chronic headache pain myofascial treatment trigger point therapy

As a myofascial therapist, I know that chronic headache pain is routinely listed as the second most common chronic pain complaint after back pain. If we grouped it with neck and shoulder pain, it would certainly be #1.

However, I want to focus on classic headache pain. After all, it is a complicated topic on its own, so we will have our hands full.

This is an introduction to chronic headache pain and myofascial therapy approaches to treating it.

They have been around the block, so to speak, and have often endured a variety of treatments. Unfortunately, many of these are not effective.

In addition, many people are motivated to reduce or eliminate the medications that are almost inevitable. Whether you regularly take Excedrin when a headache crops up or are taking poweful drugs for migraines and other severe headaches, you may want to stop that medication. Of course, we know that we need to attempt that gradually.

In addition, many people are motivated to reduce or eliminate the medications that are almost inevitable. Whether you regularly take Excedrin when a headache crops up or are taking poweful drugs for migraines and other severe headaches, you may also want to stop that medication. Of course, we know that we need to consult our physician and reduce medications gradually.

Causes of Chronic Headaches

Most sufferers have had a variety of tests searching for a causative diagnosis. We are sorting out options for chronic headache pain myofascial treatment. Therefore, we assume that most of these alternative diagnoses have been eliminated. For instance, we assume that you do not currently have a brain tumor, a slow-bleeding sub-dural hematoma, Chiari malformation, etc.

All of these medical diagnoses for headache, and more, require proper evaluation and treatment by an appropriate MD or OD.

Myofascial Therapy Can Be Very Helpful

However, even in these cases, myofascial pain can be part of the picture. Complete resolution may require myofascial therapy to fully resolve chronic headache pain.

Finally, if we assume you are suffering from a true migraine, cluster headache, or certain other types, you are probably being treated with medication and/or other means.

Yes, we all hope you can move past those treatments. However, this may take some time. At first, we like to think of chronic headache pain myofascial therapy as another important tool in your kit to manage chronic headaches!

chronic headache pain myofascial treatment trigger point therapy

Myofascial Aspects of Chronic Headache Pain

chronic headache pain myofascial treatment trigger point therapy

Is This You?

Unfortunately, you have classic, one-sided migraine without aura. Yours is triggered by MSG and certain scents. Light is intolerable and no OTC medication is effective. Your hand on the same side is typically cold.

Myofascial treatment is an important aspect of comprehensive migraine treatment.

Subsequently, you have had a series of tests that don’t reveal too much. However, your doctor thinks that there may be a problem with blood vessels in your brain. She prescribed some medication to help, but you can only take it a few times a month.

In addition, you received some nifty bio-feedback training. In learning how to warm your hands, your migraines relent. Of course, you also avoid your triggers, like MSG and perfumes.

Fortunately, you are much improved, but not completely better. Why?

Myofascial pain can be one of the peripheral system stimulants that causes a fully developed migraine. Release some of these muscles is helpful.

In addition, some of these muscular problems can restrict venous return from the brain and cause it to back up. In turn, blood pressure within the vessels in the brain can increase. Some of these can also interfere with blood supply to your arm, making your hand colder.

Addressing muscle imbalance issues is necessary to eliminate a key myofascial perpetuating factor.

Maybe with chronic headache pain – myofascial treatment of these muscles will also help!
chronic headache pain myofascial treatment trigger point therapy

Tension headache is a broad term that can include some forms of cervicogenic headache (originating in your neck) and other types related to stress, posture, exertion, etc. Most tension headaches have significant myofascial components.

Is This You?

You have dull, aching head pain. It still feels pretty severe to you. It feels like there is a band around your head. Sometime it is tight across your forehead. However, sometimes you feel it along the sides and back of your head. In addition, your scalp, neck and shoulder muscles are usually tender when you have a headache.

Many of the common pain patterns of tension headache match almost precisely some common myofascial referral patterns in the head.

Episodic tension headaches

Your husband gets tension headaches too, but they only last an hour or two. Maybe even a couple of days if it is really bad. But he doesn’t get them that often. Your headaches started that way,¬† but then they became chronic. But your husband just takes some OTC meds if he needs to, once and a while, and he’s fine.

Chronic tension headaches

However, your headaches last longer. Sometimes, it seems like they never go away! You have then at least half the time and its been going on this way for many months.

