It’s not always in your head: Headaches and tension-related head pain

Jesse Albert 2015

By: Jesse Albert
Jesse is a registered massage therapist at Body Poets who knows a thing or two about what it is like to find relief from headaches caused by trigger point activity. With an interest in trigger point therapy, Jesse has been able to cultivate further knowledge and experience in how trigger points behave and how they relate to head pain and tension.

Headaches. We’ve all experienced at least one in our lifetime, in one form or another. Most resolve themselves over time or with your standard over-the-counter medication and a big glass of water but sometimes, they require a little more effort to be rid of them.

Sometimes headaches can be so distracting and bothersome that nothing seems to help. In this case, you might be suffering from tension-related head pain, commonly known as tension headache. Tension headache can be caused by many factors or a combination of issues.

Dehydration, sleep deprivation, hunger, posture, or myofascial trigger points can all contribute to tension headache.

Headache photo

Myofascial (meaning they involve both muscle and fascia) trigger points are a common issue that massage therapists see on an almost daily basis. Trigger points are hyper-irritable areas, which, when pressed, cause a referral of pain or sensation to other areas of the body. In the case of tension headache, trigger points can radiate pain to the front of the head, the temples, the top of the head, and even behind the eyes. Through the use of multiple techniques by your RMT, including myofascial release, you will surely find relief from your tension headaches, sometimes in as little as one treatment.

Trigger points are typically caused by:

•    Unresolved physical trauma to a muscle
•    Muscular overuse or underuse
•    Chronic straining of a muscle

Since the head and neck are home to a plethora of muscles that aid in posture and movement, it is without wonder that tension related head pain is so common, especially among office employees who may spend hours daily at a computer. Of the many muscles in the head and neck, there are a few repeat offenders for trigger points and tension headache, such as:

  1. Trapezius
  2. Sternocleidomastoid (SCM)
  3. Splenius capitis and splenius cervicis
  4. Occipital group

1. Trapezius

The trapezius muscle of the back and neck, having three sections (upper, mid, lower) is mostly responsible for, but not limited to, neck extension, shoulder blade retraction, and shoulder blade rotations. More specifically, the upper portion of the trapezius muscle is where tension headaches typically occur. The images below show the trapezius group and a classic upper trapezius referral pattern, often called a “question mark” pattern.

(Hover over images for captions)

2. Sternocleidomastoid

The sternocleidomastoid (SCM) from the ear to the front of the neck aids in neck flexion, extension of the skull, and neck and head rotational movement. Its trigger points (the black Xs) cause pain in several areas of the jaw, face, and head.


‘X’s show common trigger points in SCM, while the red areas are typical pain referral patterns

3. Splenius capitis and splenius cervicis

Splenius capitis (“head”) and splenius cervicis (“neck”) at the back help extend the neck and skull; and when only one side of the muscle is activated, it can assist in lateral neck and skull movements. Its typical pain patterns include the top of the head, the eye, and where the neck joins the shoulder.


4. Occipital group

Finally, the occipital group of muscles is responsible for stabilizing the skull on the spine, holding it in place when we nod, peer forward at a computer screen, tablet, or phone, drive, or walk down the street. A pain across the temples is common for this group.

ottawa massage blog suboccipital-group trp

It is also this group that I find to be the most troublesome for tension-related headaches. Because of their close proximity to the greater occipital nerve, tightened occipital muscles can create tension involving this nerve, causing a pulling sensation from the back of the head to above or even behind the eye. This tension on the nerve can cause a very uncomfortable full scalp headache, eye pain, and difficulty with vision.

Because this group of muscles causes such diffuse head pain, it is difficult for the sufferer to pin point exactly where the pain is coming from, which makes massage therapy, with its muscle-and-tissue-based approach, very helpful for treating headaches caused by tension within the occipital group of muscles.

Registered massage therapists have extensive training in trigger point therapy and how trigger points operate. Having the ability to tune in to the finer details of trigger point referral patterns, we can thoroughly and successfully treat trigger points and the symptoms that follow them, especially with regards to headaches and head pain.

Although massage therapy is quite beneficial for all sort of physical ailments, it is important to practice good posture, good eating, and a balanced lifestyle not only to help prevent tension headaches, but to maintain an overall state of well-being. Having experienced my own forms of headaches caused by trigger points, I feel I have a personal understanding of what some of my clients are dealing with, which has led me to start providing headache-focused treatments with very positive outcomes.


Read some of our other posts on these topics:

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