Headaches Due to Myofascial Trigger Points by Devin Starlanyl, MD

[Guest guest]

[Moderator's note: myofascial trigger points are

different than fibromyalgia tender points, but often

exist in people with fibromyalgia.]

Headaches Due to Myofascial Trigger Points

Devin Starlanyl, MD

(This information may be freely copied and distributed

only if unaltered, with complete original content.)

There are many possible causes of headache. For people

with the hyper aroused autonomic nervous system of

FMS, sensitivity to noise, cold, heat and light can

add to our headache woes.

Allergies, fatigue, hormonal imbalances, reactive

hypoglycemia, congestion, vasomotor rhinitis, and

neurotransmitter dysregulation can also be factors.

By far, however, the most common cause of headaches is

referred pain from myofascial trigger points (TrPs).

All the before-mentioned factors often activate and/or

perpetuate TrPs. Since TrPs can entrap blood and lymph

vessels as well as nerves, TrP pain is often confused

with neurological, rheumatic, or inflammatory pain,

especially with some of the more bizarre autonomic

symptoms that can occur. TrP headache pain is often

variable, and may change with body position or

muscular activity. It may be so severe at times that

you can't function or even think clearly. TrPs refer

pain

elsewhere in specific patterns, so it is important to

become familiar with the pattern and any possible

accompanying symptoms, as well as the location

of the instigating trigger point. All of these TrPs

are documented in the detailed medical texts

" Myofascial Pain and Dysfunction: The Trigger Point

Manuals " Vol I and II by Janet G. Travell and G.

Simons.

The frontalis muscle is part of the broad

musculo-fibrous layer of the occipito-frontalis

muscle, which stretches across the forehead, top and

back of the skull. The frontalis portion is -- you

guessed it -- in the front. TrPs in the frontalis

muscle remain local, causing pain over the forehead,

often radiating upwards over the scalp. The TrPs will

let themselves be known to you, they aren't shy. When

you press them, they scream at you, " HERE I AM! " You

usually feel like screaming right back at them, " GO

AWAY! " These TrPs are often activated by overwork,

especially in tense people who have a lot of facial

expression.

Occipitalis TrPs cause local pain over the area of the

rest of the skull, but also refer pain to the back of

the head, pain through the skull, and to the back of

the eyeball. You often can feel the lumps and bumps of

the TrPs with your fingers. These may become so severe

that you cannot bear weight of back of your head on a

pillow. TrPs in the head and neck region respond

to moist heat, unless there is nerve entrapment. Then,

ice will help. Massage is beneficial, as well as

CranioSacral Release (CSR) and Spray and Stretch

(S&S), but you also must check for perpetuating

factors such as stress, eye strain and overwork.

Temporalis TrPs occur in a line a little beyond the

outer edge of the eye to just behind the tip of the

ear. Each temporalis TrP refers pain in a different

pattern. The one closest to the eye refers pain over

eyebrow, straight up the side of the head, and the

front upper teeth. TrPs further back along the line to

the ear refer pain to different teeth. The further

back the TrP, the further back the tooth or teeth.

They also refer pain upwards of their position,

causing headache.

TrPs in the extrinsic eye muscles are a frequent

contributor to headaches. For your vision to be clear,

both eyes must take the same picture at the same time,

and all the muscles of each eye must work together in

harmony. A misalignment of the eyes can be caused by

TrPs in any of these muscles. Double vision, blurry

vision and/or changing vision can result if these

muscles are being contracted at different tension. Put

one hand on your head, above your forehead. Then,

keeping your head still, try to look at your hand.

This shouldn't hurt. If it does, the TrPs are calling

to

you, letting you know they're around. Move your eyes

from one upper corner to the other, but do this

gently. This may activate the TrPs and cause a

headache. This does not mean you shouldn't do the

exercise -- it is a

warning letting you know how badly these stretches are

needed. Start slowly, and go gently, but keep at it.

Remember to vary your gaze -- look up and out once in

a while when you are doing close work. Poorly fitting

glasses or improperly corrected vision can contribute

to your headaches. This is especially tiresome if your

vision is changing constantly due to these extrinsic

TrPs. TrPs around the eyes are also likely to be

involved. Get into the habit of doing acupressure work

on your face and neck for brief periods, whenever you

have the time. Check for masseter TrPs along the lower

border of the jaw just after the " corner " . These TrPs,

by no means the only possible ones in the masseter,

refer pain along the eyebrow line, as well as to an

area along the side of the lower jaw, contributing

to headaches. TrPs in the lateral pterygoid muscle are

found about an inch in front of the center of the

outer ear, and about an inch below that. These TrPs

refer pain in front of the ear and pain deep in the

TMJ and

the maxillary sinuses. Both of these, especially the

sinus pain, can add to headache misery. There is a TrP

in the back of the digastric muscle that sometimes

refers pain to the back of the skull. You can find

this TrP right off the corner of the lower jaw,

immediately next to it in the throat. It also radiates

to the upper part of the sternocleidomastoid (SCM) --

which

is an exceedingly complex muscle we'll tackle later.

The spillover pain can be from the front of the throat

under the chin along the line of the jaw,much worse

under the ear, and continuing to extend upward and

backward in a diagonal nearly to the back of the head.

