Maybe one of the most common conditions I have treated throughout my career has been headaches and migraines. I am not talking just simple once-in-a-while stress headaches (even though those do benefit from massage as well), but chronic, ongoing, life-disrupting headaches and migraines. I have had many clients who come in for their first session who suffer frequently (if not daily) from chronic headaches who have tried many different options for treatment, including strong medications to alleviate their pain, with no positive results. Unfortunately, it often seems like finding a cure for chronic headaches and migraines is like taking a stab in the dark, hoping to find a cure.
I would like to mention that there are many causes of chronic headaches and migraines. Certainly, allergies to certain foods, or chemicals can cause them. Also, more serious conditions like brain tumors and infections can have headaches and migraines as part of their symptoms. These are only a couple more serious causes, but I mention this to make sure that we as practitioners are aware that just because someone is suffering from this issue, does not mean that we have the only magical cure. We should be fully cognoscente that headaches can be a symptom of an underlying condition, and our good judgment should be used to refer out if something else is suspected.
This being said, I would like to talk about the Sternocleidomastoid (SCM) and its amazing ability to ruin some people’s lives…at least until us therapists get our hands on it.
The sternocleidomastoid is a unique muscle. It is one of the strongest muscles in the neck and has the ability to do multiple actions. These include contralateral rotation (rotation to the opposite side), flexion of the neck, and ipsilateral lateral flexion (lateral flexion to the same side). Last and certainly not least, it assists in forced inhalation due to its origin on the sternum and clavicle.
Because of its many different actions, the SCM is used a lot, thus putting it in line to be overused as well as used improperly. The most common form of this misuse presents in a forward head posture type of issue. When poor posture is present and the head travels forward, the natural tendency is for the SCM to shorten. This occurs because of its insertion into the mastoid process. As the neck becomes stuck in a flexed (forward) position, the upper cervical vertebra are forced to extend more in order to allow the head (and our vision) to continue looking ahead. This positioning automatically shortens the SCM (among other muscles), limiting cervical mobility and leading to a host of other issues.
So how does this affect the SCM directly?
When the SCM is chronically shortened down, it no longer has the ability to lengthen and stretch properly, continuing the cycle of limited mobility and forward head posture. Also, as the muscle is shortened for longer periods of time, it becomes more likely to develop adhesive tissue and trigger points due to overuse and chronic muscular tension. Once this atmosphere is present, it is only a matter of time before the threshold of acute trigger points is formed and pain and symptoms will begin to be felt.
Posture is not the only cause of trigger points in the SCM. Another one of the biggest contributors is whiplash. When whiplash occurs, the SCM muscles are usually injured. Of course, the severity of whiplash affects how much injury occurs in the muscles. In many cases which I have seen, whiplash is a main factor in chronic headaches and migraines. Straining of the cervical muscles (including the SCM muscles) create the environment for adhesive tissue, scar tissue, and eventually trigger points to form.
Once trigger points have formed, the health of the muscle continues to be affected and even decreases further the longer they are present. Chronic dysfunction will be continued and symptoms of trigger points will be felt. These symptoms are numerous in number and diverse in kind. Some are more common than others, but still possible to be felt depending on the severity and location of trigger points.
Sternocleidomastoid Trigger Point Symptoms
- Occipital Headache/Pain
- Frontal Headache
- Temple and Eyebrow Headache/Pain
- Cheek Pain (like Sinusitis)
- Brain Fog
- Ear Pain
- Tinnitus (Ringing in ear)
- Chest Pain
- Post-Nasal Drip
- Sinus Congestion
- Tearing of Eye
- TMJ Pain
- Throat & Front of Neck discomfort
- Visual Perception issues
The most common of these symptoms are headaches and migraines. However, all of these listed are certainly seen relatively frequently if trigger points are present in the SCM. However, in my experience headaches and migraines usually seem to be the primary symptom with other symptoms being ancillary. For example, a client may have headaches or migraines as their main pain symptom with sinus pressure, brain fog, and referral pain into the jaw as their secondary symptoms. Many times, your client will be unaware of the secondary symptoms as being connected to the same root problem.
The overuse due to posture and the limited mobility of SCM due to potential injury makes it possible for clients to suffer from chronic ongoing trigger point symptoms for months and even years. Often, these same people are ones who have suffered from chronic debilitating migraines, sometimes occurring daily. This is truly a life-altering and limiting condition which is, unfortunately, relatively common. I have talked to many clients who have suffered from headaches and migraines for years without any relief, even after medications, diet changes, and a multitude of tests. The unfortunate fact is that SCM trigger points are commonly overlooked, and certainly not treated by western medicine.
Certainly, SCM trigger points are not the only cause for headaches and migraines. They are not even the only muscle which can cause them. However, they are so commonly related to this type of pain that, in my opinion, they should be assessed every time a new client comes in with chronic headaches and migraines. Successful treatment of the SCM can bring real relief to clients who have suffered for a long time. The change can be a little surprising. This is especially true if they have had a few different symptoms listed. Chronic migraines, brain fog, and chronic sinus congestion simply going away as a result of successful trigger point treatment is potentially a life-changing experience. It may sound strange, but for someone who has experienced chronic migraines and headaches, and knows how debilitating they can be, relief is dramatic.
As a closing note, treatment of SCM trigger points can take many sessions. SCM trigger point therapy can be intense during treatment because the symptoms can be highly intensified before they relieve. These can include dizziness, nausea, and elevated pain in the head. Because of this, treatment must be done slowly and to the client’s tolerance. Also, numerous trigger points can be present which, of course, takes time to treat all of them. I would highly recommend treating over a course of multiple sessions and only doing maybe 15 minutes at a time.
Also, addressing other involved muscles is a necessity. While the SCM muscles are important, scalenes trapezius, suboccipitals, semispinalis cervicis and capitis…etc. are all important. This is not only true for posture but for specific headache symptoms as well.
Along with the treatment provided to the client, I would suggest a stretching regimen to help lengthen the tissue. This is important when posture has been an issue for an extended period of time. Daily stretching to the tissue can help re-educate it to maintain a lengthened state and better posture. Once flexibility is gained, muscle health improves and trigger points can improve. Here are links to stretching which I would recommend.
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