Trigger Points and headache – Fakery or Fact?

Has this happened to you?  You have a headache, and a friend says,"Here, just press your finger there and it will help you feel better".  They explain to you that it’s a trigger point, and that they learned all about it from their Mom/massage therapist/Uncle Frank.  So what is all this Trigger Point Therapy stuff?  Is it just folk remedy mumbo-jumbo, or does Uncle Frank know what he’s talking about?

I’ll tell you right up front – Frank is not completely out to lunch.  Still, he may be confused about exactly what trigger points are.  But trigger point therapy is a real and well researched treatment, with great potential to keep the pain in your head away.

Muscles

To understand what trigger points are, you need to understand how muscles work.  A muscle’s job is to contract.  So how does it do that?

Your muscle is made up of bundles of cells called fibres (fibers), smaller around than one of your hairs.  A fibre contains myofibrils, which are made up of protein filaments.  These proteins slide past each other, which causes the "contraction" or movement of your muscle.  This complex system in the myofibril is called a sarcomere.  (we’re focusing on skeletal muscles here – other types are arranged differently)

We could get a lot more complicated, but I just want you to remember these tiny sarcomeres are contracting, and that means the muscle is contracting.

When trigger points appear

So when we’re talking about trigger points, (more properly mayofascial trigger points or MTPs) what do we mean?  Once in a while, these sarcomeres go crazy.  A bunch of them all contract together – a part of the muscle contracts, as opposed to a full muscle cramp.  The muscle actually ends up in a tug-of-war with itself, meaning that some of it is pulled together, and some is stretched tight.  The patch of clenched muscle actually gets very sick, actually cutting off its own blood supply.

Now the problem is you can’t really use the part of the muscle that’s "stuck" like this.  You can’t strengthen it, you can’t stretch it – it just stubbornly folds its hands and refuses to do anything.

Where do they come from?

People who have regular headache or migraine attacks will appreciate this one – we have an idea what gets them going, but in the end they’re very unpredictable.  Certainly an injury or poor posture can aggravate a muscle.  But there are also major trigger points that seem to appear out of nowhere.  Or, pain itself could actually trigger them – chronic headache, anyone?

Tracking down trigger points

So is that what we call a knot, or a tight band?  Well, it could be.  But the truth is, you can’t always feel trigger points, and sometimes something that feels like one isn’t.  A trigger point could actually be tiny – even microscopic – making it very tricky to find!

The most common way to identify trigger points is how they feel to the patient – they’re often sensitive and painful – but strangely it’s a "good pain" – there’s a feeling like release when the trigger point is worked on.

Trigger points and your head

Trigger points and headaches

There are a lot of things going on in a trigger point.  Not only is the muscle tissue unnaturally contracted, there is also a soup of metabolic waste around the area.  These acidic chemicals could have a lot to do with the pain – and may show why the problem of trigger points goes beyond the exact area.

MTPs not only cause pain where they are, they can mysteriously cause pain in other parts of the body.  Just because you have pain in the back of your head doesn’t mean the MTP is there – it could be in your lower trapezius muscle – in the middle of your back!

What kinds of signals are these chemicals sending to the rest of your body?  We don’t understand everything that’s going on, but we do know that migraine, for example, is tightly connected to the pain signals and sensitivity of your body.  Recent studies have shown that a) migraine patients very often have trigger points related to their areas of pain (Calandre et al. 2006) and b) working on trigger points can improve quality of life for those with chronic migraine, especially helping with the headache pain people often get between the major attacks (Jensen et al. 1988).

Ignoring mayofascial trigger points

Ignoring these problems is not a good idea.  In fact, if left long enough, serious MTPs may cause permanent damage.

The researchers in the study mentioned above discovered that people who had had migraine symptoms longer also had more trigger points.  That’s right, it looks like there is a cumulative effect!  The pain of a headache may bring on MTPs which can trigger more headaches…  More evidence that you should not just "hope the problem goes away" – whether it be chronic headache, migraine, or the trigger points themselves!

Coming up

This is the first post in a series on mayofascial trigger points and headache.  Later on, we’ll go more in-depth on how trigger points may be involved in the cluster headache, migraine or tension type headache scenerio, how they can be treated, and what you can do on your own to fight back.  Stay tuned!