In the neck, as in many other parts of the body, TrPs

can occur in many layers of muscles. The splenius

capitis muscles are wide bands that run from the back

of the skull at the sides to the upper vertebrae. TrPs

here feel like sore areas on either side of the back

of the head, directly under the skull. These TrPs

transmit pain to the top of the head. Splenius

cervicis muscles are thinner muscles connecting

vertebrae. TrPs in the

upper splenius capitis muscles send pain to the back

of the head and diffusely throughout the skull, with

intense pain behind the eyeballs. They can cause

blurring of near vision in the eye on the same side as

the TrP. TrPs in the lower splenius cervicis muscles

are found on either side of the neck below where it

joins the trunk, above the shoulder blades. Referred

pain flows down to the shoulder, collar bone, and

angle of the neck. You may not be able to rotate your

neck due to pain. There are several types of posterior

cervical muscles. A TrP in the semispinalis cervicis,

alongside the spine right below the skull, creates

pain up the back of the head toward the top. A TrP in

the semispinalis capitis muscle just above the base of

the skull, on the back of the side of the head,

creates a

headache like half a headband, with the highest

intensity in the temple and over the eye. If you have

TrPs on both sides, the pain can be incapacitating. A

TrP in between these two other TrPs sends pain up to

the base of the skull. It may also cause neck pain,

spilling over to the top of the collar bone and

upper inward border of the shoulder blade. Posterior

cervical TrPs below the skull can also produce pain in

the hands and feet on both sides, or to the body below

the shoulder on the same side as the TrP. Place your

hand alongside your head, with the heel of your hand

directly under your ear, resting against the square of

your jaw. Your outstretched fingers should be wrapping

diagonally around to the back of your head. Find

suboccipital TrPs on a diagonal line (the higher side

is toward the back of the skull) underyour palm. These

TrPs initiate deep head pain that radiates from the

back of your head to the cavity of your eye. The pain

seems to penetrate inside your skull, because these

muscles are deeply placed, just below the base of

the skull on the side.

Multifidi run along the entire spine. Neck multifidi

are often headache inducers. These muscles are short

and deep, and go from one vertebra to another. Pain is

transmitted in different patterns depending on which

multifidi muscle has TrPs. Activation is usually

caused by prolonged bending of your neck doing close

work, by stooped posture, or by gross trauma. If you

have trigger points in the multifidi of the neck

vertebrae,

pressure from your pillow at night can be intolerable.

In addition to pain, there can be a tingling,

numbness, or burning pain over the back of your head

on the same side as the TrPs. This is an indication

that the TrPs

are causing nerve entrapment. Check to see that your

workstation is ergonomically correct. Don't slump.

Avoid tight hats and headbands, heavy glasses, heavy

overcoats and tight collars. To relieve these

symptoms,

sit backwards in a hot shower while you stretch your

neck muscles downward.

The trapezius muscle may have TrPs in many locations.

There is one spot that sends pain up the same side of

the neck and head, in a hook shape. Follow a line

about an inch behind your ear down the side of your

neck

above the collar bone about halfway to the start of

the shoulder. There is often spillover pain in the

neck region, beneath the ear, and well as underthe

eyebrow. This is a major source of tension headache

and neck aches.There can also be a mild pain at top of

head, lower back teeth and outerear. One or both ears

can burn, turn red, or lose all color as blood vessels

dilate or contract in response to this TrP. The

sternocleidomastoid(SCM) muscle connects to the head,

but separates into two parts. One connects to the

collar bone, and one to the breastbone. TrPs in the

breastbone (sternal) part, in the front, can refer

pain to top or back of head, over the eye. Midlevel

TrPs send pain arching across the cheek and jaw, over

the eyebrow ridge, and deep inside eye, as well as

pain to

the ear on the same side. TrPs in the upper sternal

SCM cause pain behind but not close to the ear, and to

the back of the head. SCM TrPs also affect the eyes

and sinuses, and can cause tearing, reddening or

drooping of eye, as well as inability to raise the

upper eyelid. You may experience visual disturbances.

Patterns from window blinds and escalator treads can

cause an

out-of-control, seizure-like feeling. Stripes, checks

and polka dots can be a problem -- anything with

strongly contrasting light and dark spaces.

You may experience dizziness, runny nose and sinus

congestion on the involved side, as well as ringing in

ear and deafness. TrPs in the collar bone (clavicular)

section cause a frontal headache and earache. Middle

TrPs in this section also cause pain to the front of

the head, which can extend across the forehead to

other side. Anything which hyper extends the neck,

such as sleeping on two pillows, can aggravate these

TrPs. Mechanical stresses such as doing overhead work,

writing on a blackboard, or hanging curtains,

aggravate these TrPs.

For more information and diagrams see " Fibromyalgia

and Chronic Myofascial Pain Syndrome: A Survival

Manual " by Devin J. Starlanyl M.D. and Ellen

Copeland MA,MS. New Harbinger Oakland California USA

Canada .

__________________________________________________

[Guest guest]

Thank you Tina!!

Great information!

I have all these trigger points and almost all the symptoms and headaches.

I find deep tissue massage very helpful. I will try to get Rolfing paid for in

a few weeks.

I had Prolotherapy injections into the Occipitalis TrPs as well as neck,

shoulders and low back. It made a huge difference. E-mail me if you would like

more information. I believe this is a great treatment for me and my case. I

can't talk for anybody else.

Stress and tension always aggrevates the trigger points and causes more pain.

