Friday 1st July, 2022

Your complete guide Pressure points and massage for headaches, with self help advice

Using pressure points for headaches
Scientists have successfully used pressure points to treat headaches. We show you how.

If you’ve got a headache it would be nice if you do some massage or press pressure points rather than rely on drugs or other therapies. The good thing is you often can. Scientists have identified easily treatable problems and done very successful clinical trials using simple techniques you can do at home. In this article we’ll show you how to do these yourself. The way we’ll do this is to:

Is your headache something that should be massaged?

We don’t want you doing massage or pressure points if you’ve really got a brain tumour or an aneurysm that’s about to burst. Because of that we’ll give you some general information here, but for specific advice you’ll need to ask a professional familiar with your own needs.

The types of headaches: primary and secondary

There are two main types of headache: primary and secondary.

Primary headaches

These are the main type of headaches. They’re caused by pain from structures around your head and neck, typically the muscles of your head, neck and shoulders, or the joints of your upper spine. They’re often called “tension” or “cervicogenic” headaches, but also include migraines. These are usually excellent candidates for massage or “pressure point therapy”.

Secondary headaches

Secondary headaches are caused by something else, such as tumours, aneurysms or a disease. These need care other than massage or pressure point therapy.

General guidelines

This is for general information only and not a substitute for a professional diagnosis.

  • If you see a GP and he or she tells you to go home and take some pain killing drugs he or she has likely concluded that you haven’t got something like a tumour or an aneurysm.
  • If you’ve had the headache for years and it’s been more or less constant it’s probably not caused by something nasty that needs urgent medical attention.

Where should you press or massage

There are two ways to work out where to press on massage for your headaches. For want of a better way of describing them we’ll call one the “recipe system” and the other the “scientific method system”.

Acupuncture points

The recipe systems (acupressure, shiatsu and various “reflex points”)

These are systems of points that have been developed over the years using clinical observations. As an example, several ancient cultures noticed a relationship between headaches and various points. Each culture made up a different name and story around these points, but because they were observing the same thing the points and clinical correlations are very similar.

The advantage of points such as acupressure, shiatsu or “reflex points”

This system is very easy, and backed by centuries of observations. If you massage or press on all the ones that are said to cause headaches it’s likely that at least some are involved.

The disadvantage of points such as acupressure, shiatsu or “reflex points”

The disadvantage with these is that there is no real diagnosis. There is no way of telling if various points are really involved, or if your massage or pressure point therapy has fixed them. For example, acupressure is supposed clear blocked life forces along meridians. These stories were made up long before science as we know it existed, and hypothetically if they were true how do you measure this life force to see if it’s blocked or whether your treatment has unblocked it?

Trigger point chart
Scientists have found these points in muscles and mapped what they do

The scientific approach

The scientific approach has been to actually identify abnormal points, then work out why they are different and how they cause problems. By doing that they actually found specific problems called trigger points in muscles that shoot pain when pressed upon. Scientists have since been able to do things like map where each trigger point typically refers pain to, producing charts such the one pictured. They have also investigated what causes these trigger points and how they are formed, which is vital information to help prevent or treat them.

The advantage of the trigger point approach

Understanding that the headaches are caused by trigger points gives huge diagnostic advantages.

  • We can use the charts to identify which muscles potentially contain trigger points that cause your headaches. Later we will show you an exact list produced by scientists for a clinical trial of headache treatment.
  • There is actually something “concrete” that can be found, identified, then tested to see if they are involved. Also, they are something that can be re-checked after treatment to see if the treatment has been successful.
  • By identifying a specific problem scientists have been able to work out how to treat them more effectively.

How to find these points

You have two alternatives.

Alternative one: using the recipe approach

If you wish to use a recipe system simply google something like "acupuncture points for headaches". If you do this you can still use the pressure and massage techniques we give here.

Alternative two: using the scientific approach

These points are called (myofascial) trigger points. In the next section we'll show you what they are, how to find them, and how to tell if they are a problem. These points are in muscles, so later in this article we'll go over each muscle one by one and show you where the points are and the best pressure/massage technique for each.

(Myofascial) trigger points

What are trigger points

We’ve got a lot more information about trigger points in a separate article. However, in summary they are a part of the muscle that has gone into spasm forming a lump. This causes the muscles to be abnormally tight, and causes a restriction in blood flow and a build up of waste products. Eventually trigger points can start referring pain as shown in the chart above.

How do you find trigger points

Trigger points are found by examining the muscles. We use trigger point charts and and lists of common muscles involved to help point us to where to look, then we use the examination techniques below to look for these three things.

  1. We find general tenderness and tightness around the trigger point.
  2. Trigger points can be felt as a tender lump within the tight muscle.
  3. When pressed upon the lumps can shoot pain, often mimicking your headaches.
Examining head muscles for trigger points
Examining the thin muscles covering of the skull. The pads of your fingers are used to examine for tightness, tenderness and lumps.
Basic examination technique (larger muscles)

Systematically examine each muscle using the flats of your fingers. If an area of tenderness or tightness is found use one or two fingers to examine more deeply looking for a tender lump that shoots pain when pressed upon. For muscles that can be squeezed rather than pressed upon use a similar technique, except squeeze rather than press.

Examination techniques for thinner muscles

Some muscles are very thin. These do not require deep pressure, and lumps can be very small and hard to find. Therefore, systematically examine the muscles with the pads of one or two fingers. Treat any area that feels tight or tender and maybe shoots pain when pressed upon.

