Headaches are often classified into migraines, cluster headaches, tension headaches and cervicogenic headaches. A less well-known type is nummular (coin-shaped) headache, which as its name suggests occurs in a small area. Headaches can be very disabling and worrisome, causing fears about a brain tumor or other serious condition.
Traditionally these headaches have been thought to have different causes and they are usually treated differently. However, many doctors believe that myofascial trigger points (hypersensitive areas in muscles) may be a factor in all types of headaches. Even if you don't think you have such trigger points, you may be wrong.
Trigger Points and Headaches
Many migraineurs have noticed soreness in their scalp or facial muscles and people diagnosed with tension headaches are often aware of having a stiff neck or shoulder trouble, but often the trigger points can be in a muscle you would not associate with headaches at all.
The most insidious thing about myofascial trigger points is the way they can refer pain - always in a predictable pattern, but most doctors don't know these patterns. A trigger point in the back can cause pain in the leg. Similarly, trigger points in the back, shoulders and chest can manifest as headaches, even in the absence of pain in the affected muscle.
Common trigger points causing headaches are in the jaw (which may be caused by something as mundane as excessive chewing of gum), often diagnosed as temporomandibular joint dysfunction (TMJ/TMD). Another common one is at the top of the side of the neck, right below where the chinbone ends.
Treatment
Myofascial trigger points are luckily treatable, which usually reduces headache frequency or may even eliminate them altogether. Instead of pills the best treatments involve physical manipulation of the trigger points (by massage, acupuncture or other means), sometimes injections directly into them.
The best way to locate the trigger points is to palpate your head (face and scalp), neck, shoulders, upper back and chest for sore areas. If you find a trigger point, chances are there are others nearby. Once you find the trigger points you can apply self-massage into them. Some of the deeper jaw trigger points may have to be located (and massaged) with fingers inside the mouth.
Studies show that various trigger point treatments can significantly reduce headache frequency, intensity and duration no matter whether you suffer from migraine, chronic tension headache, cluster headache or nummular headache.
Traditional trigger point injections using lidocaine have been helpful for headaches in many studies. In a small trial they helped about 85% of patients suffering from cluster headaches. Many migraine studies have got similar results. In one study trigger point acupuncture proved as effective as the common prophylactic drug metoprolol (a beta blocker) in migraine prevention, but was better tolerated.
On the other hand, there is mixed evidence of the efficacy of botulinum toxin injections into trigger points. They may provide longer-lasting relief than lidocaine, but are also much more expensive. There is promising preliminary evidence of efficacy of the use of gonyautoxin injections.
References
Travell J, Simons D. Myofascial Pain and Dysfunction: The Trigger Point Manual. 1983.
Fernández-de-las-Peñas C, Schoenen J. Chronic tension-type headache: what is new? Curr Opin Neurol. 2009 Jun;22(3):254-61.
Calandre EP, Hidalgo J, Garcia-Leiva JM, et al. Myofascial trigger points in cluster headache patients: a case series. Head Face Med. 2008 Dec 30;4:32.
Giamberardino MA, Tafuri E, Savini A, et al. Contribution of myofascial trigger points to migraine symptoms. J Pain. 2007 Nov;8(11):869-78.
Hesse J, Møgelvang B, Simonsen H. Acupuncture versus metoprolol in migraine prophylaxis: a randomized trial of trigger point inactivation. J Intern Med.1994 May;235(5):451-6.
Lattes K, Venegas P, Lagos N, et al. Local infiltration of gonyautoxin is safe and effective in treatment of chronic tension-type headache. Neurol Res. 2009 Apr;31(3):228-33.
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