Chronic Headache Trigger Points

Headaches are among the most commonly treated problems in medical practice. 

In this post Paula Morgan reviews - “Myofascial Trigger Points and Their Relationship to Headache Clinical Parameters in Chronic Tension Type Headache”

There are several types of headaches with tension type headache being very frequent in the adult population. It has been reported that pain from the head, neck and/or shoulders can refer/ radiate to the head regions resulting in a headache. Myofascial trigger points have been identified as a potential cause of this pain which can lead to tension type headache.

What is a myofascial trigger point?

A myofascial trigger point is a hyper-irritable area within a band of taut muscle (Fernandez-de-las-Penas 2006). It is painful on palpation (with moderate pressure) and can lead to a referred pain distribution.

There are two types of trigger points - active and latent

Latent trigger points are present in the healthy, non-symptomatic individual and may not be an immediate source of pain – in other words there is a trigger point present but it is not causing a pain complaint. However at times they can lead to restricted range of movement and other muscle dysfunctions such as reduced control/ strength and fatigue.

An active trigger point presents with clinical symptoms including local pain, referred pain and muscle dysfunction – in this case the trigger point is causing a pain which may cause the sufferer to seek treatment. Such active trigger points in the neck and shoulder muscles have been associated with the referred pain patterns observed in those suffering from tension type headaches.

Tension type headaches - related muscles

The referenced article describes a scientific study which looked into the presence of trigger points in several head and neck muscles in patients with chronic tension type headaches (Fernandez-de-las-Penas et al (2006).

The muscles investigated included

  • the upper trapezius (running from the top of the neck to the collar bone)
  • the sternocleidomastoid (at the front of the neck, running from the sternum/clavicle to the temporal region of the skull)
  • the temporalis muscle (running from the temporal region of the skull to the jaw)

Cause - forward head position

This study looked at whether trigger points in these muscles are more likely to develop with a faulty forward head posture position. This is a posture misalignment problem where the chin tends to poke forwards, often with rounded shoulders.

If trigger points are present, are they active or latent? And what impact this has on the severity and duration of the pain symptoms.

This study found that all those with a forward head position had trigger points. The more pronounced the forward head position the more likely the trigger points would be active and produce pain (resulting in a tension type headache) - which would be of greater severity and last longer.

There were some limitations to this study including the small sample size of 50. Additionally those selected were chronic sufferers. Therefore the results obtained cannot be related to episodic tension type headaches or to other headache disorders such as migraine. However a definite link has been recognised between trigger points in these particular neck/shoulder muscles and chronic tension type headaches.


The good news is that this problem can be treated, and thereby bring relief to many suffering from tension type headaches. An integrated approach making use of both medical acupuncture/ dry needling and soft tissue release to treat such trigger points combined with specific exercises to address the posture problems which may have caused the problem in the first place. This approach to trigger point release can be used on the treatment of many muscular dysfunctions throughout the body.

Reviewed Article: 

Myofascial Trigger Points and Their Relationship to Headache Clinical Parameters in Chronic Tension Type Headache ( Fernandez-de-las-Penas C, Alonso-Blanco C, Lyz Cuadrado M & Gerwin RD ( 2006) Headache 1264-1272).

By Paula Morgan BSc (Hons) MSc Physiotherapy MISCP
Paula holds a Masters Degree in Physiotherapy and a BSc in Biomedical Science. Paula incorporates the use of medical acupuncture with her manual therapy skills and is also an APPI Pilates Instructor leading regular Physio Pilates classes at Mount Merrion Pilates Studio.

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