Headache? It’s Not All In Your Head!

By

George Pellegrino, LMT, CMTPT and Victoria L. Magown, CMTPT, LMT

Early in December, Stacey slipped on a wet floor while carrying four heavy rubber mats over her left shoulder.  As she went down, she hit her left elbow and shoulder, as well as her left hip.  As a consequence, she was out of work during the holidays.  This really put a strain on her budget. 

When she came in for treatment, she was suffering with left shoulder pain and headaches.  After we reviewed Stacey’s history and performed Range Of Motion Tests, we were able to determine which muscles were involved.

The impact injured the upper trapezius muscle, laying down trigger points that referred pain up into her head. (Illustration A)  A Trigger Point is a hypersensitive spot in a muscle that when stimulated, produces pain that is referred in a predictable pattern usually away from the Trigger Point.

  Since Stacy came to MyoRehab within two weeks of her injury, treatment time was substantially reduced.  When an injury is still acute, muscles have not had time to develop patterns of bracing and splinting, which can lead to postural distortions the body uses to “accommodate”, or “mask” pain.

  Inactivating Trigger Points in the trapezius muscle relieved the headaches within two treatments.  Once her headaches were resolved, successful treatment of her shoulder soon followed.

During treatment, Stacey was given a specific Home Exercise Program for her neck, shoulders and upper back.  It didn’t take long to get Stacey back to work, pain free.

Robert, a truck driver, was involved in a motor vehicle accident causing a whiplash injury to his neck.  He came in with severe headaches reminiscent of migraines he used to get in his late teens.

He felt his migraines were returning and feared he would have to resume self-administered injections of Imitrex for relief.  As a result of the whiplash, the sternocleidomastoid muscle (pronounced ster-no-cly-do-mast-oid - Illustration B) that checkreins excessive backward movement of the head was injured.

His neck and head pain was consistent with Trigger Points in the sternocleidomastoid.  Trigger Points in this muscle can produce tearing of the eyes, runny nose, nausea, dizziness, loss of balance, and blurring and dimming vision, similar to migraine headaches.

After a course of treatment for his upper back and neck muscles, Robert no longer had headaches and neck pain.  He was delighted that his Home Exercise Program kept him pain free and he didn’t have to use a drug to accomplish this.

Injuries to neck muscles that can cause headaches are not always the result of trauma.  Inappropriate head positioning, such as working at a desk with the head turned to one side and projected forward to see documents or a computer monitor can activate the splenius cervicis muscle (Illustration C).

In addition, falling asleep with the head and neck bent in a crooked position, as with the head on the armrest of a sofa or sleeping on an airplane can activate Trigger Points in this muscle.

Active Trigger Points in the splenius cervicis will refer a diffuse pain through the inside of the head that focuses strongly behind the eye and sometimes to the back of the head.  Some people experience numbness in the back of the head with or without pain.  Trigger Points in the upper part of this muscle may cause blurred vision.  These symptoms often resolve immediately and completely with treatment.

Treatment also includes identifying and eliminating perpetuating factors such as reviewing correct posture, workstation ergonomics, sleeping positions and body mechanics.  Modifications are made when necessary.  Sometimes, relieving head pain can be as simple as teaching someone how to properly adjust their car seat.

Have a headache?  It may not be “all in your head”. Give us a call at MyoRehab.