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
Self massage and pressure point therapy for headaches
Massage or “pressure point” therapy has given excellent relief of headaches in clinical trials. In this article we will show you how to do this at home, including:
- where to apply the massage or “pressure point “therapy, and
- the simple techniques you can easily do yourself.
CONTENTS
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, so please check out the guidelines below. Standard disclaimer: this article is for general information only. For specific advice please see a professional familiar with your needs.
An overview of the points
Most videos and articles give inadequate advice
Most articles on pressure points for headaches just give a small number of acupuncture based points. The problems with this are:
- there is no way of knowing whether these points are involved or not, and
- scientists have identified 9 different muscles that contain points that commonly cause headaches, and each muscle has multiple possible points.
Giving a hand full of acupuncture points makes for great “click bait” headlines, but with only a fraction of the potential points and not knowing if they are actually involved any relief will usually be incomplete and short lived. In this guide we will show you all 9 muscles. It sounds a lot, but don’t worry though. In our video demonstration we will show you a simple routine where you can examine all in under a minute.
About the “pressure points”
The points we are looking at have been around for ever. When ancient civilisations found them without the scientific knowledge we have today they came up with things like acupuncture meridians and “life forces”. More recently scientists have identified the same points, calling them (myofascial) trigger points, or trigger points for short, and giving them proper scientific analysis.
That’s made a huge difference. We can now properly identify them and see if they ‘re involved or not. Even more importantly it’s enabled better ways of treating them to be developed.
How to find the points
Overview
The scientists have found:
- that trigger points are tender lumps within tight bands of muscle that shoot pain when you press on them, and
- developed charts like these that show where each point shoots pain to.
So, the way we find trigger points is to use the charts to see where to look, then examine looking for the tight muscle, tender lump and the shooting pain. In the next section we will show you the examination techniques, then show you where to look in the section on individual muscles and points.
Video demonstration
Please note that later in this article we have a video of Dr Graeme demonstrating all the procedures.
Simple examination techniques to find trigger points
The 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. Often this shooting pain will mimic your headaches, confirming the points are part of the problem.
Technique 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.
The simple techniques you can do yourself
The muscles containing headache producing points vary from thin muscles that overlay your skull through to the much thicker muscles on top of your shoulders. Because of this we will show you several effective techniques.
Video demonstration
Please note that later in this article we have a video of Dr Graeme demonstrating all the procedures.
Basic pressure techniques (larger muscles)
Therapists have found that if you apply pressure to these points they will gradually fade. Therapists often use prolonged painful pressure, but a trial has found that repeated moderate pressure is very effective (1). To do this all you need to do is apply moderate (not painful) pressure for 10 seconds, then repeat for a total of five times. In the video we show you three ways to apply this pressure.
- direct pressure with fingers
- pinching
- using a tool (note: not a ball or roller )
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).
- 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.
- 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.
- Finish with about 5-10 seconds of gentle rubbing using a circular motion about 1 cm in
diameter.
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
We have mentioned that scientific investigation has helped scientists understand these points and work out better ways to treat them. The best example is vibration massage. For this all you need to do is place the head of a vibration massager ( not a massage gun ) over the trigger point, and as this picture shows the vibrations penetrate, relaxing the muscle, increasing blood flow and helping flush out waste products. This method is the best by far for larger muscles, but is not suited for the very thin muscles and you need a proper massager . For more info please see our article How to treat trigger points .
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.
Video demonstration by Dr Graeme
Individual muscles and points
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.
Upper trapezius
SCM (Sterncleidomastoid)
Sub occipital
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
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.
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.
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.
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).
Other massage and trigger point therapy articles
If you found this useful please check out our other self massage and trigger point therapy articles.
Massage And Trigger Point Therapy For Low Back Pain, With Self Help Options
Massage And Trigger Point Therapy For Calf Pain, With Self Help Options
Massage And Trigger Point Therapy For Shoulder Pain, With Self Help Options
Self Massage And Trigger Point Therapy For Tennis Elbow
Trigger Point Therapy For Fibromyalgia: Inc. Self Help Advice
Self Massage For High Blood Pressure
Self Massage For Anxiety
Reference: 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 |
|---|---|---|
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 |
|
Eight 30 minute sessions of massage and trigger point therapy over four weeks |
Excellent reduction in frequency of headaches |
|
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. |
|
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. |
|
Self trigger point therapy three times a day for four weeks. |
Intensity, frequency and duration of headaches and use of medications all reduced |
References
- 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.
- 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.
- Quinn C, Chandler C, Moraska A. Massage therapy and frequency of chronic tension headaches. Am J Public Health. 2002;92(10):1657–61.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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).
- Jaeger B. Are “cervicogenic” headaches due to myofascial pain and cervical spine dysfunction? Cephalalgia. 1989;9(3):157–64.
- 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.
APPENDIX
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
This are the main 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 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 you needs urgent medical attention.
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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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