Assessing Headaches

Clients who present with headaches seem to have limited tools to remedy their condition. In today’s article, I’ll outline muscles & their associated trigger points, which refer around the head, and provide a foam rolling technique to relieve head, neck, and shoulder discomfort.

For you to interpret trigger point referral charts know this, the X represents a point & the red, shaded area represents common areas of referral; the deeper the red, the more intense the referral.

I would hesitate to say this is an in-depth look at headaches, with all of the ways they form and can be relieved. Rather, this is how I begin assessing clients & their symptoms. Is your headache in a specific place or is it all over. Does it always return to the same place? Does the ache relieve with certain movements and worsen with others? Take a few moments for one to embody these questions.

These articles are becoming a blueprint for anyone to cultivate awareness around discomfort and manifest tools to actively manage basic symptoms. *All tips and techniques are suggestions only. This is not a replacement for professional bodywork but it may be a good place to start.

My massage practice is a never ending inspiration for learning. Not only do I get to observe posture & movement patterns across hundreds of people, I also get the pleasure of knowing which patterns I really need to work on. I may not do each stretch, rolling technique, or manage to hold “pain free posture” every day but when I am aware that I am feeling uncomfortable, I try to make a change. ~ D. Chernati, LMT

Trapezius (Traps) - The Trapezius question-mark

• Anatomical Actions

  • Upper Fibers (hood of trapezius) - Extend & Rotate Neck to the same side / Elevate & Upwardly Rotate Scapula

    • Top of the shoulder / Back of the neck area

  • Middle Fibers - Retract & Stabilize Scapula

    • Between the Scapula

  • Lower Fibers - Depress & Upwardly Rotate Scapula

    • Scapula to T12, mid / lower back

• Referral Patterns

  • Upper Fibers (hood of trapezius) - The question mark, from the side of the neck, bending around the ear, terminating around the eye.

    • Side headaches / eye aches / stiff neck

  • Middle Fibers - Tension & pain around the medial border of the scapula.

    • Letting the shoulders always protract, usually in slouching, seated positions, will result in chronic pains here.

  • Trapezius Trigger Point Referrals can be felt as far away as the tricep & back of the arm

Sternocleidomastoid (SCM) - Devil Horns

• Anatomical Actions

  • Neck Flexion & Lateral flexion, to the same side

  • Rotation to the opposite side

  • Assist elevation of the ribcage during inhalation

  How to find it:

  • Turn your head to the side, find the thick diagonal band oriented from the clavicle to behind the ear. You may even be able to pinch it and roll it between the fingers, to relieve some tension.

• Referral Patterns

  The referral area for the SCM is all over the face but strongly associated to the forehead, just above the eyes, like horns or a coat hanger.

  If you find the attachment behind the ear, on the Mastoid Process, this area also has a strong referral. Many people may press here or lay on a ball to relieve some pressure.

  • Try pinching the band, rotating & laterally flexing the neck to relieve some pressure. Stimulating the area, you may also feel he referral to the forehead.

Platysma - The Grimace

• Anatomical Actions

  • Tighten fascia of the neck

  • Draw down the corners of the mouth (grimace)

  • Assist Depression of the Mandible, at the TMJ

  Look in a mirror, try these actions. In doing so, you may see the superficial fibers appear on the front of the neck.

  • Now. place your palms on your chest, just below the clavicle. Do the actions again. Can you feel the fibers activate all the way to the middle of the chest & front of the shoulder?

• Referral Patterns

  Although the referral does not seem to be very strong, I commonly find that clients have excessive tension in the front of the throat & chest. To work this muscle, I commonly have clients make silly faces, while turning the head to the side.

Splenius Cervicis & Splenius Capitis - Deep muscles of the neck

• Anatomical Actions

  These muscles lie deep to the trapezius & rhomboids. Unlike the muscles of the neck, running parallel with the spine, these run obliquely. Their fibers may not be easily distinguished.

  When do you use the Splenii? Checking lanes in traffic, putting in eye drops, pinching the phone between the ear & shoulder, etc

  • Rotate & Laterally flex the neck, to the same side

    • Capitis inserts on the skull; Cervicis inserts on the neck.

• Referral Patterns

  Splenius Cervicis - Around the Eye

  Splenius Capitis - Top of the head

Occipitofrontalis - Surprise

• Anatomical Actions

  It is a unique muscle with four thin bellies— two frontalis bellies on the forehead and two occipitalis bellies located on the back of the head. (Biel, Andrew. "Chapter 5 - Head, Neck, & Face." Trail Guide To The Body, p 258)

  • Raise the eyebrows & wrinkle the forehead

  • Anchor and retract the galea posteriorly

    • Galea aponeurotica - a broad sheath of connective tissue stretching across the top of the cranium

  • When Do You Use Your OF? Raising your eyebrows in shock or surprise (frontalis) / Smiling and yawning

• Referral Patterns

  The individual fibers can not be isolated, although the muscle is superficial.

  • Side of the Head / Around the ear / Forehead

Self-therapy: Simultaneously relieve shoulder & neck tension, with a therapy ball.

• How to start

  This topic will have its own multi-part article but here is a starter:
  Relaxation is the first priority; if it hurts, you may be sore after.

  • Focus on breathing and relaxing first. Then add movements. Finally, apply focused pressure.

    • If it is in your practice, layer 3-part breathing, with a Hado Breath or Ujai. Focus the breath directly to the area; expand into the point

    • always move to the most comfortable position. let the body change position naturally Comfort is key for not feeling sore 🙏

  • Always move to the most comfortable position; let the body change position naturally. Comfort is key for not feeling sore.

• Picking An Appropriate Device

  Most People have heard of lacrosse balls, tennis balls, sometimes a Theracane, and large rollers, with all the attachments and features like heating & vibration. What if I told you all you need to start was the floor?

  Size / Shape

  • The smaller the device, the more specific the pressure; focused pressure is not always the most appropriate.

  • Depending on the intended area, different size & shaped rollers will fit better; a tennis ball may be appropriate for concave surfaces like the foot or lateral hip but a log-type roller may better suit the convex surface of the thigh.

  Density

  • The harder the object, the more force it will apply back to you. You can always change the device as tension relaxes & muscles become less sensitive.

    • In addition, the more you use devices like this, your body will adapt.

  Pressure / Working Surface

  • Consider dampening the pressure by softening the surface, adding blankets, laying the bed; a hard wood floor will press harder than a carpet floor, different from a soft mattress

• Scapula Technique

  Position:

  • Laying down, face up, with a semi-small device, like a tennis ball or a Theracane.

  • Adduct the arm across the midline. Place the device along the medial border of the scapula, next to a sensitive area;

    • Start with less sensitive areas first. The biggest “hot spot” will desensitize as other areas relax.

    • What do you feel happening at the scapula, as you move the arm horizontally, across the midline?

  • Once the device is placed, relax the elbow, arm, & shoulder into a comfortable position.

  • Breathe deeply, expanding the breath into the point.

    • Add in 3-part breathing, as slow and as deep as possible.

  Movements:

  With each new position or movement, prioritize breathing. Always move slowly.

  • Neck

    • Rotation - turning the head left and right.

    • Lateral Flexion - bringing an ear to the same-side shoulder, nose still pointing to the ceiling

  • Scapula

    • Elevation / Depression - think “shrug,” moving the shoulder up & down

    • Protraction / Retraction - with the elbow bent, pointed to the ceiling, press the elbow to the ceiling & relax it back to the floor

    • Circumduction - moving the arm through its full range; focus on areas where the movement seems to be restricted