Marc Darrow MD,JD

Over the years we have seen many patients with problems and challenges related to migraine headaches. Of course the biggest challenge these new patients are facing was finding good, effective, long-term relief. Headache is a very complex subject. Headaches can be caused by many things. In my article here we will concentrate on the musculoskeletal causes of headache: neck ligament damage and neck muscle weakness caused by tendon weakness and damage.

In the Journal of Headache Pain (December 2017), (1) researchers examined the relationship and cause of  migraine, co-existing tension-type headache, and neck pain in headache patients. One hundred forty-eight people participated in this study.

  • Out of 148 persons with migraine, 100 (67%) suffered from co-existing tension-type headache and neck pain.
  • Only 11% suffered from migraine only.
  • Persons with migraine and co-existing tension-type headache and neck pain had lower level of physical activity and psychological well-being, higher level of perceived stress and poorer self-rated health compared to healthy controls.
  • They reported reduced ability to perform physical activity owing to migraine (high degree), tension-type headache (moderate degree) and neck pain (low degree). The most burdensome condition was migraine, followed by tension-type headache and neck pain.

The conclusion of this study was that people with these challenges needed to increase their physical activity to improve well being and reduce stress.

One interesting fact of the study above is that only 1 in 9 of these patients suffered from migraine alone. This is something we see empirically in our office. Migraine is usually not an isolated problem but the symptom of many problems. Of these many problems are problems of tightness and muscle spasms. This can be a sign of muscle weakness and tendon damage being a culprit of the cause.

Cervical neck muscle imbalance cause migraines

There is a new study, August 2019, (2) examining the role and connection of neck pain and migraine attacks.

Here the researchers looked for a connection between weak neck muscles and migraine headaches.

Here are their learning points:

  • Neck pain is considered a common characteristic of migraine attacks.
  • The relationship between neck pain and migraine can be explained by central sensitization (your nervous systems reaction to a chronic pain stimulus) of the trigeminocervical complex, where superior cervical afferents (Superior cervical ganglion nerve package) and the trigeminal nerve (the nerve connected to facial movements the C5 nerve) converge.

The purpose of the present study was to determine the extensor/flexor ratio of neck muscle strength  in individuals with migraine and individuals without history of migraine or other headaches.

52 women tested

  • Fifty-two women with migraine / headaches and 52 women with neither a history of migraine nor neck pain, between 18 and 55 years old, were included in the study.
  • The electromyographic activities of the sternocleidomastoid (the big muscle connecting your sternum to the mastoid process behind your ear), anterior scalene (the muscle on the sides of the neck that sits behind the sternocleidomastoid), splenius capitis ( muscle at the base of your neck), and upper trapezius muscles were evaluated during a test of maximal voluntary isometric contraction and craniocervical flexion. (Simply during neck movement)


  • The migraine group presented lower flexor muscle strength and a higher extensor/flexor muscle strength ratio than the control group.
  • In addition, the migraine group showed a reduced electromyographic extensor/flexor muscle ratio during maximal voluntary isometric contraction in flexion. The results demonstrated worse performance in the craniocervical flexion test of the migraine group and a lower electromyographic ratio of extensor/flexor neck muscles in the last stage of the test.
  • Altogether, the migraine group presented an imbalance in cervical muscles verified not only during force production, but also during muscle activity.

Simply stated, there is a muscle imbalance. Some muscles are stronger than others. One cause of this muscle imbalance? Wear and tear damage to the muscle’s tendons at the attachment of the muscle to the bone. Possible solution PRP and stem cell injections into the damaged tendon attachment.

Finding the active trigger points where we can offer treatment

The idea that muscle spasms and muscle imbalance can cause an outbreak of migraine headaches in women is a well researched subject. A 2017 study in The Clinical journal of pain (3) demonstrates that migraine headache could be reproduced by finding and palpitating (gently pressing) these active trigger points. These trigger points (pain producers) were found in the splenius capitis, the upper trapezius), and the sternocleidomastoid muscles. Those same muscles examined in the above research.

The role of neck pain and cervical neck instability and headaches

In addition to tendon attachments causing neck instability and leading to muscle spasms and migraines, our own clinical observations of more than 20 years coupled with that of numerous research studies have demonstrated that damaged, weakened cervical neck ligaments cause head postural problems which lead to tension, stress and pain in the neck which in turn generates headaches.

  • Ligaments are the soft connective tissue that hold the vertebrae in place. When these ligaments are damaged they allow for unnatural movement of the vertebrae. This can lead to “pinched nerves,” “muscle spasms,” and tension / stress on the cervical muscles.

Treating cervical ligaments and tendons with PRP and stem cell therapy

Platelet Rich Plasma injections

PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge to separate the platelets from the red cells. The collected platelets are then injected back into the cervical spine area at the tendon and ligament attachments and regeneration. Research has shown PRP to be effective in treating degenerative disc disease by addressing the problems of cervical spine ligament instability and tendon attachment damage.

Stem cell injections

Stem cell injections involve the use of Bone Marrow derived stem cells. The stem cell treatments help restore ligaments strength by causing the regeneration of ligament, tendon, cartilage and bone regeneration.

Can stem cells reduce migraine headache attack through its reparative anti-inflammatory properties?

A study published in the journal Case reports in neurology (4) suggests that stem cell therapy may be effective in treating  refractory chronic migraines.

Here the researchers noted:

  • Stem cells may relieve migraines through their proven anti-inflammatory properties because neurogenic inflammation is one of the major aspects of migraine pathogenesis.

Our treatment begins with a physical examination of your neck and finding the sources of your headaches. After we assess your pain challenges we offer a realistic healing program with our PRP and stem cell treatments. If you want to explore treatments use the form below.

Do you have questions? Ask Dr. Darrow

A leading provider of stem cell therapy, platelet rich plasma and prolotherapy

PHONE: (800) 300-9300 or 310-231-7000

Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician. Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.


1 Krøll LS, Hammarlund CS, Westergaard ML, Nielsen T, Sloth LB, Jensen RH, Gard G. Level of physical activity, well-being, stress and self-rated health in persons with migraine and co-existing tension-type headache and neck pain. The journal of headache and pain. 2017 Dec;18(1):46.
2 Benatto MT, Florencio LL, Bragatto MM, Lodovichi SS, Dach F, Bevilaqua-Grossi D. Extensor/flexor ratio of neck muscle strength and electromyographic activity of individuals with migraine: a cross-sectional study. Eur Spine J. 2019 Aug 9.
3 Florencio LL, Ferracini GN, Chaves TC, Palacios-Ceña M, Ordás-Bandera C, Speciali JG, Falla D, Grossi DB, Fernández-de-las-Peñas C. Active trigger points in the cervical musculature determine the altered activation of superficial neck and extensor muscles in women with migraine. The Clinical journal of pain. 2017 Mar 1;33(3):238-45.
4. Mauskop A, Rothaus KO. Stem Cells in the Treatment of Refractory Chronic MigrainesCase Rep Neurol. 2017 Jun 14;9(2):149-155. doi: 10.1159/000477393. PubMed PMID: 28690531; PubMed Central PMCID: PMC5498934.

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