Victor Forge
The trapezius muscle is a large fan-shaped muscle that extends from the cervical to thoracic region on the posterior aspect of the neck and trunk and attaches to the clavicle and scapula. Recent studies have found a link between neck muscle inflammation, especially in the trapezius, and primary headaches, including migraines and tension-type headaches. This discovery has shifted the focus of headache research from traditional neurological and vascular factors to the role of neck pain. The trapezius muscle is also associated with cervicogenic headaches, which originate in the neck and refer pain to the head. Physiotherapists treat these headaches with various techniques, including postural training, neck stretches, and relaxation techniques.
| Characteristics | Values |
|---|---|
| Trapezius muscle inflammation | Linked to primary headaches, including migraines and tension-type headaches |
| Trapezius muscle T2 values | Higher in patients with mixed-type tension-type and migraine headaches (TTH+) than in those with TTH only (TTH-) or healthy controls (HC) |
| Trapezius muscle T2 values | Significantly associated with the number of headache days and the presence of neck pain |
| Trapezius muscle tension | Can be caused by stress and lead to headaches |
| Trapezius myalgia | Often associated with neck and shoulder disorders and can cause persistent pain in the upper trapezius fibres |
| Trapezius muscle stiffness | Can cause cervicogenic headaches |
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What You'll Learn
Trapezius myalgia and inflammation
Tension-type headache (TTH) is the most prevalent primary headache disorder. Neck pain is commonly associated with primary headaches. Research has found a significant connection between neck muscle inflammation and the occurrence of headaches.
Trapezius myalgia (TM) is characterised by acute or persistent neck-shoulder pain, stiffness, and tightness of the upper trapezius muscle. It is not a medical disorder but a symptom of an existing underlying condition. The pain can last from a few days to weeks and is often associated with spasms, stiffness, and tenderness in the neck region. Trigger points can also be present and cause headaches.
TM is often caused by monotonous jobs with highly repetitive work, forceful exertions, high levels of static contractions, prolonged static loads, and constrained work postures. It can also be caused by rigorous and repetitive activity, such as heavy weightlifting, where the trapezius is overworked and does not have time to repair itself. A trapezius strain can happen as the result of an acute injury or from long-term overuse.
TM can be treated with physiotherapy and exercise therapy. Ischaemic compression, stretching of the upper trapezius muscle, and transverse friction massage are manual techniques that can help patients with TM. Instant improvement on pain has been observed, but long-term effects have not been well investigated. Physical activity and exercise have been proven to give the most immediate and long-term pain relief in patients with TM. Strength training has been proven to be more effective compared to general fitness training.
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Tension-type headaches
Tension-type headache (TTH) is the most prevalent primary headache disorder. Neck pain is commonly associated with primary headaches. The trigemino-cervical complex (TCC) refers to the convergence of trigeminal and cervical afferents onto neurons of the brainstem, thus conceptualizing the emergence of a headache in relation to neck pain. However, no objective biomarkers exist for the myofascial involvement in primary headaches.
A recent study reveals a significant connection between neck muscle inflammation and the occurrence of headaches. New research links neck muscle inflammation, especially in the trapezius, to primary headaches, including migraines and tension-type headaches. The study employed advanced imaging techniques to quantify inflammation in the neck muscles, marking a shift from the traditional focus on neurological or vascular factors in headache research. This new understanding of the role of neck pain in headaches could lead to more targeted treatments, reducing reliance on medications, and improving outcomes for millions affected by these conditions.
The etiology of TTH, as well as migraine, is multifactorial, and recent pathophysiological concepts converge on central and peripheral mechanisms of pain perception, processing, perpetuation, and sensitization. For the peripheral component, complaints such as neck pain and findings such as tension, generalized or as focal hypersensitivity, taut bands, and referred sensation/pain at the neck play a major role. Nociception from myofascial structures is mediated by thin myelinated (Aδ) and unmyelinated (C) fibers that are activated by stimuli such as muscle contraction or strain, ischemia, or inflammation.
