Trapezius Muscle: The ‘Coat Hanger’ Headache!
August 07th, 2010
According to Round Earth Publishing this will give the ‘coat hanger’ headache.
Red areas represent major pain areas. The ‘x’ marks the trigger points that are referring pain to those areas. They respond well to stretching with breath, improving posture and having assessment done of jaw and cranial shape.
The upper trapezius refers a ‘fish-hook’ pain pattern up the back side of the neck to the head, and around the temple to the eye. There may be goosebumps to upper arm and thigh possibly with nausea and visual disturbances. Problems often begin with heavy bags or purses, balancing phones between head and shoulder, or imbalances and strain by tight sternomastoid or scalene muscles.
The nauseating pain of a one-sided trapezius headache is commonly diagnosed as “migraine” although migraine medications often fail to relieve the pain. Bursitis and back pain may arise from the upper and lower fibres of the same muscle.
The suboccipital muscles are comprised of eight muscles total (one set of four on either side). They are not very well known to people, but after reading the following article you should get a better idea of their significance. You can see by looking at the picture that these muscles form a triangle over the upper cervical spine.
The upper cervical spine has been shown to be the most concentrated area of mechano-receptors (joint position receptors) in the body. The suboccipital muscles have been also been shown to have a very dense number of muscle spindle cells and GTOs (Golgi tendon organs). Muscle spindles measure the rate of change in muscle length, monitoring joint position as it relates to the muscle. GTOs measure muscle tension.
When someone develops an upper cervical dysfunction and/or mis-alignment of the upper two neck vertebrae they can cause a very substantial alteration in the tone of these suboccipital muscles. It can lead to a tightening on one side or both, which often times can be the cause of tension headaches or cervicogenic headaches.
Temporalis: These are the ‘morning’ headaches felt at the side of your head after a night of clenching. If the bite is uneven which may not be noticed by your brain this can be unilateral. I was offered a “Temporal artery surgical investigation” for cause of headache when drugs did not help! Glad my intuition told me there must be further analysis!
Another fact: Tension / sinus headache, TMJ and toothache in upper teeth. Combine a head-forward position with long hours of playing a wind instrument or a violin and you can inflame the Scalene and Temporalis muscles, the cervical spine and occasionally a branch of the trigeminal nerve in the cheek area.
SUPPORTING CASE STUDIES
(Editor’s Note: Macy’s story in italics & quotations (“”), Cathy’s comments in brackets ()
Macy’s real story: “I was overdue by 10 days, and I had a difficult birth (I was in isolation for 3 days), I had digestive issues which were diagnosed as colic. I was breast fed.” (This promotes good jaw development)
[NOTE: In a study of 1250 babies there was visible trauma to head either before or during labour in 10% of the babies. Membranous articular restrictions, which could be detected by the osteopathic physician, were present in 78%. Thus, nearly 9 of every 10 infants in the study had been affected.
In a study done of 100 children between 5-14 who were having learning or behavioural difficulties it was found that 79 had been born after a long or difficult labour and had one or more of the common symptoms of the neonatal period. (Difficulty sucking, vomiting, nervous tension and irregular respiration) Also the study noted that childhood allergies can be traced to musculoskeletal strains originating at the time of birth!)
KEY POINT: The Vagus nerve provides innervations to the gastrointestinal and cardiorespiratory system. Compression transmitted through the squama to the condylar part on one side may disturb the function of the Vagus and/or Hypoglossal nerve, causing vomiting, irregular respiration and difficulty speaking and sucking.]
“I have had stomach upset for years – since my childhood and it continues now, however is not as severe.”
[PERSONAL CLINICAL OBSERVATION: I notice clinically those patients who have colic as babies seem to suffer from gastric issues as adults in varying severity.]
“Orthodontic work was done to correct my bite and wore a retainer top and bottom for years.”
[Different medical perspective on neonatal period from Osteopathic Annals (5): 197-205 May 1976.
The hypoglossal nerve (cranial nerve) which innervates the muscles of the tongue, pass out through the cranium between the base and the lateral mass, through interosseous cartilage join the space that will become the condylar canal. The occipital condyle which articulates with the atlas, spans the intraosseous cartilage: its anteromedial third is found on the base, the posterior thirds on the lateral mass. Immediately anterolateral to this condylar area is the jugular foramen, a space between the condylar part of occiput and the petrous portion of the temporal. This foramen gives passage not only to the jugular vein but also to cranial nerves 1X, X and X1 (Glossopharyngeal, Vagus and Accessorius, respectively]
“I was on the track & field team even though I had knee problems (diagnosed as patella femoral syndrome and was given orthotics).”