Fakery or fact?

Fact, but regularly misunderstood or ignored.  To quote Paul Ingraham, Registered Massage Therapist and trigger point researcher/writer:

Trigger points are not a flaky diagnosis.

You can take photomicrographs of them, measure their electrical activity, take samples of their acidic and toxic tissue chemistry, and a new MRI-like technology can now show them as well.  They rest on a bedrock of thousands of scientific papers published in mainstream, peer-reviewed medical scientific journals.   Detailed charts of the patterns of pain that they cause, as seen at the right, are widely available.

The pioneers of trigger point research still are and always have been medical doctors like Janet Travell1, David Simons, Siegfried Mense, and Chan Gunn.

You can take pictures of trigger points, and take samples of their toxic tissue chemistry.

So, I repeat, the existence and importance of trigger points is not scientifically controversial.  The problem is educating health care professionals and getting the word out.

Paul Ingraham from his article Save Yourself from Trigger Points and Myofascial Pain Syndrome!

Credits/To find out more

Some of the sources I consulted for this article:  An overview of how muscles work here.  Study New Views of Myofascial Trigger Points: Etiology and Diagnosis, and definitive manual (for professionals) Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual, materials from Paul Ingraham including this article on the physiology of sarcomeres, and Trigger Point Therapy for Headaches & Migraines: Your Self-Treatment Workbook for Pain Relief by Valerie Delaune.

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14 comments… add one
  • Beth Sep 2, 2008

    Very interesting. I’ve had experience (very limited) massaging the temples of people with bad headaches. Sometimes it’s given fairly quick relief. This gives me more information than I knew before.

  • Cory Sep 13, 2008

    Wow – these trigger points are the real deal. Sometimes the wrong pillow with not enough support under my neck can activate trigger points and then activate a migraine. Oh – as we all know: it’s not fun to wake up behind the eight ball with a full blown migraine raging. Then it is damage control for me like: migraine meds, anti-nausea meds, hot packs on upper back, ice on sub occipitals at base of skull, deep breathing and no lights in the room for the physical component. And listening to a quiet, soft mediation cd to shift the migraine mentally. Then once the migraine eases up a bit I use my miracle balls & a theracane to start pressing on those trigger points to release them. Do consult with a doctor or physical therapist that can teach you how to properly apply pressure on the trigger points so that it effectively releases and you don’t injure yourself. I am just a fellow migraine friend sharing what helps once it is in full swing from a bad pillow night. However I have not figured out how to avert the post dromal fatigue after the migraine.

  • jerry pritikin Sep 22, 2008

    For me, the main trigger has been great weather changes… a few years ago( looking for help) I went to the Diamond Headache Clinic in Chicago, and was told that weather headaches were a “Red Herring”! Needless to say… I left. In the past, I had bad reactions to a medicine called TOPAMAX… at the time it was prescribed to me, it was not yet approved by the FDA for Migraine… and was a Epilepsy medicine… In a few days, I lost the feeling in my left hand and it made food and soft drinks taste terrible. I was told I would get back to norman after stopping the drug. Years later, I still have tingling in my hands and arms and my taste was never the same. Ironically, I have seen that drug touted for losing weight or for alcohol problems on mainstream national newscast… and I can understand why… it made food and drink taste like crap! I still get weather related headaches… but I try to cope with them without any prescribed drug.

  • pen Sep 22, 2008

    I have Fibromyalgia. I don’t know which is cause and which is effect.
    I have migraines every 5 days or so and they , or the aftermath can last up to 8 days. I have little quality of life, and cant plan for anything. I am out of ideas…Where am i going with this….
    Well I think some of my pain is myofascial. Today I cant turn my neck without pain, my husband had to park the car. I have almost constant pain in the right side of my head from the occipital on up.
    I would so like to find out if anyone can help with these trigger points.
    I live in England, no one seem to be very clued up o them.
    I feel sure if I could deal with these I would be a lot better.
    Most of my migraines come on in the night. I have tried every posture, amount of pillows etc, but still’they come.
    I cant help but feel this is a trigger point problem but cant prove it, nor find out how to deal with it.
    thanks for featuring this.

