Chronic Tension Headache – TriggerPoint Therapists understand!
So, if you have recurring headaches that just don’t go away – myofascial therapy can probably help! For more information on headaches in general, please see this intro.
Symptoms of tension headaches include dull pain, tightness, or pressure around your forehead. Sometimes, it happens on the back of your head and neck.
For instance, you may think it feels like a clamp squeezing your skull. Instead, some describe pain in the temples or around the ears.
Often, they are called stress headaches. They’re the most common type for adults.
Types of Tension Headache
Many people have tension headaches from time to time. We refer to those as Episodic tension headaches.
Of course, some Episodic tension headaches recur over time. However, an additional mechanism turns episodic headaches into chronic headaches.
Usually, the episodic kind starts gradually. Often, this happens in the middle of the day.
However, chronic tension headaches come and go over time. Sometimes there is no relief.3
For treatment of tension headache pain – trigger point therapy can be a powerful tool for relief.
Chronic Tension Headache Characteristics
When you get a tension-type headache you probably describe your pain as a constant pressure. In fact, you may feel as if your head were being squeezed in a vice. Usually, your pain is on both sides of your head at the same time.
Sometimes your headaches are milder but on some days it is really severe. Also, you get some tenderness in your scalp during an attack.
Lately, you’ve been keeping a headache diary and you noted these things:
- Your headaches can be less than an hour or last up to a week.
- Also, your headaches are not aggravated by routine physical activity such as walking or climbing stairs.
- Sometimes, you get nauseated and sometimes you’re sensitive to light. Usually not at the same time.6
Official classification of headache types, duration and frequency has been done.7They say that:
- Episodic tension headaches happen less than 15 days per month.
- Chronic tension headaches happen more than 15 days a month.
We prefer to think of these as broad categories. Apparently, your 10 days a month of headaches might not qualify as “chronic”! However, we’ll bet they feel pretty chronic to you.
As we will see, the difference between episodic and chronic is not a sharp line. In fact, it has more to do with the development of central sensitization. The precise number of days a week or month you have headaches is less important.
Basically, chronic tension headaches occur frequently over a long of time. Unfortunately, for some, it’s almost always there.8
OTC pain medication can be effective for the treatment of tension headache that is not chronic. Tricyclic antidepressants appear to be useful for prevention of chronic tension-type headaches. However, the evidence is poor for SSRIs, propranolol and muscle relaxants.
Frequent use of pain medications for tension-type headache can cause medication overuse headache or rebound headache.
Chronic Tension Headache – TriggerPoint Therapy
We focus on history, lifestyle, pain patterns and other symptoms to sort out your myofascial pain. There is a myofascial component to many types of headaches.
Notably, myofascial pain is not caused by contracted or ‘tense’ muscles. They have no electrical activity.
Chronic Headache – Myofascial TriggerPoint Referral Patterns
We can clearly see how referral patterns of head and neck muscles evoke the pain patterns of migraines, tension headaches, cervicogenic headaches. They even overlay the symptoms of cluster headaches and TMJ headache pain. Some of the factors that activate those muscles may not covered by doctors. Those activation factors are things we care a lot about.
Myofascial activations are a part of most headache patterns!
Sometimes, when people are in chronic pain, medical history reveals problems with body mechanics. Body mechanics includes all the various ways that hold ourselves and move as we do things. Sometime is it how we hold ourselves when we are NOT doing things, like sitting.
When ever we are making repetitive movements, we should be mind of using proper body mechanics. This will help minimize repetitive stress injuries and myofascial activations. For instance, lifting in a stooped posture and then twisting is always ill-advised. Doing it repetitively is worse. Therefore, if this type of lifting is required, we should rethink the task and try to organize it in a way that reduces stooping and twisting.
However, even simple movements matter. For instance, what if your desk is arranged phone on the wrong side. In fact, with every call, you have to twist your head and neck and reach over with your arm to the wrong side of the desk This is poor body mechanics. Fixing it might be as simple as moving the phone.
