Four patients who had recurrent attacks of idiopathic unilateral neck pain and tenderness of the ipsilateral carotid artery are described. Two patients had never had headache. The other two had migraine without aura. All patients had dilatation of extracranial arteries during the attacks (telethermographic examination), oculosympathetic hypofunction (pupillary tests), and positive responses to vasoactive drugs which are commonly used for migraine treatment. Recurrent neck pain involving the carotid artery seems to be a variant form of migraine that may occur alone or in association with headache in patients with involvement of extracranial arteries.