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.

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Irritated Iliopsoas

Muscle of the month: Iliospoas

Psoas-majorDeep inside your abdomen, beneath your abs and beyond your viscera, lies the elusive iliopsoas.

The iliopsoas is actually a combination of two muscles, psoas major and the iliacus muscle. It spans the area of the lower back and the inside of the hip bone, and then crosses the hip joint where it inserts onto the top of the femur. Pain may occur along any area of its length but is noted as a common source of low back and hip pain.

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Holding your head high

Muscle of the Month: Suboccipitals

There are eight tiny muscles that have the huge job of keeping your head up, but they can cause a huge headache too! These are your suboccipital muscles. Resting in the nook at the base of the skull, these muscles are essential to fine head movements and in relaying proprioception of your head (where your head is in space and time) to your brain. When out of balance or strained, these muscles can cause temporal headaches and pain with neck movements.

Suboccipital - ottawa massage blog

Rectus Capitis Posterior Minor

Suboccipital - ottawa massage blog

Rectus Capitis Posterior Major

Actions – 

Rectus Capitis Posterior Major: Rock and tilt head back into extension, rotate head to same side

Rectus Capitis Posterior Minor: Rock and tilt head back into extension

Suboccipital - ottawa massage blog

Oblique Capitis Superios

Suboccipital - ottawa massage blog

Oblique Capitis Inferior

Oblique Capitis Superior: Rock and tilt head back into extension

Oblique Capitis Inferior: Rotate head to same side

Common pain culprit – Eye strain and extended head tilting.

When our eyes are strained, we adjust our head with fine movements to focus better. This puts a strain on the suboccipitals. Also, keeping our head in even a slight tilt for extended periods of time can cause increased strain resulting in pain in the suboccipitals. Having to tilt your head back while driving to avoid the sun streaming into your eyes under your visor, or having a computer screen slightly too low or too high, can keep the head in a tilted position all day. This isn’t an overly strenuous task for the body, but it is for the suboccipitals. Over time they will become strained and headaches can develop.

ottawa massage blog suboccipital-group trpThe fix: Postural adjustments, eye exams, deep trigger point work.

Adjusting your position while at your computer, while driving, even while walking, can help with suboccipital pain. Any time your head is overly tilted (up or down) for an extended period of time, your posture needs to be adjusted.

An eye exam might show the need for a new prescription. Having the proper glasses puts less stress on the eyes and on the suboccipitals! Progressive lenses can contribute to suboccipital strain if you have to tilt your head back for computer work, for example. Ask your optometrist to help you fix this.

Deep trigger point work can target these deep muscles. Remember, “deep” means into deeper layers of tissue; it doesn’t mean the treatment will hurt. Deep work will always be done within your comfort level. As superficial muscles relax, the deeper ones can be more readily accessed, and when we get access to the suboccipitals, we can relieve the trigger points causing headaches.

Strengthening your deep neck flexors, as we saw in this recent post on chin tucks, will help balance the musculature of the front and back of the neck and decrease any tendency you have to tilt your head back.

Ask your RMT for treatment and a self-care program to address any headaches you may be experiencing.

For the love of trigger points

Your beautiful body is connected via many, many different chains and pathways. A disruption in one chain can interrupt a number of paths, and cause pain elsewhere in the body. This is seen often with trigger point referral patterns.

What is a trigger point referral pattern, you ask?

It is probably what is causing your pain. It is a precise pattern of pain elicited by an active trigger point. A trigger point is a hyperirritable palpable spot in a taut band of muscle. In other words: a knot. Referral patterns have been documented by Travell and Simons and your massage therapist know them all too well.

Many of these referral patterns span the body, away from the trigger point site. What does this mean to you? It means that your headache might be caused by your back or neck, your back pain from your glutes, or your carpel tunnel pain from your elbow, shoulder or neck!

Take a look at these common patterns.Glute Medius Trigger Point - Ottawa Massage Blog Subscapularis Trigger Point - Ottawa Massage Blog Upper Trap Trigger Point - Ottawa massage blog

An RMT can help determine where the epicentre of pain is, and provide trigger point therapy for relief. When we get muscular pain, we initially think the massage should focus on the precise area of the pain, but it is important to get other areas addressed to pin-point where the dysfunction is. For your first treatment, it is good to get a general treatment as a preliminary scan of which muscles may be causing the pain; then a few follow-up appointments can be used to focus directly on the source of pain.

Discuss trigger points with your therapist at your next massage treatment.

The Gluteals – a pain in the ……

Muscle of the month: The Gluteals

Gluteals, glutes, buttock, rear-end, hiney; these muscles have been given many names over the years, and I’m sure you can think of a few more!  But (pun intended), did you know you have three gluteal muscles on each side? The gluteals consist of the gluteus maximus, the gluteus medius, and the gluteus minimus. Each has its own specific actions and pain pattern, which helps your massage therapist differentiate which glute is the dysfunctional one.

Gluteus Maximus: The big Kahuna

Gluteus maximus - ottawa massage blog

Gluteus maximus (cut) lies over top of all hip muscles

Actions – Extends, laterally rotates, abducts and adducts the hip (moves leg away from or toward the body)

Common pain culprit – Sitting for an extended period of time (underwork), or conversely, excessive hill or stair climbing (overwork)

The gluteus maximus is the largest of the glute muscles, as you can tell by its name. It covers the whole span of one cheek and plays a big role in the appearance of the buttock. When we sit for long periods of time, the glute slowly atrophies, reducing its ability to contract properly for actions such as ascending stairs.