Overall the pain from my trigger points has decreased over the last couple of

years!! This year I will make more progress with Biofeedback and Stress

management.

Then I want to go back to Prolo injections.

Thank you for the information, I know I'm not crazy, all these things ARE

related!

Take care,

, CO

Moderator's note: myofascial trigger points are

different than fibromyalgia tender points, but often

exist in people with fibromyalgia.]

Headaches Due to Myofascial Trigger Points

Devin Starlanyl, MD

(This information may be freely copied and distributed

only if unaltered, with complete original content.)

There are many possible causes of headache. For people

with the hyper aroused autonomic nervous system of

FMS, sensitivity to noise, cold, heat and light can

add to our headache woes.

Allergies, fatigue, hormonal imbalances, reactive

hypoglycemia, congestion, vasomotor rhinitis, and

neurotransmitter dysregulation can also be factors.

By far, however, the most common cause of headaches is

referred pain from myofascial trigger points (TrPs).

All the before-mentioned factors often activate and/or

perpetuate TrPs. Since TrPs can entrap blood and lymph

vessels as well as nerves, TrP pain is often confused

with neurological, rheumatic, or inflammatory pain,

especially with some of the more bizarre autonomic

symptoms that can occur. TrP headache pain is often

variable, and may change with body position or

muscular activity. It may be so severe at times that

you can't function or even think clearly. TrPs refer

pain

elsewhere in specific patterns, so it is important to

become familiar with the pattern and any possible

accompanying symptoms, as well as the location

of the instigating trigger point. All of these TrPs

are documented in the detailed medical texts

" Myofascial Pain and Dysfunction: The Trigger Point

Manuals " Vol I and II by Janet G. Travell and G.

Simons.

The frontalis muscle is part of the broad

musculo-fibrous layer of the occipito-frontalis

muscle, which stretches across the forehead, top and

back of the skull. The frontalis portion is -- you

guessed it -- in the front. TrPs in the frontalis

muscle remain local, causing pain over the forehead,

often radiating upwards over the scalp. The TrPs will

let themselves be known to you, they aren't shy. When

you press them, they scream at you, " HERE I AM! " You

usually feel like screaming right back at them, " GO

AWAY! " These TrPs are often activated by overwork,

especially in tense people who have a lot of facial

expression.

Occipitalis TrPs cause local pain over the area of the

rest of the skull, but also refer pain to the back of

the head, pain through the skull, and to the back of

the eyeball. You often can feel the lumps and bumps of

the TrPs with your fingers. These may become so severe

that you cannot bear weight of back of your head on a

pillow. TrPs in the head and neck region respond

to moist heat, unless there is nerve entrapment. Then,

ice will help. Massage is beneficial, as well as

CranioSacral Release (CSR) and Spray and Stretch

(S&S), but you also must check for perpetuating

factors such as stress, eye strain and overwork.

Temporalis TrPs occur in a line a little beyond the

outer edge of the eye to just behind the tip of the

ear. Each temporalis TrP refers pain in a different

pattern. The one closest to the eye refers pain over

eyebrow, straight up the side of the head, and the

front upper teeth. TrPs further back along the line to

the ear refer pain to different teeth. The further

back the TrP, the further back the tooth or teeth.

They also refer pain upwards of their position,

causing headache.

TrPs in the extrinsic eye muscles are a frequent

contributor to headaches. For your vision to be clear,

both eyes must take the same picture at the same time,

and all the muscles of each eye must work together in

harmony. A misalignment of the eyes can be caused by

TrPs in any of these muscles. Double vision, blurry

vision and/or changing vision can result if these

muscles are being contracted at different tension. Put

one hand on your head, above your forehead. Then,

keeping your head still, try to look at your hand.

This shouldn't hurt. If it does, the TrPs are calling

to

you, letting you know they're around. Move your eyes

from one upper corner to the other, but do this

gently. This may activate the TrPs and cause a

headache. This does not mean you shouldn't do the

exercise -- it is a

warning letting you know how badly these stretches are

needed. Start slowly, and go gently, but keep at it.

Remember to vary your gaze -- look up and out once in

a while when you are doing close work. Poorly fitting

glasses or improperly corrected vision can contribute

to your headaches. This is especially tiresome if your

vision is changing constantly due to these extrinsic

TrPs. TrPs around the eyes are also likely to be

involved. Get into the habit of doing acupressure work

on your face and neck for brief periods, whenever you

have the time. Check for masseter TrPs along the lower

border of the jaw just after the " corner " . These TrPs,

by no means the only possible ones in the masseter,

refer pain along the eyebrow line, as well as to an

area along the side of the lower jaw, contributing

to headaches. TrPs in the lateral pterygoid muscle are

found about an inch in front of the center of the

outer ear, and about an inch below that. These TrPs

refer pain in front of the ear and pain deep in the

TMJ and

the maxillary sinuses. Both of these, especially the

sinus pain, can add to headache misery. There is a TrP

in the back of the digastric muscle that sometimes

refers pain to the back of the skull. You can find

this TrP right off the corner of the lower jaw,

immediately next to it in the throat. It also radiates

to the upper part of the sternocleidomastoid (SCM) --

which

is an exceedingly complex muscle we'll tackle later.

The spillover pain can be from the front of the throat

under the chin along the line of the jaw,much worse

under the ear, and continuing to extend upward and

backward in a diagonal nearly to the back of the head.