How to do pressure point therapy or massage for headaches

Regardless of whether you use a recipe or a scientific way to find the “pressure points” to treat the way you treat them is the same. The only difference is scientific investigations has helped identify other and more effective ways to treat them in addition to traditional pressure and needles. The techniques we will show are:

  • pressure technique
  • vibration massage

Pressure techniques

Wilai stick for applying pressure for therapy
This mechanical tool was used to apply pressure in the clinical trial, but if you can reach you can use your fingers or thumb

Pressure techniques for larger thicker muscles

The common technique for trigger points or acupressure is to apply firm painful pressure for up to two minutes. Any time you are causing pain there is the potential to cause injury or harm, especially if you are not a trained therapist. Luckily scientists have found that applying just moderate pressure for 10 seconds and repeating for a total of five applications is very effective and certainly a lot more safe (1). A mechanical contraption was used to apply pressure in the clincal trial, but if you can easily reach the point you can use your fingers, thumb, or sometimes a pinching action.

Applying pressure to muscles covering the skull
Applying a pressure technique to "pressure points" in thin muscles covering the skull

Pressure technique for smaller muscles

Many of the muscles of the head, neck and jaw are very thin or overlay sensitive structures. Because of this we will give you a special modified technique. This an amalgamation of the techniques used and found to be very effective in several clinical trials (2–6)⁠.

  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.
Therapist using a pinching technique
Therapist using a pinching technique

Pinching technique

Some muscles are large enough and placed so they can be pinched, thus avoiding pressure on structures beneath the muscles. In these cases you can use a pinching action to both find the points and to apply the pressure. Use 10 seconds of pressure repeated five times as per the pressure for large muscles technique.

Vibration massage

Vibration massage treating trigger points
As this diagram shows vibrations penetrate and scientifically help "dissolve" trigger points or pressure points

What is vibration massage

As this diagram shows vibration massage is where you simply place a vibration massager over the point and let the vibrations penetrate. Scientists have found that these are excellent at treating trigger points or pressure points.

Applying a vibration massager
Basically to apply vibration massage you sit he head over the point and allow the vibrations to penetrate for 30 seconds

How to use vibration massage

Please check out our more complete guide to using vibration massage on trigger points and pressure points. However, as this pic shows you basically sit the head of an effective vibration massager over the point and allow the vibrations to penetrate for 30 seconds.

Please note that this will be the easiest and most effective method for larger thicker muscles, but not suitable for thin muscles that overlay sensitive structures.

You will need to keep repeating these treatments

As discussed in our article Why do trigger points keep coming back one or two treatments may provide temporary relief, but treatments will need to be continued to get rid of the problem. Again keeping in mind that this is general information to be discussed with a professional familiar with your own needs, you may need to repeat this daily until the tenderness has done, then less frequently but regularly to maintain your health.

List of problem muscles and points, and how to treat each

The scientists have found that pressure points or trigger points in the following muscles can cause headaches (2–4,6–11)⁠. In the following section 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

Upper trapezius muscles

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

Massage considerations

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

  • vibration massage (pictured above)
  • pressure techniques using pinching
Upper trapezius muscle with common points and pain referral
Upper trapezius muscle with common points and pain referral
Therapist using pinching technique on upper trapezius muscle
Therapist using pinching technique on upper trapezius muscle

SCM (Sterncleidomastoid)

The diagram below shows the SCM muscle with "x" marking the the site of common points and the red being where they 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 (SCM) muscle with trigger points and pain referral
Sternocleidomastoid (SCM) muscle with points and pain referral
The SCM muscle bulging
The SCM muscle seen bulging at the front of the neck

Suboccipital muscles

The diagram below shows the suboccipital muscles with "x" marking the the site of common points and the red being where they 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 and pain referral
Sub Occipital Muscle trigger points and pain referral
Therapist applying pressure to the sub occipital muscles
Therapist applying pressure to the sub occipital 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 any 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 avoid vibrating your skull.

Splenius Capitus Muscle with trigger points and pain referral
Splenius Capitus Muscle with points and pain referral
Self massage of the neck
Applying pressure to some neck muscles.

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 only use the pressure techniques for smaller muscles (pictured above).

Occipitalis and frontalis muscles with trigger points and pain referral
Occipitalis and frontalis muscles with points and pain referral
The Masseter Muscle with trigger points and pain referral
The Masseter Muscle with points and pain referral
The Temporalis Muscle with trigger points and pain referral
The Temporalis Muscle with points and pain referral

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

2

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

3

Eight 30 minute sessions of massage and trigger point therapy over four weeks

Excellent reduction in frequency of headaches

4

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.

5

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.

6

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. Wamontree P, Kanchanakhan N, Eungpinichpong W, Jeensawek A. Effects of traditional Thai self-massage using a Wilai massage stickTM versus ibuprofen in patients with upper back pain associated with myofascial trigger points: a randomized controlled trial. J Phys Ther Sci. 2015;27(11):3493–7.
  2. 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.
  3. Quinn C, Chandler C, Moraska A. Massage therapy and frequency of chronic tension headaches. Am J Public Health. 2002;92(10):1657–61.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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).
  10. Jaeger B. Are “cervicogenic” headaches due to myofascial pain and cervical spine dysfunction? Cephalalgia. 1989;9(3):157–64.
  11. 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.

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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



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