Myofascial Trigger Points and Tension Headaches

Is a tender knot in your upper back, neck, or shoulder the culprit behind your headaches? Let's take a closer look at this interesting phenomenon.

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.

A trigger point may also be painful at rest (this is called an active trigger point). A latent trigger point, on the other hand, does not produce spontaneous pain, but it may limit a person's range of motion in that area or cause muscle weakness.

In addition, 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.

It's not totally clear how trigger points develop, but experts guess that it's likely a result of injury to the muscle tissue. Sports injuries, post-surgical scars, and even workplace activities that place 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 doctor 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 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.

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 to chronic tension-type headache in some people.

One type of therapy sometimes used to treat headaches associated with myofascial trigger points is a type of massage called trigger point release massage. This massage focuses on easing the clenched, knotted muscle.

A 2015 study explored the effectiveness of trigger point release massage in alleviating tension-type headaches. In this six-week study in The Clinical Journal of Pain, 56 participants with tension-tight headaches were randomized to undergo either 45-minute trigger-point release massages twice a week or 45-minute placebo massages twice weekly. The trigger-point release massage focused on major muscles in the upper back, neck, and lower head.

For placebo, the participants underwent "detuned ultrasound," which means a sham procedure that provides no real treatment. The study was double-blinded meaning that both the participants and the ultrasound technicians were unaware that the ultrasound device used was not functional.

Study results revealed that participants had a decrease in headache frequency from their baseline (before the study began) for both the trigger-point massage and placebo. There was no statistical difference between the two groups, though, so trigger-point massage was not found to be better than placebo.

However, 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 was not altered in either the massage group or the placebo group.

What do these results mean? It's hard to say, as placebo worked just as well as the real massage. One could speculate that simply undergoing an intervention helps headaches, although the mechanisms are likely different between placebo and trigger point release massage.

It also may be an individualized process, meaning massage may work for some and not for others. A person has to test out the massage for themselves until more is known about the link between headaches and myofascial trigger points. 

In the end, more studies examining the role of trigger point release massage in reducing headaches would be helpful.

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 doctor though—headaches are complex, and it's likely that there is more than one contributing factor at play.