It pays to think about basic body mechanics in this common sense way each time we engage in a repetitive activity. Fortunately, we’re starting to teach this important skill to young people, as in this student guide at University of Michigan.
We can experience chronic overload when we do things like wear high heels, carry a heavy bag or lean into our work.
However, acute overload happens when we decide to lift, push, pull or otherwise move something that is too heavy for us. Most often, we overload our muacles with an eccentric contraction.
For example, lifting a heavy box, correctly using your legs instead of your back, requires concentric contractions of your quads. However, setting that same heavy box down, slowly and with control, require eccentric, lengthening contractions. These should be done carefully.
Of course, if you have a diagnosis from your doctor, we need to know. If you have recent imaging or other test results, even better!
We’ve all been knocked around a bit. We’d like to know everything you can think of about prior accidents, injuries, surgeries and other treatments.
It is important to know about previous or current medical conditions that could impact our treatment. Anything from high blood pressure to TMJD to disc problems are vital information.
Hopefully, medications align with your diagnosis. Sometimes, certain medications will also modify our reatment options. Some drugs interfere with nutrient absorbtion.
Increasingly, supplement use is common. Typically, we’re on the look out to make sure you whether you taking certain supplements.
Chronic Tension Headache – TriggerPoint Referrals Overlap
Surprisingly, There are several common patterns that are similar to the pain patterns of chronic tension headaches. For example, the patterns of the SCM, upper trapezius and temporalis muscles all refer pain strongly to the side of the head and the area above and behind the eyes.
In addition, trigger points in some of these muscles can also cause nausea, blurred vision, vertigo, sensitivity to light and other hearing and visual disturbances. Sound familiar?
First, take a moment to consider where your own pain is during a tension headache. We will usually have you draw it. Pay attention to the location and how it radiates.
Next, we take a look at referral patterns for that part of the body.
Sometimes, there is more than one referral pattern that seems to match your pain.
Myofascial referrals may explain most of your pain pattern!
From the outset, education is important. It is our job as therapists to educate you about our assessment and our process. Then, throughout our treatment, we continue this education process.
Myofascial treatment can get at some aspects of cluster headache pain that you might not have thought of!
Unfortunately, sleep posture and sleep disturbances contribute to many myofascial pain syndromes. However, this is especially important for relief from chronic headaches. Because of this, we always have a thorough discussion about how you sleep during an initial assessment.
Diaphragmatic breathing is at the foundation of myofascial trigger point treatment. But, if you don’t know how to do it, we will teach you. On the other hand, if you already know about it, we will help you deepen the technique.
Of course, the medications and supplements you are taking matter too. Usually, reducing drug consumption is a good thing. However, it should be done gradually and in consultation with your physician.
Keeping a headache diary is an important tool for understanding headaches. Also, it is how we clearly see things that improve our headaches – or not.
Structural variations need to be explored and understood. Once treatment begins, they can be accomodated or corrected in various ways.
It is surprising, but most of us our not taught proper body mechanics. Whether we are at home or at work, we need to learn how to use our body correctly.
Most people are self-conscious about their posture. But, identifying the postural aspects that should be improved is a challenge. Even harder, is understanding how they vary with movement. Ultimately, devising a strategy for improving them is essential.
All of these issues can be successfully addressed!
However, it usually takes more than hands on work to really erase the pain and keep it away.
First, the chances are that we were not your first stop. As a general rule of thumb, the longer you have experienced headaches, the longer it will take to make them go away.
Secondly, there are usually at least some factors that might be part of your headache picture that are out of our scope of practice.
In contrast, if we are treating someone for tennis elbow, we can work on the muscles at play. We can talk with you about some modifications for your game and your lifestyle. Then, we can tell you that if you feel the OTC pain reliever you are taking isn’t needed anymore that you can stop taking it. Finally, we can offer you stretches and other self-care advice that are pretty straightforward
However, if you are suffering from serious headaches, you may have some other more complex factors at play. Often, you may be working with other providers on vascular (blood vessel), neurological, psychological and other issues. You may be taking prescription medications that you should discuss with your doctor.