Trapezius myalgia (TM) is the complaint of pain, stiffness, and tightness of the upper trapezius muscle. It is characterized by acute or persistent neck-shoulder pain. TM is not a medical disorder or disease but rather a symptom of an existing underlying condition. The pain in the muscle can last a few days or longer. Ischaemic compression, stretching of the upper trapezius muscle, and transverse friction massage are manual techniques to help patients with TM. These techniques appear to have an instant improvement on pain. Long-term effects have not yet been well investigated.
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Migraines
A recent study found a significant connection between neck muscle inflammation and the occurrence of headaches. Specifically, inflammation in the trapezius muscle has been linked to primary headaches, including migraines and tension-type headaches. This finding suggests that neck pain associated with migraines may be an accompanying symptom rather than a trigger. Indeed, one study found no significant difference in trapezius muscle activity during rest, mental stress, and physical activity between migraine patients and healthy controls, indicating that altered muscle activity is not a trait symptom of migraines.
However, it is important to note that migraine patients have a high prevalence of neck pain, and some individuals report experiencing migraines that start in the trapezius/neck muscles and then migrate to the head, turning into full-blown migraines. While targeted exercises and physical therapy may not alleviate migraine pain that originates in the neck, they can still be beneficial for managing associated neck and shoulder issues.
In conclusion, while neck muscle inflammation and trapezius muscle dysfunction may not be the primary triggers of migraines, they are often accompanying symptoms. As such, treatments that focus on managing the migraine process rather than solely targeting the muscle aspect may be more effective.
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Neck pain
The trapezius muscle, a large fan-shaped muscle extending from the neck to the middle back, has been specifically linked to neck pain and headaches. Ischaemic compression, stretching of the upper trapezius muscle, and transverse friction massage are manual techniques that can provide instant pain relief for trapezius myalgia (TM), a condition characterised by pain in the upper fibres of the trapezius muscle. TM is often associated with neck and shoulder disorders, and the pain can linger for days, weeks, or even become persistent.
TTH and migraines have been linked to increased muscle tension in the neck, particularly in the trapezius muscle. This tension can be caused by stress and is associated with increased responsiveness of nerve endings, leading to peripheral sensitization and, consequently, headaches. Additionally, trigger points in the trapezius muscle can cause headaches, and certain movements or positions may help relax the muscle and reduce tension.
Physiotherapists often treat cervicogenic headaches, which originate in the neck, with postural training and stretching exercises. Improving lower trapezius function can reduce overactivation of the upper trapezius muscles and enhance scapular function, contributing to better posture and reduced headaches. Techniques such as diaphragmatic breathing and neck stretches can also help manage stress and improve posture, reducing neck pain and associated headaches.
In summary, neck pain, particularly involving the trapezius muscle, is commonly associated with primary headaches, especially TTH. Inflammation and tension in the trapezius muscle can contribute to neck pain and headaches, and targeted treatments, including manual techniques, stretches, and postural adjustments, can help alleviate these symptoms.
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Stress and anxiety
Additionally, stress and anxiety can cause individuals to engage in repetitive activities, such as prolonged periods of sitting, typing, or carrying heavy loads, which can lead to muscle imbalances and the formation of trigger points in the trapezius muscle. These trigger points can then contribute to tension headaches.
It is important to address trapezius trigger points through therapeutic interventions such as massage, stretching, and other manual therapies to alleviate headache symptoms associated with these trigger points. Relaxation techniques, such as diaphragmatic breathing, can also help reduce stress and anxiety, thereby reducing trapezius muscle tension and associated headaches.
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Frequently asked questions
Yes, tension in the trapezius muscle is linked to headaches, especially tension-type headaches and migraines.
The trapezius is a large fan-shaped muscle that extends from the cervical to thoracic region on the posterior aspect of the neck and trunk and attaches to the clavicle and scapula.
Tension in the trapezius muscle can cause headaches by increasing neck muscle tension and exaggerating the activity of motor units, inducing ischemia-like states. This can lead to increased responsiveness of the terminal nerve endings, resulting in peripheral sensitization and ultimately, headaches.
Techniques such as ischaemic compression, stretching of the upper trapezius muscle, and transverse friction massage can help improve trapezius muscle tension and associated pain. Physiotherapists may also recommend postural training, neck stretches, and relaxation techniques to reduce muscle tension and alleviate headaches.
