Another Tool in the Headache Toolbox: Arms

  As you may remember, headaches are particularly problematic because of the cascading effect of trigger points referring pain to other trigger points, which refer pain to still other trigger points, which refer pain to the head.  It is really hard to track down the culprit at any given time. 

  Quite by accident, I found that when I worked some trigger points in my arms, the pain referred straight up to either the side of the neck or up the back of my neck to the back of my head.  Using this knowledge, I have sometimes been able to lessen my headache's intensity or make it go away altogether by working trigger points in my arms.

  There are so many trigger points in the arm, and they are so close together that it would probably not be practical to try to identify just a couple of trigger points to work.  Instead, systematically work your arms, front and back, from wrist to shoulder.  Proceed more cautiously on the inside of your arms as they are very sensitive. 

  I have found using a bouncy ball that is around 2 inches in diameter gets most trigger points.*  I like to use a smaller ball (around 1 inch) to get into deeper spots and tight places. 

  Using a ball against the wall is my favorite method, but if you prefer, you can use it on a table, or even a chair arm.  You may also be able to use the ball in the palm of the opposing hand. 

There will be quite a few trigger points on the side of the upper arm. 

Using a 2-inch ball on the upper arm.

Working on the lower arm. 

Don't forget the trigger points right above the tip of the elbow.

Some trigger points in my lower arm refer up to the side of my neck. 

Using the one-inch ball on the forearm.  I normally would have my body weight pressing against the arm. 

  After working the trigger points, heat rice or flaxseed packs if you have them, and place them on your arms and shoulders for a few minutes afterward.  Then move your arms through their full range of motion a couple of times. 

  Meanwhile, take care of those arms and hands of yours.  The fact that we can type very quickly and easily with our modern keyboards will end up a disadvantage if we do not give our muscles a break.  We often type for long periods:  45 minutes, 2 hours, perhaps more, without stopping.  We may not even necessarily notice it in our hands or arms, but we are majorly stressing those muscles. 

  I type on a MacBook Air and it is nice and light and I can take it about anywhere.  I can have it on my lap for long stretches because it is not too heavy.  In my case, my wrists and hands hardly move, but my fingers jump around the keyboard.  Although the entire arm will be affected by this, the front-line muscles are the muscles in the forearm: The flexors and extensors of the fingers.  If I don't stop from time to time, my forearm muscles become incredibly tight.  I was amazed at how tight they were the first time I worked those trigger points. 

  Here are some suggestions to help take care of your hands and hopefully reduce your headaches:
Take breaks about every 20 minutes or so.  Remove your hands from the keyboard, push away from your desk and take a break.  Do one of the following: 

1) Shake your arms out.  Drop your arms and shake them (like a rag doll) for a few seconds.  Alternatively, you can hold them straight up and shake them.  Then go back to your typing.  It doesn't take that much time. 

Another break activity is to 2) clasp your hands together and reach your arms forward, turning your hands outward to expose the palms, and then upward over your head.  Be careful in the beginning with this stretch.  If your muscles are overly tight, you may stretch too far and injure yourself.  You don't want to overdo it.  Any stretch you feel should feel good.  If it is feeling painful at all, back off and don't stretch that far until you have worked some trigger points. 

3) Drop your hands to your side, or rest them on the chair arms, and lean your head back in your chair and close your eyes.  (If you can't do this comfortably, you need a better chair.)  Rock back and forth a couple of times if you have a chair that will rock. 

4) Get up and walk across the room or into another room.  Get a drink of water, use the restroom, let the cat out, etc. 

5) Work a few trigger points. 

  Another note about headaches.  Some people, like me, are particularly susceptible to temperature.  The problem is, I don't always know that I am cold until I reach over with my hand and feel my arm or face.  Cold activates trigger points.  Check your arm temperature from time to time and cover your arms to get them warm.  Cold arms could be kickstarting or exacerbating your headache. 

  Recently, my husband and I went on a get-away where we spent many hours of many days traveling in the car.  I discovered that having cold air-conditioning blowing on me could cause an instant headache.  My husband would sometimes notice it before I did.  I would say, "Oh my head hurts," and he would say, "Is that air conditioner blowing cold air on you?  Are you getting too cold?" We would turn it down or off, and my headache would subside.  My ears and face were particularly vulnerable. Because it was hot outside, we needed the air conditioning on at least part of the time.  So, I resorted to wrapping a towel around my head and ears, and I used a jacket to cover my arms; that helped until we could turn the air conditioner down. 

  I also found out that sometimes when I have a headache, I can make it more tolerable if I wrap a medium towel snugly against my hairline.  I overlap the towel on itself and clip it with a claw-type hair clip. 