  • Kathy Sep 24, 2008

    Hi Pen,
    Your migraines may very well have to do with what you are unintentionally putting in your body in regards to food and drink. I have battled migraines for over 20 years and have done every elimination diet that I came across. Then a very nice girl from England (I live in Canada) that I met online through a migraine group on Face Book, urged me to go see a herbalist/natural healing consultant. That was the best advice and the best $75 I’ve spent in my life! The herbalist put me on a 30 day cleanse, which wasn’t hard to do but she aslo told me to get off of all Caffeine. Including tea, chocolate and colas. I had kicked the coffee habit before for a month but there was no change in my migraine patterns. When I elimanated all caffeine in my diet my migraines dissappeared!!!
    I started to feel considerably better within a week of the cleanse and thats when my migraines actually stopped. Hope this helps 🙂

  • James Sep 30, 2008

    Oops – thought I already commented here, but apparently not! 🙂

    Thanks for the input, Cory. Certainly one of the keys to keeping the post-migraine symptoms to a minimum is to do all you can early in the attack.

    Jerry- I’m convinced that weather changes do bring on migraine attacks. The reason the clinic may have told you it’s a “Red Herring” is because it’s so hard to use that knowledge to avert the attack. For me, migraine attacks from a change in barometric pressure are the hardest to treat.

    Pen – I think Trigger Points are worth looking into for you. You need a good massage therapist who has really studied them, and who also is familiar with fibromyalgia. I’ll try to get on with the series as soon as possible – hopefully that will help equip you to find someone!

    Kathy is also right about food and drink. I think this is one of the most important basic things you can do for migraine. Search around this site for more.

    There are lots of things to try – be patient and don’t give up!

  • Wow, cool – getting quoted on the internet! The cumulative effect mentioned above is called “central sensitization” and there is a lot of research going on in that area right now in all pain syndromes – the central nervous system gets involved, and pain becomes a self-perpetuating process. And Paul I is correct – the existence of myofascial trigger points (that’s the correct spelling) is not controversial, the biggest problem is getting the word out. I don’t think any practioner can treat pain syndromes effectively without understanding trigger point referral patterns. And Pen – keep trying. I get almost as many book-on-CD ROM sales from the UK as I do from the U.S., and Lotus Publishing is located there and specializes in trigger point books, so I know there are practitioners who know about trigger points. Both of my books address Fibromyalgia. There are always trigger points concurrent with FM. And thanks to James for this website!
    Valerie DeLaune, LAc

  • jessica pitt Jul 8, 2012

    I have been getting cluster migraines for 35 years I am getting botox treatments plus some ()%”# medicine to take the edge off the pain. What is this new thing they are treating migraine with by massaging trigger points?

  • Jessica – there is nothing new about trigger points. They have been researched since the 1930’s, and there are a lot of scientific studies. I have written a book on trigger points and headaches/migraines (see http://triggerpointrelief.com/). Chances are you can get a lot of or complete relief from treating trigger points and resolving the perpetuating factors.

  • Chris BeHanna Nov 3, 2012

    I get triggerpoints all the time. They are usually located in the trapezius shoulder and neck area. They tend to be more painful on one side—typically my left; however, I find I also have some pretty bad ones on the right. I get a lot of relief from using a Ther – A – Cane to get at the triggerpoints in my shoulders and back. However, I find that it only provides temporary relief, and the exercise has to be repeated frequently throughout the day to postpone – not avoid – a migraine attack.

  • Chris – there are likely additional trigger points in other muscles that are involved that you aren’t treating, like the sternocleidomastoid and the temporalis muscles. You also likely have perpetuating factors that need to be addressed for long-term relief.

  • Gail Falzon, RN May 2, 2013

    During my own traumatic life event, I discovered that my 24/7 headaches were indeed trigger point related. I was taught how to go INSIDE my mouth to inactivate the TPs. This changed my life in such a profound way, I’ve spent well over 10 years researching and treating. I had to find a way to help everyone out there so I developed the MyoFree Solution which is a self-help “kit” to teach you step-by-step how to treat yourself whether you have TMJ (jaw disorder), headaches or atypical face pain/neuralgias. If you have this knowledge along with Valerie DeLaune’s book, you can help yourself and…take back your life! See http://www.tmjpainsolutions.com for more information.

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