Treating Trigger Point Headaches – Your Complete Guide
After treating patients with headaches for over 20 years, I’ve realized how important it is to find and treat trigger points (such as suboccipital muscle pain). Most of all, I’ve taught my patients how to treat themselves.
In this guide, we will walk through the causes of tension headache (from anywhere from suboccipital muscles pain to occipitalis muscle pain), how to get rid of tension headaches, and prevent them from occurring again. In addition to other muscles in the back of the head, suboccipital muscles and headaches are the main causes. So let's begin.
What Causes Headaches?!
No matter what you do, they never seem to go away. You may have been told that you have migraines, but medication doesn’t work as well as you’d like.
Or you decide to get a massage and the relief is temporary.
If that describes you, there may be a good chance that some, or all, of your headaches are coming from trigger points (also known as ‘muscle knots’). Most of this is from muscles such as suboccipitals and sternocleidomastoid, nerve pain being actually quite rare as a cause. These headaches can extend from muscles to areas away from the real source of pain, like having pain behind ear, base of skull, and up to the forehead and temples. The muscles can be in the front and back of the neck and even the shoulders, but one may think a knot in head is the cause. You'll learn how to find these muscle spots that give headache behind ear and base of skull and more.
Keep on reading to learn more...
Why Headaches Caused By Trigger Points Are So Difficult To Treat
If over 50% of neck pain and headaches come from trigger points, then why are they so difficult to treat? There are a couple of reasons:
Your headaches may not actually be coming from your head
Trigger points can be located anywhere. That’s what makes it so difficult to treat. Take for example Mary, a patient of mine that had severe tension headaches nearly every day. She was told by one doctor that she had migraines, and recommended trigger point injections for migraines. She was then by another doctor that her headaches were ‘tension related’ and ‘muscle related’. She also had tenderness over the areas where she felt the headache.
So why wasn’t it getting better? What she didn’t know was that half of her pain was coming from the shoulders. We treated the shoulders and the headaches reduced by about 60%. She and her doctor were so focused on the ‘head pain’, that they didn’t think of looking somewhere else.
Just take a look at the following muscles that are known to cause headaches. You don’t need to memorize the names of these muscles, like the enlarged sternocleidomastoid muscle. Focus more on where they are:
As you can see, headaches can come from trigger points in the head, jaw, back of the neck, front of the neck, upper shoulder area, and even the mid back! If you want to get headache relief, you’re going to have to explore all these areas. We’ll shortly go over how you can do this yourself. (And luckily, you won't require aggressive trigger point injections for headaches). Treatments (like a sternocleidomastoid trigger point release) can be a lot simpler and easier to do all on your own.
Being labeled with a 'diagnosis' may distract you from myofascial trigger points
As health professionals, we’re trained to provide a diagnosis for every complaint a patient comes with. That’s our way of communicating with other health professionals and provides a guideline on how best to treat the condition.
However, we may focus so much on the diagnosis that we forget to look past it.
For example, you may be given the diagnosis of ‘migraine’. Treatments are focused on the migraine itself, when in fact it could be a suboccipital headache. There are times when your health professional may not include trigger point examination as part of their assessment, or even provide any simple treatment, like sternocleidomastoid muscle exercises. This can occur quite often. Check out some of the following conditions that can have related trigger points:
Tension Headache Symptoms
Now that you know that headaches can be caused by muscle knots that are located in several different areas (like suboccipital muscles, or even a knot in shoulder causing headache symptoms), what does a trigger point feel like? Headaches can present several ways. There really isn’t one type of pain that you should be looking out for, although I've had patients describe it in many strange ways, including 'stress knots' on head.
For example, when someone has nerve pain, they often will describe it as a tingling or numbness.
The description of symptoms of tension headaches can vary greatly. You may feel a deep ache, or a band like pressure around the head. You may also feel a sharp pain if its localized, like over the eye. (For sternocleidomastoid syndrome, treatment can actually consist of treating the opposite muscle). The trigger point may even create a feeling of throbbing pain, which often mimics a migraine. It doesn’t just stop there. For example, with knots in my neck causing headaches, the same muscles can also cause a wide number of ‘strange and bizarre’ symptoms. Check out the image below on common and 'bizarre' symptoms (the sternocleidomastoid headache is usually guilty of the most bizarre symptoms, and we'll have a video shortly on how to treat it):
Most of my patients are shocked when I show them this list. These are usually not things one relates to muscle pain. When someone gets symptoms like these, then knots in neck at base of skull seem like easy concepts to remember. We’ll soon show you how to find all the spots to help you improve your headache and muscle pain.
