Why am I getting headaches when I make long phone calls?

From a reader:

Why am I getting headaches when I make long phone calls? Why do they last up to a week before the pain starts to go away? It’s hard to get to sleep with such pain, and even when I do sleep, the pain is still there when I wake up. Is this dangerous for me? Are there any health concerns?

My answer:

First, you should definitely see a physician. Make that appointment ASAP! 😉

That being said, a likely scenario is activated trigger points in the muscles of the neck and shoulder (most likely the upper trapezius, splenius capitus, splenius cervicis, and suboccipitals). These are the muscles that produce this very familiar posture:

Headaches from long phone calls

How often do we see and DO this on any given day? This action strains the muscles and the connective tissue (myofascia) mentioned above because they are probably not used to, and are definitely not “designed for,” the sustained contraction shown above.

Let’s go through the pain patterns that emerge when these various muscles undergo repetitive strain (which leads to active trigger point referral patterns):

1) Upper trapezius:

Pain in the upper trapezius muscle

2) Splenius capitus:

Splenius capitis

3) Splenius cervicis:

Splenius cervicis

4) Suboccipitals:


(Credit for all of these medical illustrations belongs to Barbara D. Cummings, the illustrator for Travell and Simons’ “Trigger Point Manual.” She had an extraordinary gift for giving the viewer an accurate, literal view of subjective pain.)

ALL of these muscles are engaged in the posture in the first picture, where someone is holding a phone between their head/ear and their shoulder. You have to hold it there somehow, right? Well, these are the muscles that do it for you, and they are most probably strained and activated through prolonged, static holding of this posture.

The most obvious way to help prevent this from happening again is by correcting the problematic posture that strains these muscles:

  1. Keep your head upright and your neck straight on prolonged conversations.

  2. Switch which hand holds the phone, so that you are not constantly loading the same muscles on the same side (thereby straining them). Give them a rest by using the similar muscles on the opposite side, then switch again when they get tired.

  3. Give yourself a few moments to slowly take your head and shoulders through their comfortable range-of-motion, in order to restore circulation and re-establish normal resting length for the muscles. This involves making SLOW circles, or moving the head in opposing directions (i.e., up/down & right/left).

Also, if the calls tend to be especially stressful, give yourself “breaks” every 5-10 minutes to disengage for at least 60 seconds. If needed, perhaps mention that you must take a moment to attend to something personal (letting the cat in, a call on the other line, etc.), then take that moment to:

  1. Consciously relax any tension you feel. For example, try tensing your muscles for 5 seconds while holding your breath, then exhale while relaxing those muscles (2-3 times in a row). This is a simple biofeedback technique.

  2. Imagine the tension as something physical (smoke, dirty water, etc.) draining out of your feet into the floor/ground. This is a simple meditative/visualisation technique.

  3. Give yourself permission to drop as much tension as you can, and to breathe as slowly, deeply, and as relaxed as you can manage. This is a simple cognitive behavioral therapy technique.

When ready, resume conversation. 🙂

If you would like to know some relatively easy ways to relax your muscles and stop the pain, and your physician has cleared you to do such exercises as the above (no contraindications), see my blog post How can I reduce knots in my shoulders (trapezius muscles)?

Good luck, truly. I think a great deal of people are struggling with this right now.

What is the difference between massage parallel to one's muscle fibers and massage perpendicular to them?

What is the difference between massage parallel to one’s muscle fibers and massage perpendicular to them?

The answer will, at least in part, depend on the massage technique you are using for the myofascial fibers.

The principal objective of friction, or “stripping” massage (gliding the finger(s), hand or tool parallel to the fibers), is to empty the venous and lymphatic channels, which encourages better circulation at the deepest layers of the tissue.

Cross-fiber work (Active Release Technique or ART, “deep tissue”, etc.) mainly addresses the breakup of adhesive connective tissue.

Reference: “The Muscular Force Transmission System: Role of the Intramuscular Connective Tissue”, by Andrea Turrina, PT, Miguel Antonio Martínez-González, PT, PhD, and Carla Stecco, MD. Published online on June 7, 2012

How would you go about finding an experienced RSI therapist?

How would you go about finding an experienced RSI therapist?

The most important first step in finding a well-trained and experienced RSI therapist is to find a great physician who is a specialist in occupational injuries (such as RSI). This doctor must be committed to referring to a good hand, physical, or manual (massage) therapist who has the training, experience and track record of success in treating RSI and associated dysfunctions.

I have had great success in working with occupational physicians at the major hospitals in San Francisco (where my practice is located). No one knows how hard these gentleman and ladies work; they are a credit to their profession. My current favorites are Jules Steimnitz, MD (at St. Luke’s), and Elliott Krames, MD, and Robert Markison, MD (UCSF). They have been exemplary physicians to their patients over several decades, and I am proud to work with them. They don’t monkey about in deciding the best and most comprehensive course of action for RSI cases, and they are willing to go to bat with insurance companies that drag their feet or are blatantly obstructive.

I believe the very best Hand Therapist in SF is Pam Silverman, LHT at Hand Therapy of San Francisco. If I had RSI, and I didn’t know which doctor to choose, or even with whom to consult, Pam would be my first stop. She has worked with, and on, the best.

Yelp is a good resource for finding good therapists, but the quality of the reviews are spotty sometimes, as they are written by patients. Use with caution when vetting medical talent.

The last resource (or perhaps the first) is your gut. Check out a therapist’s website. Talk to them. Check out their CV/resume. Check out their reviews. If you give them a “try-out” session, be ruthless: do you feel relief or not?  Have they helped you with tension reduction and helpful advice, or not?

In the end, medicine is a service, one that serves the patient. The US is a free market, and each patient is beholden only to themselves and their recovery. Find your best medical “servant” who will help you recover the fastest. Settle for nothing; life is too short.