In the neck, as in many other parts of the body, TrPs

can occur in many layers of muscles. The splenius

capitis muscles are wide bands that run from the back

of the skull at the sides to the upper vertebrae. TrPs

here feel like sore areas on either side of the back

of the head, directly under the skull. These TrPs

transmit pain to the top of the head. Splenius

cervicis muscles are thinner muscles connecting

vertebrae. TrPs in the

upper splenius capitis muscles send pain to the back

of the head and diffusely throughout the skull, with

intense pain behind the eyeballs. They can cause

blurring of near vision in the eye on the same side as

the TrP. TrPs in the lower splenius cervicis muscles

are found on either side of the neck below where it

joins the trunk, above the shoulder blades. Referred

pain flows down to the shoulder, collar bone, and

angle of the neck. You may not be able to rotate your

neck due to pain. There are several types of posterior

cervical muscles. A TrP in the semispinalis cervicis,

alongside the spine right below the skull, creates

pain up the back of the head toward the top. A TrP in

the semispinalis capitis muscle just above the base of

the skull, on the back of the side of the head,

creates a

headache like half a headband, with the highest

intensity in the temple and over the eye. If you have

TrPs on both sides, the pain can be incapacitating. A

TrP in between these two other TrPs sends pain up to

the base of the skull. It may also cause neck pain,

spilling over to the top of the collar bone and

upper inward border of the shoulder blade. Posterior

cervical TrPs below the skull can also produce pain in

the hands and feet on both sides, or to the body below

the shoulder on the same side as the TrP. Place your

hand alongside your head, with the heel of your hand

directly under your ear, resting against the square of

your jaw. Your outstretched fingers should be wrapping

diagonally around to the back of your head. Find

suboccipital TrPs on a diagonal line (the higher side

is toward the back of the skull) underyour palm. These

TrPs initiate deep head pain that radiates from the

back of your head to the cavity of your eye. The pain

seems to penetrate inside your skull, because these

muscles are deeply placed, just below the base of

the skull on the side.

Multifidi run along the entire spine. Neck multifidi

are often headache inducers. These muscles are short

and deep, and go from one vertebra to another. Pain is

transmitted in different patterns depending on which

multifidi muscle has TrPs. Activation is usually

caused by prolonged bending of your neck doing close

work, by stooped posture, or by gross trauma. If you

have trigger points in the multifidi of the neck

vertebrae,

pressure from your pillow at night can be intolerable.

In addition to pain, there can be a tingling,

numbness, or burning pain over the back of your head

on the same side as the TrPs. This is an indication

that the TrPs

are causing nerve entrapment. Check to see that your

workstation is ergonomically correct. Don't slump.

Avoid tight hats and headbands, heavy glasses, heavy

overcoats and tight collars. To relieve these

symptoms,

sit backwards in a hot shower while you stretch your

neck muscles downward.

The trapezius muscle may have TrPs in many locations.

There is one spot that sends pain up the same side of

the neck and head, in a hook shape. Follow a line

about an inch behind your ear down the side of your

neck

above the collar bone about halfway to the start of

the shoulder. There is often spillover pain in the

neck region, beneath the ear, and well as underthe

eyebrow. This is a major source of tension headache

and neck aches.There can also be a mild pain at top of

head, lower back teeth and outerear. One or both ears

can burn, turn red, or lose all color as blood vessels

dilate or contract in response to this TrP. The

sternocleidomastoid(SCM) muscle connects to the head,

but separates into two parts. One connects to the

collar bone, and one to the breastbone. TrPs in the

breastbone (sternal) part, in the front, can refer

pain to top or back of head, over the eye. Midlevel

TrPs send pain arching across the cheek and jaw, over

the eyebrow ridge, and deep inside eye, as well as

pain to

the ear on the same side. TrPs in the upper sternal

SCM cause pain behind but not close to the ear, and to

the back of the head. SCM TrPs also affect the eyes

and sinuses, and can cause tearing, reddening or

drooping of eye, as well as inability to raise the

upper eyelid. You may experience visual disturbances.

Patterns from window blinds and escalator treads can

cause an

out-of-control, seizure-like feeling. Stripes, checks

and polka dots can be a problem -- anything with

strongly contrasting light and dark spaces.

You may experience dizziness, runny nose and sinus

congestion on the involved side, as well as ringing in

ear and deafness. TrPs in the collar bone (clavicular)

section cause a frontal headache and earache. Middle

TrPs in this section also cause pain to the front of

the head, which can extend across the forehead to

other side. Anything which hyper extends the neck,

such as sleeping on two pillows, can aggravate these

TrPs. Mechanical stresses such as doing overhead work,

writing on a blackboard, or hanging curtains,

aggravate these TrPs.

For more information and diagrams see " Fibromyalgia

and Chronic Myofascial Pain Syndrome: A Survival

Manual " by Devin J. Starlanyl M.D. and Ellen

Copeland MA,MS. New Harbinger Oakland California USA

Canada .

[Guest guest]

Thank you Tina!!

Great information!

I have all these trigger points and almost all the symptoms and headaches.

I find deep tissue massage very helpful. I will try to get Rolfing paid for in

a few weeks.