How Do I Find Tension Headaches Trigger Points?
Self-treatments have always been the best option for my patients. The faster I can get them to take charge of their own health, the faster they will remain headache free.
That's why I'm going to show you how to find and treat your own knots in back of neck, causing headaches. In addition, we'll get into stretches (like an scm muscle stretch), strengthening exercises and daily activity changes.
You may say to yourself ‘with all these knots in neck causing headaches, there are so many areas to look at. Where do I start?’ In order to make it manageable, I like to divide areas for self treatment into sections. Let’s go over each of these sections (shoulder area, back of neck, and front of neck where you can have a tight sternocleidomastoid).
Note: When we talk about a tight sternocleidmastoid muscle, it doesn't necessarily need to be 'tight'. That's one of the biggest myths out there. To get sternocleidmastoid pain relief, as an example, you aren't making it less tight to provide you sternocleidomastoid muscle pain relief. A tight muscle can be pain free, while a very loose feeling muscle can be the most painful muscle ever. As you'll see, it's really about applying pressure on painful knots and then providing other treatments, like an scm stretch in this case.
Finding Trigger Points In The Upper Shoulder Area:
Oddly enough, this is the first place I look for trigger points that cause headaches. I’ve found that the most common areas are usually the upper shoulders and the back of the neck.
There is a muscle here called the upper trapezius, which can refer pain to the back of the head and the forehead.
There are several tools that one can use to target muscle knots. For this muscle, you can use your hands, a trigger point ball, cane shaped tools or the Muscle Wizard. Check out the following video, showing how you can find these spots using all these strategies:
Believe it or not, there's a muscle in the middle of the back that can also refer pain to the back of the head. If you've tried all the muscles and still can't find the cause of your headaches, don't forget to explore this muscle! I shot a short video that shows you how:
Notice how it's not that difficult to treat these knots. As I've said before, you don't need to get aggressive and get things like trigger point injections side effects. A simple Muscle Wizard or lacrosse ball will do. Side effects of trigger point injections don't outweigh the benefits of using simple tools.
Finding Trigger Points In The Back Of The Neck:
The muscles at the back of the head, all the way up to the muscles of the skull, can be targeted using the fingers, a trigger point ball or the Muscle Wizard. You may have seen detailed diagrams of all the different muscles. For self treatments, you don't need to know them all. Keep it simple.
Just remember that there are multiple layers of different muscles in the neck. Some go from one joint to the next, while others can go from the back of the skull down to the mid back. We can start in the back of the head and work our way down.
Here’s a video on how to target the small muscles at the top of the back of the head with the Muscle Wizard:
You can also target these neck muscles using your own fingers. If you don't have a Muscle Wizard, you can start off using your own fingers. I demonstrate this in the following video:
Finding Trigger Points In The Front Of The Neck:
There is a muscle in the front of the neck called the sternocleidomastoid muscle, which is responsible for a lot of forehead type headaches. You don't need a sternocleidomastoid injury to have symptoms. A simple cold draft can cause the pain to develop! You can target this muscle using your hands or even the Muscle Wizard.
Be careful with this area because this muscle is extremely sensitive in a lot of people (unlike a trapezius trigger point release where I can be more aggressive). If you over-treat this, scm muscle symptoms can increase and you'll feel bruised the next day. Watch the following video on how to use your hands to target this muscle:
If your hands tend to get tired, you can use the Muscle Wizard, which allows you to control the amount of pressure. You can also use it to ‘strip’ out the muscle. I've even been able to target the muscle knot at base of skull with this. Watch the following video on how to use the Muscle Wizard:
Find And Treat Trigger Points In The Temple Area:
There’s a muscle in the temple area known as the temporalis muscle. This is quite easy to find and treat using your fingers. I’ve never found this muscle to be the main cause of headaches. Its usually secondary to trigger points in other muscles.