The fix: Get up often from seat, prevent atrophy by hypertrophy (exercising)!

Squats, lunges, and stair climbing are good examples of exercises that engage the gluteus maximus. If you are unsure whether you are performing them correctly, ask your massage therapist, who can help you make the proper adjustments.

Gluteus Medius: The deltoid of the hip

Actions – Abducts, flexes, medially and laterally rotates, and extends hip

Common pain culprit – Standing on one side more than the other, jutting the hip out

Lateral view of Glutues Medius - Ottawa massage blogThe gluteus medius is similar to the big shoulder muscle, the deltoid. This is because of its position and actions: it covers both the front and the back of the hip joint, allowing it to do every movement of the hip (except for adduction, bringing the leg toward the body). This is the same as what the deltoid does for the shoulder joint. Having the hip too far forward or too far back can put this muscle into a shortened position, compromising its ability to contract fully. This can also happen when you place all your weight onto one hip or have even a slight imbalance of weight.

The fix: Share the weight of the hips, and strengthen the gluteus medius with abduction exercises (bringing the leg away from the body)

Gluteus Minimus: Pseudo sciatica

Actions – Abducts, medially rotates, and flexes the hip

Common pain culprit – Getting in and out of car

Gluteus Minimus Trp Referral - Ottawa Massage BlogThis muscle is the deepest of the glute muscles, and can cause some of the most intense pain. The trigger point referral pattern for the gluteus minimus mimics that of sciatic pain. Many clients fear that they have developed sciatica when it is, luckily, only a flare-up of the glute min trigger point. How can you tell? The sensation you feel normally lets you differentiate between a trigger point and sciatica. Sciatica will be a very sharp, shooting, and almost burning pain. Gluteus minimus trigger point will be a dull, achy pain along the same sciatic pathway down the back of the leg. If the trigger point is activated, getting in and out of the car or other hip actions can aggravate it further.

The fix: Massage, heat and stretch.  The best stretch for glute minimus is the Figure 4 stretch, or pigeon pose (depending on your flexibility). Ask your RMT for guidance.

Stay tuned! Next week: How to stretch piriformis, one of the hip’s lateral rotators.

The Trapezius, part 2 – Super posture!

Monthly Muscle: Trapezius

Trapezius sections - Ottawa massage blogThe middle and inferior traps fill the space from just below the top of the shoulder blades in a V down to the lower third of the back (the red and pink sections in the diagram to the right). Along with the upper traps, which we saw last week, these two muscles help move and support your shoulder blades and spine.

Middle Trapezius: The posture corrector

Actions – Pulls shoulder blades towards spine

Common pain culprit – Slouching; Internally rotated shoulders

If you work at a computer, wear a back pack or workout your pecs too much, you probably have internally rotated shoulders. With internally rotated shoulders, comes weakness in the middle trapezius. This happens because the internal rotation is drawing the shoulder blades farther from the spine, keeping the middle trapezius in a constant stretch position. Pain arises because the muscle no longer has the strength to fully contract back to its original length.

Middle Traps - Ottawa massage blogThe fix? Stretch pecs, strengthen mid traps/rhomboids, correct posture.

Keep checking our blog for great postural exercises. Or, ask your RMT to demonstrate proper strengthening exercises at your next visit.

Lower Trapezius:  Superman muscle

Actions – Depresses and upwardly rotates shoulder blade

Common pain culprit – Holding arms out unsupported (e.g.: driving with hands high on wheel, typing without support of table underneath forearms)

The lower traps are engaged when you hold your arms out in front of you, similar to Superman flying through the air. Holding this position for an extended period of time will result in overuse and strain of the lower traps.

Lower traps - Ottawa massage blog

Even though this muscle is much lower on the back, its pain referral pattern can extend into the neck. This is why it is important to include a back massage when you are coming in for treatment of neck pain. Clearing out the trigger points in the lower traps will help reduce your neck pain and improve postural control.

The fix? Ergonomic assessment of work station, stretch abdominals, strengthen lower traps

The ‘Superman’ position above is one lower trapezius strength exercise. There are many more, from isometric (without movement) to dynamic exercises. Your RMT can suggest options to suit your body and needs.

The Trapezius – that pain in your neck!

Monthly Muscle: Trapezius

The trapezius, often known as the “traps”, is a large muscle that occupies 2/3 of your back.  Divided into three parts, the trapezius muscle has a variety of actions that help move your neck, shoulder blade and spine. This muscle has a tendency to be out of balance due to our typical western posture: hunched over a computer for hours a day. Today we will learn about the upper part of the muscle: what it does, why it hurts, how to help it. Check in soon for the next segment on the middle and lower trapezius!

Trapezius - Ottawa massage blog

Upper Trapezius: That pain in your neck.

Actions – Bends head to side, extends head back, rotates head to opposite side.

Common pain culprit – Head forward posture and hiked-up shoulders.

Neck Pain - Ottawa massage blog

Many clients will exclaim that their shoulders are “hard as rocks”. What you are really feeling are the tensed fibers of the upper trapezius muscle that can’t relax back to their normal resting tension. This is primarily caused by overexerting the fibers. You might also experience neck pain or headaches. The headache is caused by the upper trapezius trigger point, which has a referral pattern that wraps behind and above the ear like a question mark.

The fix? Reduce ‘knots’ and correct postural imbalances

Rolling on a ball, self-massage, chin tucks, neck and shoulder stretches

Ask your therapist on your next visit to show you a postural correction routine tailored for your needs.