I had Prolotherapy injections into the Occipitalis TrPs as well as neck,

shoulders and low back. It made a huge difference. E-mail me if you would like

more information. I believe this is a great treatment for me and my case. I

can't talk for anybody else.

Stress and tension always aggrevates the trigger points and causes more pain.

Overall the pain from my trigger points has decreased over the last couple of

years!! This year I will make more progress with Biofeedback and Stress

management.

Then I want to go back to Prolo injections.

Thank you for the information, I know I'm not crazy, all these things ARE

related!

Take care,

, CO

Moderator's note: myofascial trigger points are

different than fibromyalgia tender points, but often

exist in people with fibromyalgia.]

Headaches Due to Myofascial Trigger Points

Devin Starlanyl, MD

(This information may be freely copied and distributed

only if unaltered, with complete original content.)

There are many possible causes of headache. For people

with the hyper aroused autonomic nervous system of

FMS, sensitivity to noise, cold, heat and light can

add to our headache woes.

Allergies, fatigue, hormonal imbalances, reactive

hypoglycemia, congestion, vasomotor rhinitis, and

neurotransmitter dysregulation can also be factors.

By far, however, the most common cause of headaches is

referred pain from myofascial trigger points (TrPs).

All the before-mentioned factors often activate and/or

perpetuate TrPs. Since TrPs can entrap blood and lymph

vessels as well as nerves, TrP pain is often confused

with neurological, rheumatic, or inflammatory pain,

especially with some of the more bizarre autonomic

symptoms that can occur. TrP headache pain is often

variable, and may change with body position or

muscular activity. It may be so severe at times that

you can't function or even think clearly. TrPs refer

pain

elsewhere in specific patterns, so it is important to

become familiar with the pattern and any possible

accompanying symptoms, as well as the location

of the instigating trigger point. All of these TrPs

are documented in the detailed medical texts

" Myofascial Pain and Dysfunction: The Trigger Point

Manuals " Vol I and II by Janet G. Travell and G.

Simons.

The frontalis muscle is part of the broad

musculo-fibrous layer of the occipito-frontalis

muscle, which stretches across the forehead, top and

back of the skull. The frontalis portion is -- you

guessed it -- in the front. TrPs in the frontalis

muscle remain local, causing pain over the forehead,

often radiating upwards over the scalp. The TrPs will

let themselves be known to you, they aren't shy. When

you press them, they scream at you, " HERE I AM! " You

usually feel like screaming right back at them, " GO

AWAY! " These TrPs are often activated by overwork,

especially in tense people who have a lot of facial

expression.

Occipitalis TrPs cause local pain over the area of the

rest of the skull, but also refer pain to the back of

the head, pain through the skull, and to the back of

the eyeball. You often can feel the lumps and bumps of

the TrPs with your fingers. These may become so severe

that you cannot bear weight of back of your head on a

pillow. TrPs in the head and neck region respond

to moist heat, unless there is nerve entrapment. Then,

ice will help. Massage is beneficial, as well as

CranioSacral Release (CSR) and Spray and Stretch

(S&S), but you also must check for perpetuating

factors such as stress, eye strain and overwork.

Temporalis TrPs occur in a line a little beyond the

outer edge of the eye to just behind the tip of the

ear. Each temporalis TrP refers pain in a different

pattern. The one closest to the eye refers pain over

eyebrow, straight up the side of the head, and the

front upper teeth. TrPs further back along the line to

the ear refer pain to different teeth. The further

back the TrP, the further back the tooth or teeth.

They also refer pain upwards of their position,

causing headache.

TrPs in the extrinsic eye muscles are a frequent

contributor to headaches. For your vision to be clear,

both eyes must take the same picture at the same time,

and all the muscles of each eye must work together in

harmony. A misalignment of the eyes can be caused by

TrPs in any of these muscles. Double vision, blurry

vision and/or changing vision can result if these

muscles are being contracted at different tension. Put

one hand on your head, above your forehead. Then,

keeping your head still, try to look at your hand.

This shouldn't hurt. If it does, the TrPs are calling

to

you, letting you know they're around. Move your eyes

from one upper corner to the other, but do this

gently. This may activate the TrPs and cause a

headache. This does not mean you shouldn't do the

exercise -- it is a

warning letting you know how badly these stretches are

needed. Start slowly, and go gently, but keep at it.

Remember to vary your gaze -- look up and out once in

a while when you are doing close work. Poorly fitting

glasses or improperly corrected vision can contribute

to your headaches. This is especially tiresome if your

vision is changing constantly due to these extrinsic

TrPs. TrPs around the eyes are also likely to be

involved. Get into the habit of doing acupressure work

on your face and neck for brief periods, whenever you

have the time. Check for masseter TrPs along the lower

border of the jaw just after the " corner " . These TrPs,

by no means the only possible ones in the masseter,

refer pain along the eyebrow line, as well as to an

area along the side of the lower jaw, contributing

to headaches. TrPs in the lateral pterygoid muscle are

found about an inch in front of the center of the

outer ear, and about an inch below that. These TrPs

refer pain in front of the ear and pain deep in the

TMJ and

the maxillary sinuses. Both of these, especially the

sinus pain, can add to headache misery. There is a TrP

in the back of the digastric muscle that sometimes

refers pain to the back of the skull. You can find

this TrP right off the corner of the lower jaw,

immediately next to it in the throat. It also radiates

to the upper part of the sternocleidomastoid (SCM) --

which

is an exceedingly complex muscle we'll tackle later.

