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The cranium, or skull, is composed of 22 bones and is divided into two regions: the neurocranium, which protects the brain, and the viscerocranium, which forms the face. The skull provides structural support and protection to the cerebrum, cerebellum, brainstem, and orbits. It also supports the muscles of the face and scalp and allows neurovascular passage between intracranial and extracranial anatomy. While the skull is not directly responsible for tight muscles, it is important to note that issues with the cranium, such as injuries or inflammation, can contribute to conditions like occipital neuralgia and tension headaches, which are associated with muscle tightness in the head, scalp, and neck areas. Treatment options for these conditions include medication, nerve blocks, physical therapy, massage therapy, and, in rare cases, surgery.
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What You'll Learn
Tension headaches
The pain associated with tension headaches may occur once, constantly, or daily. It may last for 30 minutes to 7 days. Tension headaches typically don't cause nausea, vomiting, or sensitivity to light. They do cause a steady ache, rather than a throbbing one. They tend to affect both sides of the head and are described as a tight band or vice around the head.
If tension headaches are long-term or chronic, they can interfere with daily life. It is important to seek medical attention if the headache patterns or pain changes, or if treatments that once worked are no longer effective. Severe headaches that are the "worst ever" may be a sign of a stroke, and immediate medical care is necessary.
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Sternocleidomastoid syndrome
The syndrome is characterised by trigger points or tender points within the muscle, leading to pain and stiffness in the neck. Symptoms associated with SCM syndrome include frequent headaches, ptosis (drooping of the eyelid), lacrimation (excessive tearing), eye reddening, sinusitis, sore throat, ear popping sounds, balance problems, dizziness, and facial pain.
Treatment for SCM syndrome typically involves a combination of passive and active approaches. Passive treatments may include massage, osteopathic manipulation, and chiropractic techniques. Active treatments focus on restoring normal biomechanical movement patterns to reduce postural strain and improve faulty movement patterns in the cervical and thoracic regions. Physical therapy is often recommended to improve posture and advise on daily life activities. Other self-care measures include stretching, self-massage, stress management, and maintaining good posture by avoiding positions that strain the neck. In severe cases of structural damage, surgery may be considered if conservative treatments have not provided relief.
SCM syndrome can cause a range of symptoms beyond just neck pain and stiffness, and it is important to seek professional advice for a proper diagnosis and treatment plan.
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Torticollis (wryneck)
Torticollis, also known as wry neck, is a painful condition that causes an abnormal, asymmetrical head or neck position. The condition often arises suddenly, with affected individuals going to bed without any symptoms and waking up with a stiff neck. The exact cause of torticollis is often unclear, but it can be congenital (present at birth) or acquired later in life. In some cases, torticollis may be related to underlying conditions or factors such as:
- Inherited changes or disorders of the upper spine, muscles, or nervous system
- Birth trauma or intrauterine malposition, resulting in damage to the sternocleidomastoid muscle in the neck
- Repetitive microtrauma within the womb or sudden changes in calcium concentration, leading to prolonged muscle contractions
- Sleeping in a cold room or with inadequate neck support
- Untreated dental occlusal dysfunction, caused by clenching or grinding teeth during sleep
- Infections in the posterior pharynx, irritating the nerves supplying the neck muscles
- Use of certain drugs, such as antipsychotics
- Fibrodysplasia ossificans progressiva (FOP), a rare disorder characterised by malformed great toes
The primary symptom of torticollis is the abnormal positioning of the head and neck, which can include:
- Tilting of the head forward (antecollis) or backward (retrocollis)
- Twisting of the neck (rotational torticollis)
- Lateral bending of the head towards the shoulder (laterocollis)
Treatment for torticollis aims to relieve pain and reduce stiffness in the neck muscles. In most cases, simple treatments such as painkillers, gentle exercises, and stretching are effective. For more severe or persistent cases, botulinum toxin injections or surgery may be considered.
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Occipital neuralgia
The condition can be caused by pressure or irritation to the occipital nerves, which may be due to an injury, pinched nerve, tight muscles that entrap the nerves, inflammation, or unknown origins. It can also be caused by a disease that affects the discs (the spongy cushions between the vertebrae of the spine). In some cases, occipital neuralgia may occur spontaneously.
The diagnosis of occipital neuralgia can be challenging due to its similarities with migraines and other headache disorders. A physical examination and neurological exam are typically performed, and further imaging, such as an MRI, may be ordered to rule out other possible causes of the pain.
Treatment options for occipital neuralgia include surgical and non-surgical interventions. Non-surgical treatments include heat therapy, physical therapy, massage therapy, and medications such as anticonvulsants and botulinum toxin (Botox) injections. Surgical treatments include occipital nerve stimulation, which involves placing electrodes under the skin near the occipital nerves, and occipital release surgery, where the surgeon exposes and releases the occipital nerves from surrounding tissue.
It is important to note that while treatments aim to alleviate the pain associated with occipital neuralgia, they do not cure the condition.
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Temporomandibular joint disorders (TMD)
TMDs can manifest independently or in conjunction with other medical conditions, including headaches, back pain, sleep problems, fibromyalgia, and irritable bowel syndrome. Research suggests that TMDs are more prevalent in women, especially those between the ages of 35 and 44. Furthermore, clinical, psychological, sensory, genetic, and nervous system factors may collectively elevate the risk of developing chronic TMD.
The most common form of TMD is myofascial pain, which affects the fascia (connective tissue covering the muscles) and the muscles controlling the jaw, neck, and shoulder function. Internal derangement of the joint, including a dislocated or displaced jaw, can also contribute to TMD. Degenerative joint diseases, such as osteoarthritis or rheumatoid arthritis in the jaw joint, are additional factors that can lead to TMD.
When experiencing TMD, it is recommended to consult a doctor or dentist for guidance. Initial treatment suggestions may include eating soft foods, applying heat or cold therapy in combination with jaw muscle exercises, and taking over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. While TENS (transcutaneous electrical nerve stimulation) has shown some promise in small studies, experts advise caution with more invasive procedures that alter the jaw joints, teeth, or bite, as well as surgery, due to limited evidence supporting their effectiveness.
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Frequently asked questions
The cranium, or skull, is composed of 22 bones and is divided into two regions: the neurocranium (which protects the brain) and the viscerocranium (which forms the face). The skull also supports tendinous muscle attachments and allows neurovascular passage between intracranial and extracranial anatomy.
The skull supports the muscles of the face and scalp by providing muscular and tendinous attachments. However, tightness in the neck muscles can be caused by factors such as poor posture, stress, injury, or sleeping in an abnormal position.
Tight neck muscles can be relieved through massage, yoga, stretching, physical therapy, osteopathic manipulation, hot and cold therapies, and chiropractic acupuncture.