That’s why I never want you to start here first. Most people that start here get the wrong idea that this is all they need to do. It does provide significant relief. However, you have to address the knots in other bigger muscles first. For example, a levator scapulae trigger point can provide pain going up the neck. Surprisingly, upper back pain and headache symptoms are also related. Here’s a quick video on how to find the temporalis muscle:
How To Find And Treat Trigger Points In The Jaw
There are 2 muscles in the jaw that I like to address with self treatments. There are quite a few other muscles in the jaw, but I always find these two to be the most common and easiest to treat. Also note that you can target some of these muscles by going into the mouth.
However, just applying pressure on the outside will be enough to get relief. The two muscles are the digastric muscle and the masseter muscle. The digastric muscle is a short muscle behind the mandible and is usually secondary to trigger points in the the sternocleidomastoid (which we went through in the ‘front of the neck’ section). You can also get pain to the jaw from a trapezius muscle pain trigger point. That just shows you why you need to be patient and explore and poke around all the muscles in the areas. With a loose or tight trapezius, headache symptoms can occur but can also refer pain to the jaw, confusing where exactly everything is coming from!
The best way to describe how to find these trigger points is to actually show you. Here’s a short video that goes over how to find common jaw muscle trigger points that lead to headaches:
How To Get Rid Of Tension Headaches
By now, you should have a good idea how to find the trigger points. Here are a few tips on how to relieve tension headaches:
- Don’t press too hard. Some of us may want to follow the ‘no pain no gain’ philosophy. With trapezius pain and headaches, it's easy to get carried away because it feels so good to press into the muscles. However, pressing too hard may give you more pain and make you feel bruised for a few days or even something like a sternocleidomastoid spasm. That will greatly reduce any motivation you may have for scm muscle pain if a sore sternocleidomastoid muscle doesn't get better.
- Press just enough that you can recreate the headaches (like in a trapezius headache), or begin to feel some tenderness. Then hold that position for a few seconds until you start to feel that the trapezius muscle headache pain is going away. Then you can gradually apply more pressure. If you take it slow and easy, you’re going to get results much faster. It may take longer, but things like sternocleidomastoid syndrome symptoms will eventually go away with doing less and overcoming the temptation to be aggressive with your sternocleidomastoid muscle pain treatment.
- Don’t over treat the muscle knot either. Using scm muscle treatment as an example, we tend to find one spot and then spend all our time treating that one spot. If you have five minutes to treat your loose or tight sternocleidomastoid symptoms, its much better to spend 30 seconds on each of 10 trigger points than it is to spend 10 minutes on one. You’ll most likely have several trigger points that need attention and again, won't have the risk of developing a sore sternocleidomastoid muscle.
- Don’t’ expect to feel a ‘knot’. Most muscles, like muscle behind the ear, may not have a so called ‘knot’ in it. Some of the most relaxed muscles can be the most painful. Base your decision to target a trigger point on whether there is tenderness in the area and whether you are actually recreating the headaches you set out to treat. If a knot at base of skull is tender but doesn't recreate a headache, then move on to other areas.
- You may need to treat more than once a day. Most of muscle pain appears over time. So don’t expect to get rid of the pain in one treatment (besides, you'll need to do other things, like exercises for sternocleidomastoid muscles). You may need to treat the area 5 to 6 times a day. Not all, but some. Over time, as the headaches from such things as sternocleidomastoid muscle problems get better, you can gradually reduce the amount of times you treat the pain in sternocleidomastoid spots.
- Be careful of other structures while you’re treating trigger points. The front of the neck has arteries and nerves running along side the muscles, and can mimic scm syndrome symptoms. If you feel a pulse, move away. It’s highly unlikely you will damage anything but it’s just a precaution to be careful. If you feel tingling going down your arm, you may be hitting a nerve. Again, move away from that area until you longer feel that tingling. (remember the bizarre symptoms you can get with this muscle, like scm muscle and tinnitus, which is ringing in the ears)!
Best Neck Stretches For Headaches
Most of my patients are surprised when we talk about stretching and strengthening exercises for headaches, especially for occipital trigger point or headache behind ears and temples. They wonder how they’re going to be able to stretch their suboccipital muscle in the back of the head! As you can, there are many different muscles that can lead to headaches, including scm pain.