The spillover pain can be from the front of the throat

under the chin along the line of the jaw,much worse

under the ear, and continuing to extend upward and

backward in a diagonal nearly to the back of the head.

In the neck, as in many other parts of the body, TrPs

can occur in many layers of muscles. The splenius

capitis muscles are wide bands that run from the back

of the skull at the sides to the upper vertebrae. TrPs

here feel like sore areas on either side of the back

of the head, directly under the skull. These TrPs

transmit pain to the top of the head. Splenius

cervicis muscles are thinner muscles connecting

vertebrae. TrPs in the

upper splenius capitis muscles send pain to the back

of the head and diffusely throughout the skull, with

intense pain behind the eyeballs. They can cause

blurring of near vision in the eye on the same side as

the TrP. TrPs in the lower splenius cervicis muscles

are found on either side of the neck below where it

joins the trunk, above the shoulder blades. Referred

pain flows down to the shoulder, collar bone, and

angle of the neck. You may not be able to rotate your

neck due to pain. There are several types of posterior

cervical muscles. A TrP in the semispinalis cervicis,

alongside the spine right below the skull, creates

pain up the back of the head toward the top. A TrP in

the semispinalis capitis muscle just above the base of

the skull, on the back of the side of the head,

creates a

headache like half a headband, with the highest

intensity in the temple and over the eye. If you have

TrPs on both sides, the pain can be incapacitating. A

TrP in between these two other TrPs sends pain up to

the base of the skull. It may also cause neck pain,

spilling over to the top of the collar bone and

upper inward border of the shoulder blade. Posterior

cervical TrPs below the skull can also produce pain in

the hands and feet on both sides, or to the body below

the shoulder on the same side as the TrP. Place your

hand alongside your head, with the heel of your hand

directly under your ear, resting against the square of

your jaw. Your outstretched fingers should be wrapping

diagonally around to the back of your head. Find

suboccipital TrPs on a diagonal line (the higher side

is toward the back of the skull) underyour palm. These

TrPs initiate deep head pain that radiates from the

back of your head to the cavity of your eye. The pain

seems to penetrate inside your skull, because these

muscles are deeply placed, just below the base of

the skull on the side.

Multifidi run along the entire spine. Neck multifidi

are often headache inducers. These muscles are short

and deep, and go from one vertebra to another. Pain is

transmitted in different patterns depending on which

multifidi muscle has TrPs. Activation is usually

caused by prolonged bending of your neck doing close

work, by stooped posture, or by gross trauma. If you

have trigger points in the multifidi of the neck

vertebrae,

pressure from your pillow at night can be intolerable.

In addition to pain, there can be a tingling,

numbness, or burning pain over the back of your head

on the same side as the TrPs. This is an indication

that the TrPs

are causing nerve entrapment. Check to see that your

workstation is ergonomically correct. Don't slump.

Avoid tight hats and headbands, heavy glasses, heavy

overcoats and tight collars. To relieve these

symptoms,

sit backwards in a hot shower while you stretch your

neck muscles downward.

The trapezius muscle may have TrPs in many locations.

There is one spot that sends pain up the same side of

the neck and head, in a hook shape. Follow a line

about an inch behind your ear down the side of your

neck

above the collar bone about halfway to the start of

the shoulder. There is often spillover pain in the

neck region, beneath the ear, and well as underthe

eyebrow. This is a major source of tension headache

and neck aches.There can also be a mild pain at top of

head, lower back teeth and outerear. One or both ears

can burn, turn red, or lose all color as blood vessels

dilate or contract in response to this TrP. The

sternocleidomastoid(SCM) muscle connects to the head,

but separates into two parts. One connects to the

collar bone, and one to the breastbone. TrPs in the

breastbone (sternal) part, in the front, can refer

pain to top or back of head, over the eye. Midlevel

TrPs send pain arching across the cheek and jaw, over

the eyebrow ridge, and deep inside eye, as well as

pain to

the ear on the same side. TrPs in the upper sternal

SCM cause pain behind but not close to the ear, and to

the back of the head. SCM TrPs also affect the eyes

and sinuses, and can cause tearing, reddening or

drooping of eye, as well as inability to raise the

upper eyelid. You may experience visual disturbances.

Patterns from window blinds and escalator treads can

cause an

out-of-control, seizure-like feeling. Stripes, checks

and polka dots can be a problem -- anything with

strongly contrasting light and dark spaces.

You may experience dizziness, runny nose and sinus

congestion on the involved side, as well as ringing in

ear and deafness. TrPs in the collar bone (clavicular)

section cause a frontal headache and earache. Middle

TrPs in this section also cause pain to the front of

the head, which can extend across the forehead to

other side. Anything which hyper extends the neck,

such as sleeping on two pillows, can aggravate these

TrPs. Mechanical stresses such as doing overhead work,

writing on a blackboard, or hanging curtains,

aggravate these TrPs.

For more information and diagrams see " Fibromyalgia

and Chronic Myofascial Pain Syndrome: A Survival

Manual " by Devin J. Starlanyl M.D. and Ellen

Copeland MA,MS. New Harbinger Oakland California USA

Canada .

[Guest guest]

Thank you Tina!!

Great information!

I have all these trigger points and almost all the symptoms and headaches.