*I have been able to get this size out of Golden Corral's gumball-type machines--they cost four quarters each, and there is a chance that you will get a 2-for-one breakfast coupon instead, so be forewarned.  If you get a ball that looks like a soccer ball or other sport ball, try again.  They are too slippery.  You want one that feels a bit more rubbery.  If the ball is too slippery, you will have to push down harder and it won't be as effective.  

Senses and Sensitivity

Have you ever picked up what you thought was a pitcher full of water (or other drink) and found out that it was actually almost empty? Instead of lifting the pitcher in a well-controlled manner, you may have catapulted it high into the air. You expected it to be heavier, and you automatically made adjustments in the force you used to lift the pitcher. Because you had incorrect information, you used too much force for the weight of the pitcher.

We get information from our basic five senses, but it is not as simple as: I smell, or I don't smell; I hear, or I don't hear; I feel things, or I don't feel things. In reality, there are many nuances to our senses that we might not even be aware of--unless we have a problem, for example, if certain smells give us a headache, particular sounds irritate us, or certain textures feel unpleasant. In addition, there are other less-talked-about "senses" that give us information about our world. For example, our vestibular sense helps us know where we are in space, and among other things helps us keep our balance. Our proprioceptive sense helps us perceive our muscle movement and body position.

So, what if we rarely had the correct information about the weight of an object or how much force we were exerting? We would be experiencing proprioceptive difficulties. This sense helps us to judge how much force to exert and how far to move our muscles. When we put a glass down on a table, we see visually how close we are to the table, but we also sense when we are close to and have touched the table. If our nervous system does not let us know that we have touched the table, we will continue to press down until we feel the table. If we have already reached the table, but our proprioceptive sense does not register that, we will continue to push down until we sense that we have reached the table.

Our proprioceptive sense helps us to know how much force to use, where to place our body, and gives us the ability to put our body where we want it, as fast or as slowly, and with as much control as we need for a given situation. If we have proprioceptive difficulties, these abilities can be greatly reduced.

If we are not receiving enough proprioceptive information, we might exert a lot of force in our movements:  we might stomp when we walk, press very hard down on the paper when we write, or bump and crash into things. Instead of sitting gently into a chair, we might drop into it. On the other hand, if we are receiving too much proprioceptive information, we might be extra cautious in our activities. We might not exert enough force to accomplish the task at hand. In either case our ability to grade our movement might also be affected. Instead of moving smoothly, we might move from low to medium to high with no speeds in between.

Applying this information to trigger point therapy...

1) If you are working your trigger points and you are one who has proprioceptive difficulties, it may be difficult to gauge how much force to use.

As you may have learned by now, when we work our trigger points, it is supposed to "hurt good." If we press too hard, our efforts might backfire and make things worse for a while. If we do not press hard enough, there will be no benefit.  Clair Davies suggested that it should be at about a 7 on a pain scale of 1-10.

When I first started trigger point therapy, I worked my trigger points so that they hurt at a 7. But over time, I found out that it was too hard. I was getting bruises and then I would have to wait until things healed up a bit before I could work those trigger points again. After much trial and error, I decided that I needed to be at about a 5 on a pain scale of 1-10. (As you might have guessed by now, I have proprioceptive difficulties.) I am probably exerting as much pressure as Clair Davies would to get a 7, but I am only registering a 5.

2) Taking this idea a step further, it is possible that many people with proprioceptive difficulties (at least those who are not receiving enough input) have a higher tolerance for pain.

Because they are not reacting as if they have a higher level of pain, they may not be taken seriously when they actually have intense pain.

I am one of those people. I would go to the doctor for some type of pain. Inevitably, the doctor would press here or there and ask if it hurt. Well, it hurt a little, but I hurt everywhere a little. Was it supposed to hurt more than the other places? In fact, sometimes, it actually felt better when they pressed on the spot. Or the doctor might ask me if the pain was like such-and-such, and I would hesitate and have to think about it. Because my reaction was not what they expected, they did not think I had much of a problem. I would leave no better off than I was when I came in. In fact, I was worse off because what I thought was my best possibility for help had just been nullified. I would not come in to the doctor unless I really thought I needed to come in, but I had just been treated as if I had overreacted. Now, I would wait even longer before I would go in again for something.

I have often heard people say, "Oh, you would know it if you were experiencing such-and-such type of pain." Well, I had migraines for many years before I knew they were migraines. While other women were staying home from church or school and offering each other cokes and pain relievers, I kept going, unwittingly making things worse. I did not have enough information.

Pain is exhausting. What if you are in pain, but you really aren't even aware of it? It may have become such a part of your existence that you have become resigned to it.

