What are the treatment options for headaches caused by trigger points?

Treatment Options for Headaches Caused by Trigger Points

Physical therapy is recommended for the management of tension-type, migraine, or cervicogenic headaches that may involve trigger points. 1

Evidence-Based Treatment Approaches for Trigger Point-Related Headaches

First-Line Physical Therapy Interventions

• The 2023 VA/DoD clinical practice guideline provides a "weak for" recommendation for physical therapy in managing tension-type, migraine, and cervicogenic headaches 1
• Effective physical therapy techniques for trigger points include:
  • Trigger point massage
  • Mobilization techniques
  • Manipulation techniques
  • Thermal methods 1

Exercise-Based Interventions

• Aerobic exercise or progressive strength training is recommended for prevention of tension-type and migraine headaches (weak for recommendation) 1
• Exercise frequency should be 2-3 times weekly for 30-60 minutes 1
• Upper-body progressive strength training can be performed 3 times weekly for 30 minutes 1

Specific Trigger Point Therapy Techniques

• Several trigger point therapy techniques have demonstrated effectiveness in reducing headache duration, intensity, and frequency 2:
  • Dry needling
  • Ischemic compression
  • Positional relaxation techniques
  • Massage protocols focused on deactivating trigger points

Comprehensive Management Approach

Step 1: Identify Trigger Points

• Focus on examining common trigger point locations:
  • Posterior neck muscles (trapezius, splenius, suboccipitals)
  • Anterior neck muscles (sternocleidomastoid, scalenes)
  • Jaw muscles (masseter, temporalis) 3
  • Shoulder muscles 3

Step 2: Select Appropriate Interventions

1. Physical therapy techniques:

   • Trigger point release therapy
   • Myofascial release
   • Neuromuscular therapy 3

2. Self-management strategies:

   • Regular aerobic exercise (30 minutes most days) 4
   • Maintaining regular sleep patterns 4
   • Stress management techniques (deep breathing, progressive muscle relaxation) 4
   • Proper hydration 4

Step 3: Consider Adjunctive Treatments

• For patients with tension-type headaches, consider:

  • Amitriptyline (30-150 mg/day) 4
  • NSAIDs for acute episodes 4

• For patients with migraine-type headaches with trigger points:

  • Beta-blockers (propranolol 80-240 mg/day or timolol 20-30 mg/day) 4
  • Anticonvulsants (topiramate, divalproex sodium 500-1500 mg/day) 4

Clinical Pearls and Pitfalls

Important Considerations

• Treatment duration should be sufficient - studies show benefits after approximately 6-7 treatment sessions 5
• Include both posterior AND anterior muscles in treatment plans - evidence suggests better outcomes when including sternocleidomastoid, scalene, temporalis, and masseter muscles 3
• Recognize that central sensitization may play a role in chronic headaches with trigger points, requiring a broader treatment approach 6

Red Flags Requiring Further Investigation

• Sudden severe "thunderclap" headache
• Headache with fever or stiff neck
• New headache after age 50
• Headache with neurological symptoms (weakness, vision changes, speech problems) 4

Monitoring Response

• Use headache diaries to track frequency, severity, and medication use 4
• Allow 2-3 months to assess efficacy of preventive treatments 4
• Consider referral to neurology if headaches remain refractory to treatment 4

Treatment Efficacy

• Studies have reported significant reductions in headache parameters with trigger point therapy:
  • Frequency reduction: 67.7%
  • Intensity reduction: 74.3%
  • Duration reduction: 77.3% 5
• Inclusion of both posterior and anterior muscles in treatment plans may provide greater decreases in headache frequency and disability 3

Physical therapy focusing on trigger points represents an effective non-pharmacological approach for managing headaches related to myofascial trigger points, with minimal side effects reported in clinical studies.