Your friend who has migraines says she thinks you have migraines too. Your symptoms are kind of similar. Sometimes, you wonder if you have both kinds of headaches. Some people can have both!

But unlike your friend, you don’t have visual disturbances, nausea or vomiting when you have a tension headache. Physical activity makes your friend’s migraine worse. But your tension headache pain don’t seem to be affected by your workouts. Sometimes you are sensitive to bright light and loud sounds but nothing like your friend! It’s like she has a bad hangover on migraine days…

chronic headache pain myofascial treatment trigger point therapy

Cervicogenic headache it is accompanied by neck pain and stiffness. Also, certain neck movements can provoke cervicogenic headaches. According to the NIH headache classification this is the third, discrete primary headache type after migraine and tension headache.1

Is This You?

However, sometimes you feel it one side of your head. Often, it settles right behind one eye.. In addition, you have have:

  • pain and stiffness of the neck
  • pain around the eyes
  • sensitivity to light and noise
  • nausea
  • blurred vision

That sounds quite a bit like a migraine or a tension headache! Except that, cervicogenic headaches usually include these symptoms too:

  • Reduced range of motion in the neck
  • Pain in the neck, shoulder, or arm on one side
  • Head pain that is triggered by certain neck movements or positions
Many of the common pain patterns of cervicogenic headache match almost precisely some common myofascial referral patterns in the head.
chronic headache pain myofascial therapy trigger point

Is This You?

You happen to be a male in your your 40’s, you still smoke more than you’d like to admit and drink socially. Your buddy told you that one of those ED drugs has really enhanced things with his partner and he gave you a couple. You figured, “Why not?” and gave it a try.

Cluster Headaches Often Start Suddenly

THEN, you got one of those horrible headaches again! You’ve had cluster headaches before – literally clusters of headaches that last for for weeks, sometimes even a month! The last time was over a year ago but based on experience you know what you are in for. Your sister gets them sometimes too.

Excruciating pain usually starts in, behind or around one of your eyes, but then radiates to other areas of your face, head and neck. Your eye is watering and with a droopy eyelid. Just like last time!

Traditional Treatment For Cluster Headaches

You’ve been given some prescription nasal sprays but your’re not sure about them. One time you had to go the the ER and got some IV triptan medication that worked.

Your doctor also prescribed some steroids and even lithium as a preventative. But, it has been such a long time you haven’t taken anything in months.

Myofascial Treatment Options

Eventually, these awful headaches will pass. However, in the meantime, are there any muscles that contribute to this pain? Do any of the headache referral patterns look familiar?

Maybe treating some of these muscles will also help!

The SCM and upper trapezius referral patterns look a lot like cluster headache pain.

If you have a TMJ Headache – Myofascial Pain should be on your radar! Problems with the Temporo-Mandibular Joint (TMJ) cause pain in the face and head. In addition, TMJ disorders (TMJD) can cause myofascial problems AND myofascial dysfunction can cause TMJ pain, reinforcing each other.

Sometimes, TMJ headache – myofascial pain also feeds tension and migraine headaches.

The pterygoid referral patterns are closely related to TMJ headache pain.
chronic headache pain myofascial treatment trigger point therapy

For instance, sinus headaches are typically related to sinus infections. Chronic sinus infections should be treated first. Subsequently, if myofascial problems remain, they can be treated next.

Headaches due to trauma present a different challenge. An acute condition can quickly become chronic. Treatment of headache associated with whiplash is topic in its own right.

Similarly, treatment of traumatic brain injury (TBI) is often a multi-disciplinary process. Myofascial therapy can be a part of that treatment but does not address TBI directly.

In Central Sensitivity Syndrome, the nervous system begins to wind-up. It gets set to persistent state of high sensitivity/reactivity. Then, this persistent sensitivity lowers your threshold for what causes pain. Subsequently, your nervous system maintains this pain even after the cause is gone.


Allodynia occurs when you experience pain from things that are normally not painful. For example, simple touch or pressure become painful. Nerves in the area that was touched sends signals to your brain. But, your nervous system is in a heightened state. So, your brain doesn’t produce a mild sensation of touch as it should. Instead, it produces a sensation of pain and discomfort.