If we are aware of our proprioceptive difficulties, there are adjustments that we can make to the way we do things and to how much we expect of ourselves. (See the link below for more information.)

Add to that a regular routine of working our trigger points (with the appropriate pressure), and we can lessen our overall pain, be more physically active and hopefully get fewer trigger points. In other words, hopefully, we can reverse the vicious cycle of pain, immobility, trigger points, more pain....

3) If our movements are not smooth and gentle, but are more choppy and abrasive, chances are that we might injure our muscles as we bump into things, stomp our feet and even clench our jaw.

Clenching my jaw is a big one. I know that as soon as I get to sleep, my jaw will clench. This overworks several muscles, including the masseters, which contribute to headaches. I have noticed that if I work some trigger points before I go to bed, all of my muscles seem to be more relaxed, including my jaw.

I have noticed that when I work my trigger points that I feel like I have been oiled. My movements are more fluid and I feel like I have more control over my movement. I am more relaxed, and, I am actually a little more coordinated. (It's pretty motivating, actually.)

4) If we are not receiving enough input, we may overuse our muscles because we do not quit when they get tired.  

This is a big one for me. I also have a personality that likes closure, so between those two characteristics, I can really overdo it. Again, working the trigger points seems to give me more awareness. Instead of beating a dead dog to do things, which is how it usually felt for me--I already felt like my muscles had given all that they could give, even before I started an activity--I was starting out with, well, maybe not a peppy puppy, but at least I felt like I had energy and when I started to get tired, I could tell a difference.

Janet Travell, the doctor who pioneered the research on trigger point therapy, suggested that we mix up our activities during the day. It may be helpful to set a timer for 20 or 30 minutes at a time. It might also be good to post this statement somewhere that you will see it:


Pushing through to finish an activity is not worth being in pain for several hours or days.

It is hard to remember when we are deep in a project what happened the last time we decided to push through. In fact, we might just remember that we finished and may not have made the connection between the pushing through and the symptoms that followed perhaps a few hours later.

So, take a break. Your future self will thank you.

If you think that you or someone you know may have some proprioceptive issues, check out the link below.


If you are interested in learning more about sensory processing difficulties, this site has a good overview.  This link goes directly to a checklist, but there is a lot to explore on the site itself.  http://www.sensory-processing-disorder.com/sensory-processing-disorder-checklist.html

Dealing with Headaches: The Sternocleidomastoids

You might be intimidated by the name, but you needn’t be. The sternocleidomastoids (pronounced STERNO-CLYDE-OH-MAST-OYDS), or SCMs, are muscles that contribute to headaches, especially migraines. Located on the sides of the neck, they are the fleshy muscles that extend from the ear down to the sternum (breastbone) and clavicle (collarbone). 

There are two branches of the SCMs. Both branches attach just below the ear at the top, but the clavicular branch descends and attaches to the clavicle, while the sternal branch attaches to the sternum. 

Side View

Front View

There are better (and more to scale) drawings in The Trigger Point Therapy Workbook.  See pages 51-55 for more information.  

The sternal branch refers pain to 

• the top of the head 
• above the eye  
• front of the ear 
• the side of the head 
• the chin 
• upper neck 
• lower neck.  
• deep eye 
• tongue (when swallowing) 
• jaw (can mimic TMJ) 

(Note:  You don't have to have pain in all of these places in order for the SCM to be the problem...)

Trigger points in the sternal branch can also cause 

• dimmed, blurred, or double vision 
• red eyes
• excessive tears
• runny nose
• drooping eyelid
• twitching eye
• the print to appear as if it is jumping all over the page

And it can mimic trigeminal neuralgia (face pain).


The clavicular branch causes 

• frontal headache
• pain in the ear 
• pain behind the ear. 

It also can refer pain to the opposite side of the forehead, which is kind of unusual; most pain referral is to the same side of the body.

In addition, trigger points in the clavicular branch can cause 

• deep earache 
• toothache 
• dizziness
• nausea 
• fainting 
• unilateral deafness or hearing loss. 

The range of symptoms of the SCMs is really quite incredible. Besides headaches, they can cause: 

• disturbed weight perception 
• cold sweat on forehead 
• excess mucus in sinuses, nose, and throat
• chronic cough 

The SCMs are fairly easy to work. And you can work them practically anywhere.  


Massage these trigger points between your fingers and your thumb. This is one area where using a tool will not work. If you grab the flesh just below your ear, and begin to squeeze, you may be able to discern the two different branches of SCMs. Trigger points can be found anywhere up and down the two branches of the muscle.  Work your way down both branches.  Be sure to work both sides of your neck.  

Massaging the sternocleidomastoids near the top of the muscle.  

Moving further down.  

Working with the opposite hand.  

Following the sternal branch down.