photo courtesy of ABMP
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 wrap 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 found out she’s allergic to corn.”
I had him show me exactly where he feels the headaches and perform some basic range-of-motion to help me understand his headaches more.
Determined to dethrone the “headache king” part of all this, I started in on 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 said. 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.
I thought 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 stay contracted until we changed something further down the kinetic chain. 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 is how your occipitals contract and they’ll do that every time. If your head is forward, your suboccipitals may stay contracted, causing painful headaches and limited flexion.
After releasing the suboccipitals, he begged me to wrench on his SCMs. “He’s a jester now,“ I thought happily obliging. I soon wrapped up, saying goodbye to the tissue.
He made another appointment, bought his wife a gift certificate for Mother’s Day, then left doing neck rolls, stretching and whistling a happy tune as he walked back out into the dark and stormy night.