Sunday 16th January, 2022

Self massage and trigger point therapy for headaches and migraines

Woman performing self massage for headaches
In this article we will show you effective scientifically proven self massage and trigger point therapies for headaches

Scientists have found that a high proportion of headaches result from pain coming from the muscles and joints of your head and neck. They refer to these as tension or cervicogenic (means coming from the neck) headaches. One of the main causes of these is tension and (myofascial) trigger points in the muscles.

Clinical trials have shown that these headaches can often be relieved by simple, easy to apply home therapy where gentle massage is performed, and pressure temporarily applied to the trigger points.

In this article

In this article we will go over the basis of this pain, the types of headaches most likely to benefit from this therapy, and the other possible causes of headache you need to be aware of. We’ll then give you a guide for home therapy. For the most it will be based upon the combined results of several clinical trials, but for some of the muscles involved we’ll give you alternative techniques that from our experience and knowledge will be easier and more effective.

CONTENTS

Is your headache suitable for massage or trigger point therapy?
Self massage and trigger point therapy
Appendix: summary of clinical clinical trials of massage and trigger point therapy for headaches and migraines
References

Is your headache suitable for massage or trigger point therapy?

Whether massage or trigger point therapy will be useful will depend upon the cause of your headaches. These causes are grouped as either primary or secondary. We will look at each. Of course diagnosing the cause is the job of a professional, so we ask that you always seek advice from a professional familiar with your own needs to ultimately work out the cause and whether any therapy is appropriate or not.

Primary headaches (the main type)

Primary headaches are those not caused by another disorder. They are typically caused by pain from pain sensitive structures around the head and neck. Of these about 95% are typical tension or cervicogenic headaches while about 5% are headaches such as migraines (1)⁠.

Tension or cervicogenic headaches

These involve pain from muscles and joints, just like other musculoskeletal conditions such as back, neck and shoulder pain.

The muscles

While there are a lot of muscles in your neck, there are also muscles associated with your jaw movement and thin layers of muscle covering some of your skull. Any of these muscles can cause pain due to tension and due to the development of (myofascial) triggerpoints. For more information on trigger points see our Complete guide to (myofascial) trigger points. Later in this article we will go over the individual muscles involved.

The joints

Problems with the joints of the neck are also a major cause of headaches (2–5)⁠. For further information about what these problems are and how they are treated please see our article Do vertebrae get misaligned or go out of place. It describes the joint problems that cause back pain, but exactly the same principles apply for joints in your neck. They are just a bit smaller.

Treatment overview

The self massage and trigger point therapy we will show you should definitely be very helpful relieving pain from muscle tension and trigger points. Joint problems require assistance from a properly qualified professional such as a Chiropractor, Osteopath, or a Physiotherapist with appropriate post graduate qualifications. Most likely, to get great lasting results you will need a combination of both professional help for the joints and home massage or trigger point therapy for the muscles.

Migraine type headaches

Migraines are a lot more complex. However, scientists have found a strong association between migraines and issues such as trigger points and abnormal neck function (2,4–8)⁠. This appears to be caused by a similar mechanism to the way that trigger points cause fibromyalgia. That is, the prolonged pain from issues such as trigger points cause the nervous system to become sensitised. If this is the case, the treatments discussed for tension and cervicogenic headaches will be very helpful.

Secondary headaches

Secondary headaches result from other conditions such as diseases or tumours. These are far less common, but need to be identified when they exist so the proper care is received.

Overview of the muscles involved

According to several studies the muscles involved in headaches are as follows (1,3,9–15)⁠. Later we will go over each muscle individually, showing where the common problems are and recommending the best treatment for each.

Most important muscles for headaches

  • Upper trapezius
  • SCM (Sterncleidomastoid)
  • Sub occipital

Other important muscles

  • Splenius capitus
  • Temporalis
  • Occipitalis
  • Masseter
  • Frontalis

The basic self massage and trigger point therapy techniques

We recommend the following easy to apply home massage and trigger point therapies. We discuss how to examine your muscles and do these therapies our article How to treat trigger points at home.

  1. Basic self massage
  2. “Thai” home massage
  3. Vibration massage (the best)

Special techniques for the muscles of head, neck and jaw

Many of the muscles of the head, neck and jaw are very thin or overly sensitive structures so the basic massage and trigger point therapies techniques above are sometimes not appropriate. Because of this we will give you some modified techniques. These are an amalgamation of the techniques used and found to be very effective in several clinical trials (1,9,13,14,16)⁠.

Pressure technique

These are most suited for the thin muscles that overly the skull or the jaw. The basic technique is as follows.

  1. Using the tip of your finger(s) examine the muscle for tightness and tender lumps (trigger point). Because some of the muscles are thin these lumps may only be felt as localised areas of tightness.
  2. Once found, using the same finger tip(s) apply pressure to your tolerance. You may feel the pain fade and/or the muscle relax. Maintain this pressure until this relaxation is felt, or for a maximum of two minutes.
  3. Finish with about 5-10 seconds of gentle rubbing using a circular motion about 1 cm in
    diameter.
Pressure technique for thin muscles
Pressure technique applied to thin muscles covering the skull
Pressure technique used on thicker muscle
Pressure technique used on thicker, deeper suboccipital muscles

Pinching technique

When using the pressure technique described above the pressure passes through to the structures behind the muscles. In some cases this is not appropriate. However sometimes the muscle is large enough to pinch. To do this, examine the muscle with your finger tips for tightness or trigger points. Instead of pressing the muscle against something pressure is applied to the trigger point by placing it between the pinching fingers.

