Neck pain is a common feature of migraine, with a high prevalence between attacks as well as during attacks. This often leads migraine patients to assume cervical pathology , but the mechanism behind neck pain in migraine is unknown. It could be caused by convergence of nociceptive input from pericranial neck muscles and dura mater in the trigeminocervical complex . In support, preclinical studies have also shown that second-order neurons localized in the cervical spinal cord are sensitized by stimulation of C-fiber afferents of the dura and the neck muscles . Furthermore, one study reported that stimulation of the first cervical nerve evoked frontal and periorbital pain in individuals with migraine. Interestingly, the same stimulation only evoked occipital and cervical pain in migraine free individuals with chronic occipital pain. Thus, nociceptive drive from upper cervical afferents might be of importance in migraine pathogenesis.
The rectus capitis posterior minor muscle (RCPmi) is of particular interest in migraine as it is innervated by the first cervical nerve and connected to the dura via a myodural bridge. The myodural bridge is proposed to protect the dura and uphold the integrity of the subarachnoid space during neck movement. It is a possibility that increased activity of the RCPmi may cause hypertrophy and thereby dural tension via this myodural bridge. This may result in increased nociceptive input from upper cervical and dural afferents, which could contribute to migraine headache.