[Possible Explanation: Postural adaptation can occur because the brain tries to align, maximize & optimize the lower pharyngeal airway, with the bite and visual tracking. Facial and muscular restrictions at front of neck affect mandible (jaw) position: forward tip of pelvis follows shift of centre of gravity of head. This affects lower leg muscles, pelvis rotates backwards and moves body forward due to shortness of Dural sheath/fascia (see past newsletter): Hamstrings tighten to balance the pelvic shift, and often feet rotate outward in response to pelvic rotation. Patient then complains of IT band and hip issues.]
“I have had IT band tightness which leads to hip pain since becoming a runner a few years ago.
Age 10, I had a couple of traumas to the head which was the start of my headaches and migraines – they are above my eyebrows and temples. Neck and shoulder pain is aggravated by working at a computer every day. In my adult years, my sinuses have had infections, had a “stuffy feeling” giving me head pressure and plugged ears.”
[For causes see: Sternomastoid Trapezius, Masseter, Pterygoids]
“I have also experienced relief from seeing Cathy, and it has been helpful to learn about the musculoskeletal head to toe connections and how that affects how I feel day to day.”
FACIAL AND TEETH PAIN
1. Masseter > TMJ, tinnitus, “sinus”, and toothache. For its size and weight, the masseter is the strongest muscle in the body and its effects are not trivial. It refers pain to both upper and lower molar teeth, causes TMJ dysfunction, earache and a “sinus” pain over the eyebrow. Interesting that people who develop headaches from worrying may get depressed and are given. Prozac and related anti-depressants such as Paxil, specifically cause tightness in this muscle. If you’re grinding your teeth at night and waking with a headache, ask your doctor about taking the medication during the daytime when you can be more aware of clenching and tooth-grinding which tense the masseter but also strain the Temporalis.
2. PTERYGOIDS > TMJ and “sinus” pain. The lateral pterygoids (at right) help to open and protrude the jaw. These relatively weak muscles are easily strained in opposing the powerful masseter and temporalis muscles that close the jaw.
The pterygoids commonly develop trigger points which in turn cause pain and/or clicking in the TMJ joint. They may block drainage from the maxillary sinus causing more still more pain. They are also linked to tinnitis, and cause lateral deviation on opening the jaw. There may be entrapment of the buccal nerve causing numbness / tingling in the cheek (see buccinator, below). The masseter muscle and medial pterygoid support the jaw like a sling. Masseter is on the outside, medial pterygoid inside; together they close the jaw.
MEDIAL PTERYGOIDS produce diffuse pain in the mouth involving the floor of the nose, tongue, throat and hard palate; pain below and behind the TMJ joint, pain and/or stuffiness of the ear, difficulty swallowing, lateral deviation and possibly pain on opening the jaw. They can also entrap the lingual nerve producing the odd symptom of a bitter, metallic taste in the mouth (which the patient may not connect with other symptoms and may not report for fear of being thought “crazy.”)
Cheek pain. This muscle forms the wall of cheek and mouth. It’s the part of the cheek that puffs out when playing the trumpet (for which it is named), blowing up balloons or stuffing one’s mouth too full. Buccinator pain may appear suddenly following dental/orthotic work or progressively after repetitive wind instrument playing.
There are no entrapments by the buccinator itself, but the lateral pterygoid can entrap the buccal nerve which supplies the skin and mucous membrane in this area. The muscle itself can cause local pain deep in the cheek while chewing, commonly misdiagnosed as TMJ dysfunction
4. DIGASTRIC > Neck pain and toothache in the lower incisors. The digastric assists the lateral pterygoid in opening the jaw against the counterforce of the far more powerful temporalis and masseter muscles. The upper portion can entrap the external carotid artery and auricular artery decreasing blood flow to the brain. Strained by retrusion of the jaw (as in playing the clarinet or similar wind instruments) or by holding a violin in place with the chin. Commonly damaged in whiplash injuries in concert with other neck muscles such as trapezius and splenius.
Dentally, trigger points in the anterior belly send pain to the four lower incisor teeth and the alveolar ridge. There may also be pain in the throat and tongue and difficulty swallowing because of the relationship to the hyoid bone.
Trigger points in the posterior belly refer pain to the upper sternocleidomastoid muscle, pain to the throat possibly as far back as the occiput. There may also be difficulty swallowing and a bothersome feeling of a persistent “lump” in the throat. That “lump” may be the hyoid bone which, again, is not moving properly.