What does where the pain lies tell you about the nature of a headache?

Most headaches around the eyes, cheeks, temples, and top, back or base of the skull involve the muscles, connective tissue (myofascia), nerves or structures around the joints of the jaw, ear, and/or sinuses. These headaches can be primarily caused by a direct strain or sprain, or secondarily caused by drug side effects or other conditions that precipitate inflammation in those areas. The brain tissue itself does not have nerve endings that perceive pain, but the tissue surrounding it certainly does!

There are many muscles in the neck and head. I’ll primarily address the myofascial pain pattern of each one, since their are too many related conditions and drug effects to list in a single answer. In any case, a thorough examination by a physician to determine the cause of the pain would still be called for.Areas of pain in muscles (from Travell and Simons’ Myofascial Pain and Dysfunction, volume I) are grouped into the following areas:

Varieties of headache (from Travell and Simons' "Myofascial Pain and Dysfunction," volume I)

(Ch.5, pg.167)

The muscles that create the referred pain in these areas are grouped here, in the same text:

Travell and Simons' "Myofascial Pain and Dysfunction," volume I

If you are curious about the specific pain pattern of a particular muscle, you can visit this site (or other similar accredited sites) to find out: National Association of Myofascial Trigger Point Therapists.

For the temporalis muscle, a sample pattern might look like this:

Temporalis muscle

Muscles of the neck can refer pain locally or up into areas of the head, including the face and jaw. Most facial muscles (including muscles of the eye, ear and jaw) tend to refer pain very locally; they very rarely refer down to the neck.

Pain in the face and jaw, especially, tend to indicate problems with the sinuses, eyes, muscles of mastication (chewing), dental problems (such as malocclusion or infection), or some other local infection (such as a cold or flu). Pain can be triggered by any recurrent infection or source of inflammation, even cancer. This essentially means that therapy for the muscles may provide temporary relief, but since the primary trigger has not been resolved, it will keep recurring.

If the problem is primarily myofascial, correction of any source of mechanical strain (including postural or ergonomic strain) must be removed or at least reduced for the therapy to be effective and lasting.  

The first 3 books on this list are my favorites on non-migraine headaches for the layperson: Amazon.com: trigger points and headache: Books

BUT, of course, if a headache is especially severe, has lasted for longer than three days, happens repeatedly, is interfering with your functioning significantly, is affecting your eyesight, hearing, balance, cognitive function, or is doing anything other than just making your head hurt, please go see a doctor right away!

What is the best self-treatment for a myofascial trigger point?

First, be certain that you actually have a trigger point. There are other, more serious problems that can mimic the referral zones of myofascial trigger points. (A referral zone is an area of pain that is caused by the trigger point, but is not necessarily in the same area as the trigger point.) See a competent doctor who can rule these factors out.

Once you have a firm diagnosis, the texts mentioned here are useful in finding the trigger points and understanding what factors cause them. Included in the books is useful, everyday advice on what actions or positions to avoid so you don’t re-activate the trigger point and thus the pain cycle. Clair Davies’ books are particularly good. For example:

The Trigger Point Therapy Workbook on Amazon.com

I also recommend Sharon Sauer and Mary Biancalana’s book on self-treatment for lower back pain:

Trigger Point Therapy for Low Back Pain on Amazon.com

In addition, the website of the NAMTPT (National Association of Myofascial Trigger Point Therapists) has a great *free* feature called the “symptom checker.” This allows you to see common areas of pain and the trigger points (and their locations) which are most likely the cause.

To release a trigger point yourself, you will need to use your fingers or some sort of compression tool. Such tools include a Backnobber or Theracane:

The Backnobber at the Backnobber Store

You can also use a simple tennis ball or racquetball.  No expensive tool is needed; some just reach “difficult” spots better.  You can also put a tennis ball in a sock to use as a compression tool against a wall.

The trigger point is suffused with muscle-fatigue chemicals and pain chemicals, which lock the affected fibers into a state where they can’t contract or expand properly. With tools such as your hands or the Backnobber, you are trying to direct blood to the trigger point. What you are not trying to do is “break it up” by rubbing across it. This can, in fact, bruise and/or irritate it.  A myofascial trigger point is not the same thing as an adhesion or scar tissue, although sometimes they coincide.

Presuming the trigger point does not include much inflammation, swelling or an entrapped nerve, here is what I’ve found works best:

  1. Heat the tissue. The connective tissue softens and the muscle relaxes more. Blood is redirected to the area through vasodilation. Sometimes, this alone is effective enough to reduce the pain.

  2. Perform compression to the trigger point. Use only enough pressure to “just feel it,” not as much pain as you can stand. If you press too hard and you tense against it, you will not gain a release. A muscle cannot tense and relax at the same time. By holding the compression steady for a minute or two, you are “showing the blood where to go.” Wait until you feel a softening or dissolving feeling in the knot (trigger point), and hold it until it feels “done.”

  3. Stretch the muscle slowly though its comfortable range. If you force the end of the stretch, you could reactivate the trigger point.

  4. Apply a non-heating, anti-inflammatory cream. I use Myoflex cream.

  5. Avoid whatever actions seem to make it worse. For help with that, see the books above.