Courting the Headache King's Royal Pain

It was a dark and stormy night. I had just finished writing my notes for the day when I heard a knock on the door. I went to open it and I saw a man standing there, squeezing his neck at the base of his skull.

 “Are you the Anatomy Nerd?” he asked, wincing a little. 

“Yes, and you are…?”

 “The Headache King,” he replied.

I nodded, dimmed the lights and led him to a comfortable chair in my office.

“Do you get headaches very often?” I asked.

​“Yes. I’ve been in a few car accidents over the years, fallen off horses, fallen skiing, and now I sit at a desk all the time.” He grimaced. “The pain starts in the back of my head and wraps all the way around to the front. It’s worse if I get a draft on my neck. My wife gets them too, but they’re much better since she stopped using anything labeled diet or light.” 

I had him show me exactly where he feels the headaches and asked him to perform some basic range-of-motion moves such as moving his head in an ear-to-shoulder way and a few neck rolls to help me understand his headaches more.

Determined to de-throne the “headache king” part of all this, I started to massage the suboccipital muscles. I decided to start on the one called Rectus Capitis Posterior Minor, because that’s usually a biggie for people with headaches when… “Thaaat’s the spot!” he exclaimed. Like most people when their massage therapist gets THE spot, he acknowledged that I was in a very good place to work.

The sub-occipitals are a group of muscles that allow you to turn your head and look up. Turning the head we’ll call rotation, and looking up we’ll call extension. If these muscles are locked long or short you may have difficulty rotating your head as well as flexing or extending. If he is sitting at a desk all day, his head probably comes forward, and his suboccipitals have to work to tilt his head back and keep his eyes level with the horizon so he’s not looking down. It’s just the way our nervous system and by default our muscles respond to the conditioning.

As I worked, I thought more about how our brains control our muscle length and realized that if his head was forward of his center of gravity, his sub-occipitals would go back to what they were used to until we changed something further along the kinetic chain and even made a plan for him to change up his ergonomics a little. The Sternocleidomastoid, the SCM for short, came to mind. If you are familiar with this muscle then you know that its main action, when both the right and left contract, will bring the back of the ears (mastoid) toward the breastbone (sternum). Try that on yourself. Try to bring your mastoid process, the bump behind your ear, toward your sternum. Now, keep your eyes level with the horizon. Because of neurological laws, your body will adapt to that position in a very short time. Did the back of your head move toward your spine? Even though for most of us that movement was an exaggeration, that action does cause your occipitals to contract and they’ll do it  Every. Single. Time.

 If your head is forward, your suboccipitals may stay contracted, possibly becoming swollen, restricting bloodflow, increasing trigger points and causing painful headaches.

After applying some techniques to the suboccipitals, he begged me to wrench on his SCMs. “He’s a jester now,“ I thought happily. I soon wrapped up, saying goodbye to the soft-tissue I had been working and showing him a couple of key moves to do at home to help relieve the pain and and bring fresh oxygen and nutrients to the muscle tissue.

Before he left, he made another appointment, bought his wife a gift certificate for Mother’s Day, and left-- doing neck rolls, stretching and whistling a happy tune as he walked back out into the dark and stormy night. 

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