Is Your Headache Really a Shoulder Problem? ~ by Keelin Regan Reed PT, DPT

In situations involving my patients who have chronic headaches, once I perform a thorough biomechanical evaluation, I often find they have a dysfunctional rotator cuff or upper trapezius muscle. Many clients actually see me for their shoulder pain first and don’t even tell me about the headaches or realize that their headaches are connected to the shoulder injury. 

The muscle dysfunction occurs from what we call muscle compensation; usually from an injury, which happened as a result of a motor vehicle accident, trauma, sports, or a fall. After the initial injury or incident, the damaged part of the body over time can heal but often the muscle never regains its strength.  When this happens, other muscles will start to help out and work extra hard for the weaker ones.  Over time these muscles become strained and angry. Those angry muscles around the upper shoulders and neck create a radiating pain that can wrap around the ears, head, and eyes.  This might be misdiagnosed as a migraine because people will refer to their symptoms as light sensitive, shooting pain around their eyes, fullness in their ears or nose and classic pounding or ache in the head and face..

How could shoulder or neck muscles cause headaches? Let’s understand why.

There are 12 cranial nerves that begin in the brain and brainstem.  Most of them innervate and give both motor and sensory to parts of the face, eyes and head.  Cranial nerve 11, also called the accessory nerve (CN XI) is the only cranial nerve that supplies innervation to muscles below in the neck and shoulders.  These muscles are the sternocleidomastoid and trapezius and are unique in where they get their innervation. Innervation of the other muscles of the neck, shoulders, and the rest of the body come from the spinal cord.  When the sternocleidomastoid and trapezius are involved or damaged, they have pain referrals into the face and head. This could be a reason why people then have symptoms into the head, ears, eyes, and face.  

Understanding and diagnosing where the origin of the pain comes from can be complicated, but it makes the difference in having successful treatments. Thorough biomechanical evaluations are the best way to uncover muscle compensations that contribute to pain referral patterns that others may miss. If you are in the Longmont area, our physical therapists offer Free in Person Discovery Sessions where you can discuss what’s happening and find out if we can help you. 

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