what makes a NUCCA correction specific to the individual patient rather than generalized to the region.
Patients who proceed with care receive atlas corrections calculated from their imaging, with follow-up imaging used to assess correction quality and holding time. As the atlas correction stabilizes and the surrounding musculature adapts, many patients find that the frequency and intensity of headache episodes decreases – not because the correction is treating migraine directly, but because removing one contributor to the neurological burden lowers the threshold at which episodes occur.
If Your Migraines Aren’t Fully Controlled, the Neck Is Worth Evaluating
Chronic migraine is a significant quality-of-life condition, and every tool that might reduce its burden deserves consideration. If you’ve been managing headaches for years primarily through medication – whether with good results that could be better, or with inadequate results you’ve accepted as normal – a structural evaluation of the upper cervical spine is a step that most migraine sufferers have never taken.
Draper Spinal Care serves patients throughout Draper, Sandy, South Jordan, Riverton, and the broader Salt Lake Valley. Dr. Joshua Stockwell is a recognized NUCCA practitioner with specific experience in headache presentations. Call (801) 701-2111 to schedule a free consultation and find out whether atlas misalignment may be contributing to your migraine pattern.
