Myofascial Trigger Points and Tension Headaches

A myofascial trigger point, which is a tender knot in the upper back, neck, or shoulder, can be the culprit behind tension headaches. While there are many different causes of tension headaches, a myofascial trigger point has specific treatments to help alleviate your pain.

This article will explain how to recognize myofascial trigger points, their link to headaches, how they develop, and how you can get treatment and prevent them from coming back.

A woman rubbing her right shoulder
Patrik Giardino / Getty Images

What Is a Myofascial Trigger Point?

A myofascial trigger point—sometimes just called a trigger point—is a tight knot located within a taut muscular band. The knot or nodule can be distinctly felt underneath the skin and is tender when pressed or when external pressure is applied.

It can cause pain at different times:

  • A trigger point can be painful at rest. This is called an active trigger point.
  • A latent trigger point does not produce spontaneous pain, but it may limit a person's range of motion in that area or cause muscle weakness.

When pressure is applied to the knot, the taut muscular band which holds the knot contracts. This contraction or spasm creates a twitching of the muscle that can be felt or seen.

How Do They Form?

It's not totally clear how trigger points develop, but they can develop after an injury to the muscle tissue. Sports injuries, post-surgical scars, and repetitive stress on certain muscles (for example, sitting at a desk with limited back support) may be potential culprits.

While there is no specific laboratory or imaging test to diagnose trigger points, a healthcare provider can usually diagnose it with a thorough physical examination. That being said, imaging and blood tests may be required to rule out pain conditions that mimic the symptoms of myofascial trigger points in the neck, shoulder, and head muscles.

While not an exhaustive list, some examples of these conditions include:

  • Inflammatory arthritis
  • A cervical disc problem
  • Shoulder tendonitis

Fibromyalgia also causes tender points (not to be confused with trigger points), but there is no associated referred pain—a key distinction.

Trigger Points and Tension Headaches

When a trigger point is located in the neck, shoulder, and head muscles, it can cause referred or spreading pain that creates the same pain pattern as that of a tension-type headache.

Moreover, some experts believe that prolonged pain input from myofascial trigger points can sensitize the central nervous system, making it more easily excitable or more vulnerable to pain nerves firing.

This suggests that trigger points in the neck and shoulder area may lead to the transformation from episodic tension headaches to chronic tension-type headaches in some people.

Treatment of Myofascial Trigger Points

Several different treatments may used for myofascial trigger points. These include injections, which are minimally invasive, and external massage, which is non-invasive. If you have tension headaches that seem to be associated with a myofascial trigger point, you and your healthcare provider can discuss whether any of these options could be appropriate for you.


One type of injection, targeted trigger-point injections using isotonic saline, was found to be safe. In one study, participants with chronic tension headaches who received four sessions of injections reported a more significant improvement in symptoms and quality of life than participants who received fewer than four sessions. The researchers noted that the participants who received fewer than four sessions also experienced improvement.

A small study examined the effects of dry needling, which involves the placement of a needle into a trigger point, without injection of any substance. Participants with tension headaches who received this type of treatment reported significant improvements in symptoms after one session.


A trigger point release massage, which focuses on easing the clenched, knotted muscle, has also been found to be useful for treating tension headaches that are associated with myofascial trigger points.

A six-week study included 56 participants with tension headaches who were randomized to undergo either 45-minute trigger-point release massages twice a week or 45-minute placebo massages twice weekly. The participant's self-report of their perceived pain revealed a greater reduction in pain for the massage group versus the placebo group. Headache intensity and duration were not altered in either the massage group or the placebo group.


You can develop a myofascial trigger point again after treatment, especially if it was caused by factors such as repetitive movements. That's why it's important to discuss ergonomically safe seating and lifting if you tend to repetitively strain your muscles, such as at work.

Another way to prevent a trigger point is to regularly stretch your muscles to counteract potential problems. Ask your physical therapist for guidance about stretches and exercises that you can do to prevent tense muscles.

A Word From Verywell

The precise connection between tension-type headaches and myofascial trigger points is still unclear. If you think a trigger point may be a culprit in your headaches, attempting trigger point release under the care of a healthcare provider may be a sensible approach.

Talk with your healthcare provider though—headaches are complex, and it's likely that there is more than one contributing factor at play.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Shah JP, Thaker N, Heimur J, Aredo JV, Sikdar S, Gerber L. Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. PM R. 2015;7(7):746-761. doi:10.1016/j.pmrj.2015.01.024

  2. Moraska AF, Stenerson L, Butryn N, Krutsch JP, Schmiege SJ, Mann JD. Myofascial trigger point-focused head and neck massage for recurrent tension-type headache: a randomized, placebo-controlled clinical trial. Clin J Pain. 2015;31(2):159-68. doi:10.1097/AJP.0000000000000091

  3. Cho SC, Kwon DR, Seong JW, Kim Y, Özçakar L. A pilot analysis on the efficacy of multiple trigger-point saline injections in chronic tension-type headache: A retrospective observational study. J Clin Med. 2022 Sep 15;11(18):5428. doi:10.3390/jcm11185428

  4. Mohammadi Z, Shafizadegan Z, Tarrahi MJ, Taheri N. The effectiveness of sternocleidomastoid muscle dry needling in patients with cervicogenic headache. Adv Biomed Res. 2021 Feb 26;10:10. doi:10.4103/abr.abr_138_20

Additional Reading

By Colleen Doherty, MD
 Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis.