Headache Trigger Points
Trigger Point Therapy for Headaches
The common headache is a very good example of unrecognized trigger point referred pain. Few people, and few doctors for that matter, recognize trigger points as a predominant source of headache pain. It seems so natural to blame headaches on nervous, vascular, or psychological conditions, but the truth is simpler than those explanations.
Headache pain is produced by trigger points in overloaded neck muscles. To understand this, you simply need to examine the way that headache pain changes your behavior. When you have a headache, the pain is typically worse when you move your head. You often just want to lay down and be very still until the headache passes. When you do this, you are resting the muscles that move the head, the muscle groups in the neck and shoulder region.
Of course, some headaches are caused by other problems, but trigger points play a role even in these conditions. Migraines, sinus headaches, and cluster headaches can typically be managed by trigger point therapy, and many times people are mistakenly diagnosed with these conditions when trigger points are actually responsible.
While there many muscles that can contain trigger points that refer pain to the head, the two muscle groups that are involved in nearly every case are the Trapezius and Sternocleidomastoid muscle groups.
The Trapezius Trigger Points that Cause Headaches
The Trapezius is the large, diamond shaped muscle group that forms the base of the neck and upper back region. It has attachment points at the base of the skull, along the spine, on the shoulder blade, and on the collar bone.
When this muscle contracts it typically moves the shoulder blade, but it also plays a part in moving the neck and head. Trigger points in this muscle refer pain to the back and side of the neck, to the temple region, behind the ear or back of the head, to the shoulder joint, and in the upper back region.
Trigger points in this muscle develop for a number of reasons, including
poor posture, emotional stress, whiplash injuries, falls, and poor sleeping positions (or sleeping under a strong ceiling fan). Additionally, hypoglycemia (low blood sugar) and dehydration (like the dehydration associated with a hangover) may activate trigger points in this muscle.
Trapezius Trigger Point Symptoms
A person coming to see me with active trapezius trigger points may have any or all of the following symptoms, depending on how far along their trigger point activity has progressed:
Neck Pain and Stiffness: Trapezius trigger point pain usually starts in the neck, along one side. If there is significant stiffness in the neck it typically means that the levator scapula trigger points are involved as well.
Headache: The pain will spread to the base of the skull, behind the ear, to the temple, and above the eye. Often this headache pain will exist simultaneously with the neck pain.
Pain at the Angle of the Jaw: In severe cases, the pain may extend down into the rear jaw region. This pain can activate other trigger points that contribute to TMJ disorder symptoms.
Top of the Shoulder Pain or Soreness: In most cases, the neck and headache pain will be preceded by pain, soreness, and a sense of "heaviness" on the top of the shoulder (acromio-clavicular) joint. This sensation is produced by the lower trapezius trigger point and is not often noticed by the patient until I remove it by releasing the trigger point. I think in most people, this pain is present so much that they learn to ignore it. It's the proverbial "weight of the world on the shoulders" sensation.
The Sternocleidomastoid Trigger Points that Cause Headaches
The Sternocleidomastoid (SCM) is a muscle group that is found on each side of the neck. This muscle group has two divisions or parts, the sternal division and the clavicular division. Both divisions contract to flex the head forward or to the side, as well as to help rotate the head to each side.
The sternal division attaches at the base of the skull behind the ear, and runs downward wrapping around the neck and attaching to the breast bone. Trigger points in this part of the SCM muscle refer pain to the top of the head, temple, above and around the eye socket, and to the back of the head. Additionally, these trigger points may produce other symptoms such as sore throat, dry cough, and eye redness and tearing.
The clavicular division also attaches behind the ear, but wraps downward around the neck to attach to the collar bone instead of the breast bone. Trigger points in this division refer pain to the forehead, to the ear (and behind it), and sometimes to the molar teeth. These trigger points may also be responsible for bouts of dizziness or vertigo, as the SCM muscle is involved with orientating the head in space, which provides feedback for the sensory information derived from the "balance receptors" in the inner ear.
Unlike Trapezius trigger points, SCM trigger points do not refer pain or stiffness to the neck. The pain from SCM trigger points is almost always severe, and is typically misdiagnosed as migraine or cluster headaches.
Sternocleidomastoid Trigger Point Symptoms
Sternocleidomastoid trigger points can have serious symptoms associated with them. Many of my patients that come to me with active SCM trigger points have been treated for many conditions, by many doctors, with little success.
Because these muscles are responsible for positioning the head in space, they are intimately tied to vision and hearing. In order to process visual and auditory information correctly, your brain needs to know the position of your head. It uses proprioceptors in the SCM muscles to determine if your head is turned or elevated in relation to your body. SCM trigger point activity reeks havoc on the proprioceptors, causing diverse symptoms such as blurred vision, double vision, a dimming of the perceived light intensity, deafness (in one ear only), and ringing in the ear.
By far the most common complaint caused by these trigger points is "a headache like-no-other". Call it a tension headache, a cluster headache, or the dreaded migraine, in my clinical experience they always have SCM trigger points at the root of them. That is not to say that these conditions don't have other causes, only that SCM trigger points have some role in their physical expression. Depending on what is causing these headaches, trigger point therapy can offer temporary or lasting relief, but I haven't had a patient yet that wasn't grateful for any type of relief.
Some other interesting symptoms associated with these trigger points include dizziness and vertigo. A person will experience this dizziness when moving their head, such as when raising it to turn over in bed or when looking up by tilting the head back. Quick movements of the head may cause nausea or even fainting. Motion sickness in a car or boat are also common.
I've also seen patients with facial pain in the cheek and jaw from these trigger points. There can also be drooping of the eyelid (ptosis), or excessive tearing in one or both eyes. Red eyes is very common.
The middle trigger point of the sternal SCM branch can reportedly produce a sore throat and difficulty swallowing, but I've never seen this in practice. And lastly, another weird symptom that I've never personally seen is forehead sweating, just on one side of the forehead.
Secondary Trigger Points that Cause Headaches
Trigger points in two other muscle groups can contribute to headaches: the Temporalis and Suboccipital muscle groups. Clinically, it is extremely rare that trigger points in these muscles are the sole cause of headache pain. They are typically secondary or satellite trigger points that form in response to active trigger points in the Trapezius and Sternocleidomastoid muscles. They resolve naturally when the trigger points in the primary muscles are properly treated.
Related Instructional Videos from Dr. Perry
While the videos below were created to teach therapists how to locate and release these trigger points, many non-professionals have used them to learn these techniques successfully.
If you have a partner, a little time, you can use these videos to learn how to treat your own trigger points.
Related Articles from Dr. Perry
More extensive articles on these muscles and trigger points are available from Dr. Perry on our sister website TriggerPointTherapist.com. Click on the titles below to read them: