Friday, June 7, 2013

Scream “4,”Cervicogenic Migraine and Myofascial Trigger points: June Awareness


Cervicogenic Migraines and Myofascial Trigger Points

Migraine headaches are not only a severe pain source in their own right, they also co-exist more frequently with fibromyalgia (FM) and chronic fatigue syndrome (ME/CFS), which overlaps with many other painful conditions, the domino effect.  Because they originate within the central nervous system, they can be a great factor in decreasing our pain threshold, every  nerve ending is fresh, raw and exposed.  

Cervicogenic migraine is a migraine attack that is perpetuated or preceded by neck pain. You know this excruciating pain is generated from the peripheral nervous system (anything outside the brain) when you feel a golf ball size muscle at the base of the skull, or the muscles that hold your head up are tighter than guitar strings. You know it is a migraine because it has all the same hallmark symptoms. An aura, preceding symptoms warning you of the impending attack,  may or may not be present, but migraines generally manifest themselves on one side of the head and are often accompanied by other symptoms, such as extreme sensitivity to light and sound, vomiting or nausea, blurred vision, lethargy, etc. This is the description of a cervicogenic migraine. You can read about other types of severe headaches on my website here

“A myofascial trigger point (TrP) is a self-sustaining, irritable area in the
muscle that can be felt as a nodule in a taut band. This irritated spot causes
the muscle to gradually shorten, interfering with the motion function of the
muscle and causing weakness and pain.” (Book excerpt, here

A common cause of cervicogenic migraine shares the overlapping condition to FM and ME/CFS called myofascial pain syndrome, read more here. Usually you start to feel the muscles in your neck tighten, or you feel a golf ball at the base of your skull scream F-O-R-E  or “4.”  They are doing this because some of the muscle fibers that make up the muscles are shortening causing pea sized knots you can easily feel unless the muscle is too rigid, in which case you can track the offending trigger point (TrP) by its referral pain pattern. Now, check that side of your face too.  Most likely you will feel tiny little strings of fine little muscles in the temple or around the eye.  These muscles are responsible for our facial function and expression.  I am not going to get to windy on the subject, and I could, but understanding this simple phenomenon could help bring you some relief.  We discuss all this at length in our book, here, but there are some key points to get your started on trigger point pressure therapy:

  • Find the knots just mentioned
  • If the muscle is too tight, you may have to massage it to get it to relax enough to locate the TrP. If you can get someone else to do it, all the better.
  • If you have them and you are not too sensitive to odors, use essential oils to massage.
  • Once you locate the knotted up piece of muscle (in the neck usually about the size of a pea, unless it is in one of the tiny muscles between the neck bones or on the face), hold pressure (about 80% of maximum) for 30 seconds or so. Try to locally stretch the TrP coaxing it back to its normal resting length. Do this periodically to tolerance and ability.

The neck muscles can get sassy for a number of reasons, stress (psychological or physical), degenerative neck disease, or the presence of myofascial pain syndrome, which is not uncommon in migraine either.  
Treating all of these TrPs can help with the attack, as can identifying the perpetuating factors. Once you become an expert at pressure therapy, and you have plenty of training ground to learn from, do this as preventative therapy. It is when you neglect your muscles that you are more likely to have this type of migraine, and the greater the neglect, usually, the more intense the headache and more difficult to treat.

If these types of headaches are a chronic problem, see a physician because other tests and treatments may be indicated.

In healing and hope, Celeste

All answers and blogs are based on the author's opinions and writing and are not meant to replace medical advice.  For more information about the author see


Unknown said...

What a great article. I found much great info about cervicogenic migraines and myofascial trigger points. Of course massage therapy is best solution to reduce the pain. back and neck pain bergen county , low back pain bergen county

Celeste Cooper said...

Jim, I am uncertain that my reply is getting to you. It appears that Google is interfering with my ability to post on my own blog.

Yes, MTrPs are the least understood by doctors who treat pain and deal with the after effects of spinal conditions, surgery, etc. However, they are the greatest pain generator. We need more education and movement of therapies such as massage in to main stream medicine.

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Serenity said...

I'm not certain that what I have is migraines. It feels like a tube on the left side of my neck is filled with something that is moving around. I can compress that "tube", starting at the lowest point and moving up to the skull, which causes the sensation of moving to go away. I place pressure on the base of my skull, and that sensation stays away. Once the pressure is let off, the sensation starts again, moving downwards. I am wondering if I have a leak in the arachnoid and a hole in the skull, allowing CSF to move into the area. When I do move that sensation back into my skull, I feel pain which lasts for at least an hour. I'm hoping someone understands what I am saying, and has an answer or a comment that I can make to a doctor that will cause him/her to order tests for diagnosis. Thank you for any information you can give me.

The Pained Ink Slayer said...

Serenity, without being able to assess if you are talking about one of the scalene muscles, I cannot tell you what you are dealing with. Most likely if you have a spinal fluid leak, you would have already sought emergency medical treatment. It causes severe headache. That said, You need to see a doctor to evaluate what is going on. You can read more about migraines on my website, but please get a medical evaluation.

Wishing you the best

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