So we’re going to look at different stretches for tension headaches. Notably for the back and front of the neck (suboccipital and sternocleidomastoid treatment being the most common).
The following video shows you how to do our multi angle neck stretch so that you can get all the muscles involved:
If you found trigger points in the front of the neck that are causing your tension headaches, check out this short video. Although the stretch is for the scalene muscle, you're also going to be doing sternocleidomastoid pain treatment in some of the angles. The key is to stretch in multiple angles:
NOTE: I've often been asked whether the stretching will aggravate a trigger point, or if it will 'inflame' it. Actually you aren't getting any inflammation. There is no such thing as an scm tendonitis.
The key is to start with only one stretch and work on that. If most of your trigger points are from the back of the neck (example: trigger point base of skull), you want to start with multi angle stretch. If you find trigger points in the front of the neck (like scm neck muscle), then start with that.
However, here’s a simple chin tuck exercise that you can do to target both the muscles in the back, and front, of the head. Some may feel the stretch in the front, while others will feel it in the back of the head. It works really well for some of the sternocleidomastoid pain causes.
If you don't feel anything, be patient and keep trying. It takes a few times to learn how to do it properly. Again be careful not to over do it and cause a sternocleidomastoid muscle spasm from the scm syndrome:
Best Strengthening Exercises For Headaches
Your trigger point migraine or tension headache symptoms can come from a wide variety of sources, the most common from sitting slouched over at your desk all day. (Sitting with head done and rotated to the side for along time can cause sternocleidomastoid muscle pain)
Once you begin to feel better after self treatments (treating spots on back of neck) and stretching (making sure not to overdo, causing a sternocleidomastoid muscle strain), you’re going to want to strengthen up your muscles so you can remain headache free.
The following videos take you through the different strengthening exercises you can do for headaches and neck pain, including the suboccipitals, scalenes and sterno cleido mastoid muscles.
Just remember, you don’t’ have to do all of them at once. Muscular migraine type of symptoms can increase if you try to overdo it in the beginning. I’ve outlined the proper progression to treat myofascial headache in the video.
How To Prevent Tension Headaches
By now, you know that aggressive treatments like trigger point injections for neck pain are not required. Most of the headaches can be due, fully or partly, to muscle trigger points in the jaw, head, upper shoulders, front (example: scm strain) and back of the neck.
There are many different things you can do to help prevent headaches, even before starting off with any self treatments (like trigger point release neck), stretching or strengthening program. I usually start with these first before doing any neck trigger point release. Sometimes the most simplest thing can work, rather than spending time looking at complicated trigger point chart pdf files!
Here is a list of things that you can do today to relieve back of the head, muscle tension headaches. See something that best describes you? Then make those changes today and you may be pleasantly surprised in seeing improvements in your trigger point headaches:
- If you have jaw tenderness causing headaches, avoid chewing gum or breathing through your mouth.
- Avoid forward head posture positions, like sitting at a work desk or driving your car. Check to see if your driver’s car seat’s headrest is too far forward. This forward head posture puts certain muscles into a chronic tension, leading to trigger points.
- Avoid reading a book where your head is slightly rotated to one side. This often happens when someone is reading in bed and turning the book towards one of the lamp lights. You can easily buy a book light, which will allow you to read facing forward. This position often leads to sternocleidomastoid symptoms.
- If you’re finding yourself using a phone a lot, resting between your ear and shoulder, get a phone headset instead. This keeps your head in the neutral position. Otherwise, muscles on one side of the neck will stay in a state of contraction, leading to the formation of a trigger point, back of head or front.
- If you find yourself working long periods where you’re looking at material to the side and on a table, you need to bring it to the middle. If you have a computer, you can attach the paperwork next to the computer so you don’t have your head turned for long periods of time.
- Avoid having your head turned to one side when talking to someone next to you. Doing this over the long term will lead to muscle knots in the neck muscles, creating tension headaches (not to mention turning the back and getting trigger points for lower back pain)! Changing this simple position has led to significant relief in a lot of my patients, in addition to adding some scalene or sternocleidomastoid exercises. The key is to make simple changes. Your body will thank you!