I find deep tissue massage very helpful. I will try to get Rolfing paid for in

a few weeks.

I had Prolotherapy injections into the Occipitalis TrPs as well as neck,

shoulders and low back. It made a huge difference. E-mail me if you would like

more information. I believe this is a great treatment for me and my case. I

can't talk for anybody else.

Stress and tension always aggrevates the trigger points and causes more pain.

Overall the pain from my trigger points has decreased over the last couple of

years!! This year I will make more progress with Biofeedback and Stress

management.

Then I want to go back to Prolo injections.

Thank you for the information, I know I'm not crazy, all these things ARE

related!

Take care,

, CO

Moderator's note: myofascial trigger points are

different than fibromyalgia tender points, but often

exist in people with fibromyalgia.]

Headaches Due to Myofascial Trigger Points

Devin Starlanyl, MD

(This information may be freely copied and distributed

only if unaltered, with complete original content.)

There are many possible causes of headache. For people

with the hyper aroused autonomic nervous system of

FMS, sensitivity to noise, cold, heat and light can

add to our headache woes.

Allergies, fatigue, hormonal imbalances, reactive

hypoglycemia, congestion, vasomotor rhinitis, and

neurotransmitter dysregulation can also be factors.

By far, however, the most common cause of headaches is

referred pain from myofascial trigger points (TrPs).

All the before-mentioned factors often activate and/or

perpetuate TrPs. Since TrPs can entrap blood and lymph

vessels as well as nerves, TrP pain is often confused

with neurological, rheumatic, or inflammatory pain,

especially with some of the more bizarre autonomic

symptoms that can occur. TrP headache pain is often

variable, and may change with body position or

muscular activity. It may be so severe at times that

you can't function or even think clearly. TrPs refer

pain

elsewhere in specific patterns, so it is important to

become familiar with the pattern and any possible

accompanying symptoms, as well as the location

of the instigating trigger point. All of these TrPs

are documented in the detailed medical texts

" Myofascial Pain and Dysfunction: The Trigger Point

Manuals " Vol I and II by Janet G. Travell and G.

Simons.

The frontalis muscle is part of the broad

musculo-fibrous layer of the occipito-frontalis

muscle, which stretches across the forehead, top and

back of the skull. The frontalis portion is -- you

guessed it -- in the front. TrPs in the frontalis

muscle remain local, causing pain over the forehead,

often radiating upwards over the scalp. The TrPs will

let themselves be known to you, they aren't shy. When

you press them, they scream at you, " HERE I AM! " You

usually feel like screaming right back at them, " GO

AWAY! " These TrPs are often activated by overwork,

especially in tense people who have a lot of facial

expression.

Occipitalis TrPs cause local pain over the area of the

rest of the skull, but also refer pain to the back of

the head, pain through the skull, and to the back of

the eyeball. You often can feel the lumps and bumps of

the TrPs with your fingers. These may become so severe

that you cannot bear weight of back of your head on a

pillow. TrPs in the head and neck region respond

to moist heat, unless there is nerve entrapment. Then,

ice will help. Massage is beneficial, as well as

CranioSacral Release (CSR) and Spray and Stretch

(S&S), but you also must check for perpetuating

factors such as stress, eye strain and overwork.

Temporalis TrPs occur in a line a little beyond the

outer edge of the eye to just behind the tip of the

ear. Each temporalis TrP refers pain in a different

pattern. The one closest to the eye refers pain over

eyebrow, straight up the side of the head, and the

front upper teeth. TrPs further back along the line to

the ear refer pain to different teeth. The further

back the TrP, the further back the tooth or teeth.

They also refer pain upwards of their position,

causing headache.

TrPs in the extrinsic eye muscles are a frequent

contributor to headaches. For your vision to be clear,

both eyes must take the same picture at the same time,

and all the muscles of each eye must work together in

harmony. A misalignment of the eyes can be caused by

TrPs in any of these muscles. Double vision, blurry

vision and/or changing vision can result if these

muscles are being contracted at different tension. Put

one hand on your head, above your forehead. Then,

keeping your head still, try to look at your hand.

This shouldn't hurt. If it does, the TrPs are calling

to

you, letting you know they're around. Move your eyes

from one upper corner to the other, but do this

gently. This may activate the TrPs and cause a

headache. This does not mean you shouldn't do the

exercise -- it is a

warning letting you know how badly these stretches are

needed. Start slowly, and go gently, but keep at it.

Remember to vary your gaze -- look up and out once in

a while when you are doing close work. Poorly fitting

glasses or improperly corrected vision can contribute

to your headaches. This is especially tiresome if your

vision is changing constantly due to these extrinsic

TrPs. TrPs around the eyes are also likely to be

involved. Get into the habit of doing acupressure work

on your face and neck for brief periods, whenever you

have the time. Check for masseter TrPs along the lower

border of the jaw just after the " corner " . These TrPs,

by no means the only possible ones in the masseter,

refer pain along the eyebrow line, as well as to an

area along the side of the lower jaw, contributing

to headaches. TrPs in the lateral pterygoid muscle are

found about an inch in front of the center of the

outer ear, and about an inch below that. These TrPs

refer pain in front of the ear and pain deep in the

TMJ and

the maxillary sinuses. Both of these, especially the

sinus pain, can add to headache misery. There is a TrP

in the back of the digastric muscle that sometimes

refers pain to the back of the skull. You can find

this TrP right off the corner of the lower jaw,

immediately next to it in the throat. It also radiates

to the upper part of the sternocleidomastoid (SCM) --

which

is an exceedingly complex muscle we'll tackle later.