Pinching trigger point therapy to the upper trapezius muscle
Pinching trigger point therapy to the upper trapezius muscle

Acupressure and other techniques

There are many systems of points that are said to benefit headaches and other conditions. Examples are acupuncture/acupressure and shiatsu. There is a very large overlap between these points and trigger points (17)⁠. The easiest way to think of these is that over time different people or cultures have found basically the same points but made up their own story around them. The description of trigger points is based upon science. The take home message is that you just look for the changes in the muscles and treat them irrespective of the label they have been given. In separate articles on sleep, high blood pressure and anxiety we discuss that scientists have successfully used massage and trigger point therapy to help these conditions without considering any special system of points.

Upper trapezius muscle trigger points (18)
Upper trapezius muscle trigger points (18)

Upper trapezius muscles

This diagram shows the upper trapezius muscle with "x" marking the the site of common trigger points and the red being where those trigger points commonly refer pain to.

Massage considerations

The upper trapezius muscle is large and easy to pinch. Our recommended massage techniques are:

  • vibration massage
  • pressure techniques using pinching
Upper trapezius vibration massage
Upper trapezius vibration massage
Therapist squeezing upper trapezius muscle
It is very easy to reach around with your opposite hand and squeeze your own upper trapezius muscle like this

SCM (Sterncleidomastoid)

The diagram below shows the SCM muscle with "x" marking the the site of common trigger points and the red being where those trigger points commonly refer pain to.

Massage considerations

The SCM overlies several sensitive structures therefore we only recommend you use pinching techniques. To help find the correct muscles and use the correct technique the second picture below shows the SCM bulging at the front.

Sternocleidomastoid muscle trigger points
SCM muscle trigger points and pain referral (18)
SCM (Sternocleidomastoid) muscle
SCM (Sternocleidomastoid) muscle showing prominently

Suboccipital muscles

The diagram below shows the suboccipital muscles with "x" marking the the site of common trigger points and the red being where those trigger points commonly refer pain to.

Massage considerations

These muscles are deeper and at the base of your skull. I'd personally use a vibration massager for the quickest and best results, but for a non-professional a pressure technique using your thumb is probably easiest and best. The picture below shows someone else applying the pressure, but it is easy to use your own thumb. These muscles are often tight secondary to a joint problem so if the issues are difficult to clear or keep coming back please consult a professional such as a Chiropractor, Osteoptah or a Physiotherapist with special post graduate qualifications.

Sub occipital muscle trigger points
Sub occipital muscle trigger points and pain referral (18)
Pressure technique used on thicker muscle
Pressure technique used on thicker, deeper suboccipital muscles

Splenius capitus muscles

The picture below shows this muscle with the common trigger points and their pain referral pattern.

Massage considerations

These are quite substantial muscles not overlying anu highly sensitive structures, therefore vibration massage, self massage and pressure techniques all work well. If you use pressure limit it to light to moderate, and if you use vibration avoide vibrating your skull.

Splenius capitus muscle trigger points
Splenius capitus muscle with common trigger points and pain referral

Temporalis, Occipitalis, Masseter and Frontalis muscles

As shown below these four muscles sit over your skull and your jaw and commonly refer headache pain.

Massage considerations

Because all these muscles are relatively thin and overly either your skull or your jaw we only recommend pressure techniques using the pads of your fingers. However, the muscles are all easy to reach and very easy to massage. There are some example pictures below.

Temporalis muscle trigger points
Temporalis muscle with common trigger points and pain referral (18)
Occipitalis and frontalis muscle trigger points
Occipitalis (top) and frontalis muscle (bottom) with common trigger points and pain referral (18)
Masseter muscle trigger points
Masseter muscle with common trigger points and pain referral (18)
Self applied temporalis muscle massage
Self applied temporalis muscle massage
Frontalis muscle massage
gentle pressure massage to the frontalis muscle

Appendix: summary of clinical clinical trials of massage and trigger point therapy for headaches and migraines

NOTE: You may need to scroll the table below left/right for more information

Trial

What they did

Results

9

One session of trigger point therapy using simple pressure techniques

Relief for about 52% of sufferers. Researches said that these simple techniques can be self applied

13

Eight 30 minute sessions of massage and trigger point therapy over four weeks Eight sessions of acupressure over one month.

Excellent reduction in frequency of headaches (see chart below)

1

Eight sessions of acupressure over one month.

Significant reduction in headaches, including at six moth follow up. The acupuncture points identified by their meridian and number. These largely coincided with the sites of common trigger points.

16

Trigger point therapy twice a week for an average of 6.5 sessions

Headache frequency reduced 67.7%, intensity by 74.3%, and duration by 77.3%. No side effects were noted.

