Headaches, Jaw Pain & The Often Overlooked Sternocleidomastoid Muscle

Sternocleidomastoid Muscle

I am always astounded by the amount of massage therapists that do not address the sternocleidomastoid, known as SCM for short, muscle in the neck. The SCM is one of the largest and most superficial cervical muscles and it divides the neck into anatomical anterior and posterior triangles. Responsible for flexing and rotating the head, it is named by the anatomical origin and insertion points, being Sterno- (refers to the sternum), Cleido- (the clavicle, or collarbone), and -Mastoid (the mastoid process, a bony knob behind the ear).​
​
When this muscle is really tight and produces "active" trigger points, which are irritable localized spots of exquisite tenderness that refer pain, the SCM can cause moderate symptoms. These symptoms include headaches, dizziness, blurred vision, ear pain, postural imbalance, jaw and sinus pain, teeth hypersensitivity, stiff neck, chronic cough, and sore throat.

---

Causative or Perpetuating Factors

• Mechanical overload in neck extension or flexion
• Chronic rotation to one side
• Whiplash- sudden and extreme overstretching of muscles in the chest, upper back, and neck, often accompanied by pain, tingling, and/or numbness in the extremities
• Compression of the neck
• Paradoxical breathing- the diaphragm moves opposite to the normal directions of its movements creating health problems. The diaphragm normally moves downwards during inspiration and upwards during expiration, but paradoxical breathing presents the opposite diaphragmatic motion.
• Chronic cough

Neck Pain and Headaches

According to Travell and Simons, authors of Myofascial Pain and Dysfunction: The Trigger Point Manual Volumes 1 & 2, trigger points are responsible for much of the pain associated with headaches, neck pain, and temporomandibular joint (TMJ) syndrome.
​
Neuromuscular therapy is an approach to soft tissue manual therapy in which manual pressure and friction techniques are used to release trigger points. This is a technique employed by massage therapists, physical therapists, among many other healthcare professionals. "Active" trigger points, small contraction knots that typically refer pain, are often caused by injury, muscular strain, and overuse. Trigger points can be so intense that they may elude to misdiagnosis. For example, "chronic jaw pain, toothaches, earaches, sinusitis, ringing in the ears (tinnitus), and dizziness may be symptoms of trigger points in the muscles around the jaw, face, head and neck."

According to data and discoveries in the medical field, Travell and Simons' work has shown that trigger points are "often the hidden and unsuspected cause of most headaches, no matter what name they're given: tension headaches, cervicogenic headaches, cluster headaches, vascular headaches, or migraines. Davies, author of The Trigger Point Therapy Handbook, goes on to say, "The paradox about headaches is that the cause is rarely found to be in the parts of the head that actually hurt. Most headaches, in fact, come from trigger points in the jaw, neck, and upper back muscles. This physical distance between cause and effect is why headaches can be so mysterious and hard to deal with.”

SCM Pain Referral Patterns and Massage Therapy

Whereas massaging the upper shoulders and upper back "fixes neck pain", massaging the neck "fixes headaches." Perhaps this muscle is often overlooked by massage therapists because clients generally do not feel pain in the front of the neck. However, treating the root cause would require an investigation of the underlying symptoms by addressing "active" trigger points in the SCM that may be causing headaches and other referred pain symptoms, as mentioned above.
​
In blue you'll notice the typical referring pain pattern of the sternocleidomastoid (SCM) muscle. With massage therapy, over time, the "active" trigger points will relax and refer less pain, tingling, and numbness. They will become "latent" and perhaps only tender locally to the touch. Headaches diminish with persistent attention to releasing its trigger points.

The SCM has two attaching heads, one to the sternum and one to the clavicle. The sternal head refers pain to cheek, temple, orbit, eye, tongue when swallowing, headaches over the eye, behind the ear, and in the top of the head. These may contribute to temporomandibular (TMJ) joint pain. Additionally, sternal branch trigger points can cause "dimmed, blurred, or double vision, reddening or excessive tearing in the eyes, and runny nose". This branch could also cause a drooping or twitching eyelid from a referred spasm in the orbicularis oculi muscle surrounding the eye orbit. A persistent dry cough or cold, sinus congestion, and phlegm in the throat may be alleviated by working the sternal attachment.

The clavicular head refers pain to the frontal area, and when severe, extends across the forehead to the opposite side. Symptoms are frontal headache, deep earache, and deep toothache in the back molars. The clavicular attachment also causes dizziness, nausea, and the ability to be prone to falling by way of postural imbalance. "When aberrant tensions in the muscle are caused by trigger points, confusing signals are sent to the brain" which affect your spatial orientation. Additionally, "clavicular trigger points can be a case of unilateral deafness or hearing loss on the side where these trigger points exist.”

---

Sternal & Clavicular Branch Referral Pattern

Sternocleidomastoid Functions

"Look at the floor. Now look over your shoulder. Now put your ear to your shoulder. You have just given your sternocleidomastoid
muscle a good work out.”

The SCM has two primary functions:

1. Acting unilaterally: rotates face to the opposite side and lifts chin (looking over shoulder); aids in side-bending neck to the same side (putting ear to shoulder)
2. Acting bilaterally: flexes head and neck (looking at the floor)

Exacerbating Causes

• Holding head back to work overhead
• Keeping your head turned to one side for long periods
• Lifting heavy objects
• Holding cell phone to your ear with your shoulder
• Motor vehicle accidents
• Slouching on a couch or chair
• Reading in bed
• Sleeping on stomach
• Shallow breathing

Self-Treatment for SCM

Fortunately, this muscle is easily accessible and can be worked consistently to reduce tension and release trigger points. Because of the shape of this muscle, it is best accessed with "pincer compression" by picking up and grabbing the SCM between your thumb and first two fingers. Following the trigger point diagram above, you will tilt your head (to the same side of the muscle being accessed) to grab the muscle and apply just enough pressure to those trigger points (marked "X") until you feel it reactivate your pain pattern, whether it be to your jaw, ear, cheek, eye, or forehead. Once you feel the referral pattern (and it may stay localized to your touch without any referral), you will hold for 15 seconds to one minute until the referral pattern has subsided and you just feel the pressure locally at your fingers. You can then move on to the next trigger point on that same side of the SCM until all are trigger points are released, and then repeat on the other side. Remember to breathe! Full video demonstration of "How to self-treat sternocleidomastoid muscle trigger points -- trigger point release" on the YouTube.

.Davies, Clair and Amber. The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief. Oakland: New Harbinger Publications, Inc., 2004. Print.
Finando, Donna & Finando, Stephen. Trigger Point Therapy for Myofascial Pain: The Practice of Informed Touch. Rochester: Healing Arts Press, 2005. Print.
Cauthen, Lisa. "Sternocleidomastoid Muscle: Origin, Insertion & Action." Study.com. 
Retrieved from https://study.com/academy/lesson/sternocleidomastoid-muscle-origin-insertion-action.html.
Sternocleidomastoid muscle: Anatomy and functions
[Digital Photograph]. https://www.kenhub.com/en/library/anatomy/sternocleidomastoid-muscle.
Sternocleidomastoid Muscle Referred Pain
​[Digital Photograph]. https://www.pinterest.com/pin/104286547593957933/. 
Sternocleidomastoid Trigger Point Diagram
​[Digital Photograph]. http://www.triggerpoints.net/muscle/sternocleidomastoid.
“How to self-treat sternocleidomastoid muscle trigger points -- trigger point release." Online video clip. YouTube. YouTube, 21 August 2015. Retrieved from https://youtu.be/bHRpaBzaLrc.