The spillover pain can be from the front of the throat

under the chin along the line of the jaw,much worse

under the ear, and continuing to extend upward and

backward in a diagonal nearly to the back of the head.

In the neck, as in many other parts of the body, TrPs

can occur in many layers of muscles. The splenius

capitis muscles are wide bands that run from the back

of the skull at the sides to the upper vertebrae. TrPs

here feel like sore areas on either side of the back

of the head, directly under the skull. These TrPs

transmit pain to the top of the head. Splenius

cervicis muscles are thinner muscles connecting

vertebrae. TrPs in the

upper splenius capitis muscles send pain to the back

of the head and diffusely throughout the skull, with

intense pain behind the eyeballs. They can cause

blurring of near vision in the eye on the same side as

the TrP. TrPs in the lower splenius cervicis muscles

are found on either side of the neck below where it

joins the trunk, above the shoulder blades. Referred

pain flows down to the shoulder, collar bone, and

angle of the neck. You may not be able to rotate your

neck due to pain. There are several types of posterior

cervical muscles. A TrP in the semispinalis cervicis,

alongside the spine right below the skull, creates

pain up the back of the head toward the top. A TrP in

the semispinalis capitis muscle just above the base of

the skull, on the back of the side of the head,

creates a

headache like half a headband, with the highest

intensity in the temple and over the eye. If you have

TrPs on both sides, the pain can be incapacitating. A

TrP in between these two other TrPs sends pain up to

the base of the skull. It may also cause neck pain,

spilling over to the top of the collar bone and

upper inward border of the shoulder blade. Posterior

cervical TrPs below the skull can also produce pain in

the hands and feet on both sides, or to the body below

the shoulder on the same side as the TrP. Place your

hand alongside your head, with the heel of your hand

directly under your ear, resting against the square of

your jaw. Your outstretched fingers should be wrapping

diagonally around to the back of your head. Find

suboccipital TrPs on a diagonal line (the higher side

is toward the back of the skull) underyour palm. These

TrPs initiate deep head pain that radiates from the

back of your head to the cavity of your eye. The pain

seems to penetrate inside your skull, because these

muscles are deeply placed, just below the base of

the skull on the side.

Multifidi run along the entire spine. Neck multifidi

are often headache inducers. These muscles are short

and deep, and go from one vertebra to another. Pain is

transmitted in different patterns depending on which

multifidi muscle has TrPs. Activation is usually

caused by prolonged bending of your neck doing close

work, by stooped posture, or by gross trauma. If you

have trigger points in the multifidi of the neck

vertebrae,

pressure from your pillow at night can be intolerable.

In addition to pain, there can be a tingling,

numbness, or burning pain over the back of your head

on the same side as the TrPs. This is an indication

that the TrPs

are causing nerve entrapment. Check to see that your

workstation is ergonomically correct. Don't slump.

Avoid tight hats and headbands, heavy glasses, heavy

overcoats and tight collars. To relieve these

symptoms,

sit backwards in a hot shower while you stretch your

neck muscles downward.

The trapezius muscle may have TrPs in many locations.

There is one spot that sends pain up the same side of

the neck and head, in a hook shape. Follow a line

about an inch behind your ear down the side of your

neck

above the collar bone about halfway to the start of

the shoulder. There is often spillover pain in the

neck region, beneath the ear, and well as underthe

eyebrow. This is a major source of tension headache

and neck aches.There can also be a mild pain at top of

head, lower back teeth and outerear. One or both ears

can burn, turn red, or lose all color as blood vessels

dilate or contract in response to this TrP. The

sternocleidomastoid(SCM) muscle connects to the head,

but separates into two parts. One connects to the

collar bone, and one to the breastbone. TrPs in the

breastbone (sternal) part, in the front, can refer

pain to top or back of head, over the eye. Midlevel

TrPs send pain arching across the cheek and jaw, over

the eyebrow ridge, and deep inside eye, as well as

pain to

the ear on the same side. TrPs in the upper sternal

SCM cause pain behind but not close to the ear, and to

the back of the head. SCM TrPs also affect the eyes

and sinuses, and can cause tearing, reddening or

drooping of eye, as well as inability to raise the

upper eyelid. You may experience visual disturbances.

Patterns from window blinds and escalator treads can

cause an

out-of-control, seizure-like feeling. Stripes, checks

and polka dots can be a problem -- anything with

strongly contrasting light and dark spaces.

You may experience dizziness, runny nose and sinus

congestion on the involved side, as well as ringing in

ear and deafness. TrPs in the collar bone (clavicular)

section cause a frontal headache and earache. Middle

TrPs in this section also cause pain to the front of

the head, which can extend across the forehead to

other side. Anything which hyper extends the neck,

such as sleeping on two pillows, can aggravate these

TrPs. Mechanical stresses such as doing overhead work,

writing on a blackboard, or hanging curtains,

aggravate these TrPs.

For more information and diagrams see " Fibromyalgia

and Chronic Myofascial Pain Syndrome: A Survival

Manual " by Devin J. Starlanyl M.D. and Ellen

Copeland MA,MS. New Harbinger Oakland California USA

Canada .