Where the pain actually lives · 1 of 5

Your headache might be living in your shoulders

Hands working into the upper trapezius and side of the neck during a bodywork session

Photo: add credit on swap

Most of the headaches I see in clients aren't really headaches.

They're shoulder pain that's traveled north.

There's a piece of bodywork knowledge that almost nobody outside the field knows about, and it explains why this happens. It's called referred pain.

Here's the idea. A tight muscle doesn't always hurt where the muscle is. It can send pain to a completely different part of the body. Sometimes a few inches away. Sometimes across the body. The nerves carrying the signal don't always know where the trouble started. The brain interprets the signal and shows up with pain in a place that, anatomically, makes no sense.

Until you learn the maps.

The upper trapezius is the muscle that sits on top of your shoulder, between your neck and the bony point at the end. It's the muscle that hunches up when you're stressed. The one that's quietly working overtime any time you're at a laptop. When that muscle holds tension long enough, it stops saying "my shoulder hurts." It says "I have a headache at my temple, behind my eye, and along the angle of my jaw."

That's the most common headache pattern there is. And it almost never gets pointed at the shoulder.

Anatomical illustration of the trapezius muscle (highlighted in red on the upper back), with X marks on the upper trapezius and a sage cloud over the head indicating where pain refers.
The upper trapezius referral pattern. The X marks sit on the muscle. The pain blooms up at the head. Base illustration: Chrizz / Nikai, CC BY-SA 3.0 via Wikimedia Commons.

A handful of muscles quietly run the show on tension headaches.

Upper trapezius. The most reliable headache referrer in the body. Sends pain to the temple and behind the eye.

Levator scapulae. Runs from the base of the skull down the side of the neck to the inner edge of the shoulder blade. When it locks, you can't turn your head and you get a deep ache at the corner where neck meets shoulder.

The suboccipitals. A cluster of small muscles right under the base of your skull, holding your head up against gravity all day. When they lock, you get the headache that feels like a band wrapping from the back of the skull around to the forehead.

Sternocleidomastoid. The rope of muscle on the side of your neck, the one you can grab and feel. Refers pain to the forehead, behind the ear, sometimes into the cheekbone.

Side view of the head and neck (Gray's Anatomy illustration) showing the sternocleidomastoid muscle in red, with X marks along the muscle and sage clouds on the forehead, cheek, and behind the ear where pain refers.
The SCM referral pattern. The muscle is the diagonal rope of red. Its pain shows up at the forehead, the cheek, and behind the ear. Base illustration: Gray's Anatomy (1918), public domain.

Most tension headaches are some combination of these.

When I work this area in a session, I'm not chasing the headache. I'm tracing the muscles I can feel are loaded and asking them to let go. The headache usually follows.

What you can try this week.

One. Stretch your chest, not your neck. Stand in a doorway, forearm against the frame, walk your body forward until you feel the front of your shoulder open. Thirty seconds each side. Tight chest pulls your shoulders forward, which loads the back of the neck, which feeds everything I just listed. The fastest way to ease the back is to open the front.

Doorway pec stretch position A person stands sideways in a doorway with one forearm flush against the door frame at shoulder height, leaning gently forward through the doorway to open the front of the shoulder and chest. lean forward
Doorway pec stretch. Forearm flush at shoulder height, lean forward gently until the front of the shoulder opens. Thirty seconds each side.

Two. Raise your monitor. If your screen is below eye level, your head spends all day forward of your shoulders. Stack books under it until the top of the screen is at your eye line. This one change is responsible for more headache relief than any product I could name.

When to see somebody.

A bodyworker, if the headaches are a regular pattern and you can feel tight neck and shoulder muscles. That's what this is for.

A physical therapist, if the headaches come with neck weakness, posture you can't seem to correct, or pain that doesn't shift with manual work.

A doctor, immediately, if a headache comes on suddenly and is the worst you've ever had, if it comes with vision changes, fever, a stiff neck, weakness, or a change in alertness. That's a different category of headache, and it isn't muscular.

Most of what shows up as a tension headache is reachable. It's a body asking for adjustment, not a brain doing something wrong.

The pain is real. It's just living somewhere you didn't expect.

If this sounds like you, you can book a session.

Part 1 of a 5-part series on referred pain. Next week: the shoulder that won't reach behind your back.

Further reading: Andrew Biel, Trail Guide to the Body's Quick Reference to Trigger Points (Books of Discovery, 2019). Janet Travell and David Simons, Myofascial Pain and Dysfunction: The Trigger Point Manual.


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