Chronic headache treatment is often inter-disciplinary.
Myofascial tigger point therapy – it’s how you work this!
Education is the first step in the myofascial treatment protocol.
Sometimes, we may not be good enough at explaining how myofascial pain works and how it activates your headaches.
However, we believe that people can make more progress when they know more about their condition. So, we try to understand what your learning style is give you as much information as you want – but hopefully not too much!
Typically, we performing series of miniature cycles of test/assess, treat and test/assess again. It is an informed exploration for both of us.
We have an initial assessment from your history, postural and range of motion exams, etc. Then, we use various treatment techniques before testing and assessing again.
Manual Therapy Techniques
First, we specifically expertly use manual pressure release therapy, neuromuscular techniques, and deep stroking, friction, skin rolling. When indicated, we also use fascial stretching. Sometimes, we use less common techniques like cupping, spray and stretch and acoustic compression.
In addition, we may also use active and passive muscle activation techniques. This includes reciprocal inhibition, postisometric relaxation, contract/relax, strain/counter-strain and muscle energy techniques. Sometimes, we also use hot/cold therapy.
Range of Motion/Testing
Finally, routinely run the muscle we are treating through its entire, pain-free range of motion. This is part of your treatment. However, it also the start of a new test/assess cycle.
We learn together whether your range of motion has increased and whether your pain is reduced. We may have you get up and use your body in the way that causes pain to ‘test’ more dynamically.
As we finish our hand-on work, we transition into learning new movement strategies and self-care.
Myofascial tigger point therapy – it’s how you work this!
For general myofascial wellness, a quiet, regular self-inspection of our own bodies will often tell us where trouble lies. In addition, it will also give us the opportunity to address problem areas.
For example, in Tai Chi, we go through a slow, controlled series of movements. However, we are not trying to stretch or strengthen anything. Rather, we are re-calibrating our nervous system and our myofascial system with each other. Instead, it is basically a form of movement or neuromuscular therapy.
However, during these gentle movements, we may notice variations in our range of motion. In fact, limited range of motion is a symptom of an unhappy muscle. Plus, we may experience pain. That is also a symptom of an unhappy muscle.
In activities like the Yamana rolling ball technique, we also go through series of movements. However, as we move, we are rolling over muscles that may be sore. So, we also have the opportunity to treat them with manual compression.
Cluster Headache – Myofascial TriggerPoint Compression
First, the most basic self-care tool is the tennis ball. Actually, we suggest using two tennis balls in a sock. Also, the sock gives you a “handle” so you don’t drop the ball. Finally, two balls will give you more options and control.
Sometimes, we use fitness balls, large foam rollers or handheld rollers such as the Tiger Tail for self-compression.
However, awesome tools like the Backknobber can be used sitting, standing or lying down. Happily, it allows you to target specific areas in each muscle you want to work with. In fact, the leverage of the tool and pinning it between your body and floor allows access to quite a number of back and neck muscles. In addition, this approach can also be used with some large chairs, recliners and couches when sitting.
There are other approaches to passive self-compression for muscles of the head.
Myofascial self-care helps reduce the frequency and severity of migraines!
Chronic Tension Headache – TriggerPoint Self-Care Stretches
Typically, certain muscles tend to be tight in most chronic headache patients. Your therapist will give you specific advice about muscles that you should stretch.
However, most of us need to stretch our pecs, SCM, upper traps and levator scapula. After self-compression, these muscles can be stretched gently and effectively. You may also benefit from stretches of certain muscles on the back of your neck. Unfortunately, most of these muscles are over-stretched by head forward posture anyway. Your therapist can help you target specific muscles in the back of the neck.
Neck rolls and other vigorous neck stretches are always a bad idea.
It is the time to explore problems with the muscles of your TMJ more thoroughly. In addition, this is the time to strengthen your deep cervical flexors, serratus anterior, lower traps and other postural muscles.
Myofascial self-care helps reduce the frequency and severity of chronic tension headaches!
Specific Causes Chronic Tension Headache
Chronic Tension Headache Causes
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.