Hyperalgesia occurs when something that typically painful is more painful than it should be. For example, a simple bump would ordinarily be mildly painful. However, if you are a chronic pain patient it might send your through the roof. Again, your nervous system is more sensitive. Of course, it produces pain that is amplified.

Other Symptoms of Central Sensitization

Central sensitivity has other characteristics. They occur less often.  For example, it can lead to heightened sensitivities across all your senses.

For instance, some chronic pain patients report sensitivities to light, sounds and odors. Normal levels of light can seem too bright. Perfume can produce a headache…

In addition, central sensitivity is associated with cognitive deficits. For instance, this includes poor concentration and poor short-term memory. Also, it corresponds with increased levels of emotional distress, particularly anxiety. After all, the nervous system isn’t just responsible for sensations, like pain. In addition, it produces our emotions.

Central sensitivity can occur with chronic low back pain, chronic neck pain, whiplash injuries, headaches and other conditions.

Fortunately, for Chronic Pain – Myofascial Trigger Point Therapy helps break the cycle of central sensitivity…

Chronic Headache and Myofascial Therapy

chronic headache pain - trigger point referral

First stop to consider where your own pain is. We will usually have you draw it. Pay more attention to the location and how it radiates than how good your art skills are. Knowing the location accurately is important. You might need someone else to look at where you say it hurts other than where you draw it. We often have especially poor visualization of where our our pain is on the back side of the torso.

Where Does The Pain Refer?

Next, we take a look at referral patterns for that part of the body. These usually show an outline of the muscle with a referral pattern, typically in red, spread over that muscle and extending around it.

Sometimes, there is more than one referral pattern that seems to match your pain. In that case, we’re going to need to look more closely at some other aspects of these muscles.

The manual compressions of trigger point therapy are not simply deep tissue massage. A well trained trigger point therapist knows exactly where the trigger points for these muscles are supposed to be. We also know that there are lots of variations and we know how to feel the difference. Finally, the actual technique that we use to apply trigger point pressure release is not as simple as pushing hard on a given spot. We work into it gradually and more deeply than traditional massage therapy does.

Why Do We Focus on Manual Pressure Release?

There are other ways to treat trigger points, but manual pressure release has been documented to be as effective as dry needling and more effective than cupping and most other techniques. It is completely non-invasive and safe when practiced by a skilled therapist.

Fascial Stretching

Fascial stretching is a gentle technique for balancing the length of connective tissues by working together with you to gradually move connective tissues. We can’t actually make significant changes to your connective tissue with just our hands.

If we could easily deform fascia, the clients of poorly trained therapists would leave looking like slightly squished clay models. The real changes in fascial stretch therapy come from the guided way that your own muscles affect your connective tissue.

Active/Passive Release and Activation Techniques

In addition, we use a variety of techniques that are similar to what you may see referred to as reciprocal inhibition, positional isometric release, active release and strain-counterstrain. There some similarities between all of them. However, there are important differences that help decide which is the best technique to use.

Vigorous stretching of your neck can cause problems.

In myofascial treatment, we usually passively run the muscles we’re working on through their full pain free range of motion. So, that means that you don’t use the muscle to move it. Either someone does it for you or you use props to minimize active use of the muscle. However, we don’t just gently stretch it. Importantly this means we also shorten the muscle.

We Only Engage In Limited, Gentle Stretching Of The Neck

There are some gentle stretches for key neck muscles that I might recommend in some cases. However, because of the delicacy of these muscles, you can easily overdo it and make things worse.

For instance, the sternocleidomastoid (SCM) stretch pictured should be done very gently and only after releasing the muscle. .

In fact, we are quite am conservative about this and more likely to recommend stretches for the chest, upper back and arms than neck stretches for most headache sufferers.

Janda's Upper Crossed Syndrome causes elevated, rounded shoulders, poor posture and pain the upper back and neck

Upper Crossed Syndrome

For many headache sufferers, the myofascial issues are part of a larger pattern of imbalance such as Upper Crossed Syndrome. Re-establishing balance between the postural muscles of the upper back, neck and shoulder is essential.

This means that deeper stretching is probably going to be limited to our chest and our upper traps/levator scapula.

Meanwhile, we might try to strengthen the deeper muscles in the front of our neck and our lower traps.

strengthening cervical flexors reduces pain