14

Self trigger point therapy three times a day for four weeks.

Intensity, frequency and duration of headaches and use of medications all reduced

References

  1. Hsieh LLC, Liou HH, Lee LH, Chen THH, Yen AMF. Effect of acupressure and trigger points in treating headache: A randomized controlled trial. Am J Chin Med. 2010;38(1):1–14.
  2. Marcus DA, Scharff L, Mercer S, Turk DC. Musculoskeletal abnormalities in chronic headache: A controlled comparison of headache diagnostic groups. Headache. 1999;39(1):21–7.
  3. Jaeger B. Are “cervicogenic” headaches due to myofascial pain and cervical spine dysfunction? Cephalalgia. 1989;9(3):157–64.
  4. Tali D, Menahem I, Vered E, Kalichman L. Upper cervical mobility, posture and myofascial trigger points in subjects with episodic migraine: Case-control study. J Bodyw Mov Ther 2014;18(4):569–75.
  5. Fernández-de-las-Peñas C, Simons DG, Cuadrado ML, Pareja JA. The role of myofascial trigger points in musculoskeletal pain syndromes of the head and neck. Curr Pain Headache Rep. 2007;11(5):365–72.
  6. Giamberardino MA, Tafuri E, Savini A, Fabrizio A, Affaitati G, Lerza R, et al. Contribution of Myofascial Trigger Points to Migraine Symptoms. J Pain. 2007;8(11):869–78.
  7. Calandre EP, Hidalgo J, Garcia-Leiva JM, Rico-Villademoros F, Delgado-Rodriguez A. Myofascial trigger points in cluster headache patients: A case series. Head Face Med. 2008;4(1):1–4.
  8. Do TP, Heldarskard GF, Kolding LT, Hvedstrup J, Schytz HW. Myofascial trigger points in migraine and tension-type headache. J Headache Pain. 2018;19(1):84.
  9. Doraisamy K&, Gnanamuthu. Chronic Tension Type Headache and the Impact of Myofascial Trigger Point Release in the Short Term Relief of Headache. Glob J Health Sci. 2010;2(2):238–44.
  10. Fernández-de-las-Peñas C, Ge HY, Arendt-Nielsen L, Cuadrado ML, Pareja JA. Referred pain from trapezius muscle trigger points shares similar characteristics with chronic tension type headache. Eur J Pain. 2007;11(4):475–82.
  11. Fernández-De-Las-Peñas C, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA. Trigger points in the suboccipital muscles and forward head posture in tension-type headache. Headache. 2006;46(3):454–60.
  12. Palacios-Ceña M, Castaldo M, Wang K, Catena A, Torelli P, Arendt-Nielsen L, et al. Relationship of active trigger points with related disability and anxiety in people with tension-type headache. Med (United States). 2017;96(13).
  13. Quinn C, Chandler C, Moraska A. Massage therapy and frequency of chronic tension headaches. Am J Public Health. 2002;92(10):1657–61.
  14. Karimi, N. Tabarestani, M. Sharifi-Razavi A. Efficacy of Trigger Points Self-Massage in Chronic Tension-Type Headache: An Unmasked, Randomized, Non-inferiority Trial. Neurol Asia . 2021;26(February):323–31.
  15. Sedighi A, Nakhostin Ansari N, Naghdi S. Comparison of acute effects of superficial and deep dry needling into trigger points of suboccipital and upper trapezius muscles in patients with cervicogenic headache. J Bodyw Mov Ther. 2017;21(4):810–4.
  16. von Stülpnagel C, Reilich P, Straube A, Schäfer J, Blaschek A, Lee SH, et al. Myofascial trigger points in children with tension-type headache: A new diagnostic and therapeutic option. J Child Neurol. 2009;24(4):406–9.
  17. Melzack R, Stillwell DM, Fox EJ. Trigger points and acupuncture points for pain: Correlations and implications. Pain. 1977;3(1):3–23.
  18. Travell, J. & Simons, D. Myofascial Pain and Dysfunction: The Trigger Point Manual

We are continually adding more information on research and uses. Subscribe below to have us email them to you "hot off the press".

Dr Graeme

About Dr Graeme

Several years ago Dr Graeme, a Chiropractor practicing in Victoria, Australia was looking for a serious hand held massager his patients could use at home to get the extra quality massage they needed. The ones he found in the shops and on-line for home use looked nice but were not serious, and... read more



Other Articles You May Like

Your complete guide to (myofascial) trigger points

Trigger points are those tender lumps in muscles that therapists find. This article covers what they are, what they do, and how they are... Read Article  

An easy safe way to improve sleep quality while reducing anxiety, heart rate and blood pressure

A recent study published in the journal Asian Pacific Journal of Cancer Prevention showed that a simple 15 minute back massage each day... Read Article  

Do vertebrae get misaligned or go out of place

Although often described as “misaligned vertebrae” or “bones out of place” most issues that cause back pain actually involve abnormal... Read Article  

Should I get a massage gun or, or a vibration massager

You will find a well designed vibration massager easier to use, safer, and will do a much better job. This is because the scientific... Read Article