1.Tilting head forward by looking down at a desk job
2.Reading in bed
3.Looking down while reading in chair
4.Tucking chin into chest while sleeping on side
5.Sleeping with too many pillows
6.Driving on long car trips
7.Watching television in bed
8.Sleeping or lying in recliners
I didn’t know which one of these was the culprit, so I wanted her to focus on the tension at the base of the skull to determine the problem.
Also, she needed to be extra sensitive to the causes that induce tightness in the rectus capitis posterior muscles or muscles at the base of the skull. I touched the muscles so she knew where to massage and apply pressure at the trigger points. I taught her how much pressure to apply and how long to push on the trigger points. She noticed, while pushing on these muscles, the pain radiated to the forehead. I told her no more than ten to fifteen seconds on each spot, but she could move to another spot until the pressure was relieved or fogginess subsided. I told her if the headache persists after several minutes of trigger points, then she needed to trigger point the lateral trapezius muscle (muscle at top of shoulder) by pinching it. Typically this will radiate pain up into the forehead or base of skull and also cause the pressure foggy type of headache. She felt the radiating pain while I applied pressure to the trigger points. I had her try to cause the same radiating pain with her pressure. She wasn’t able to apply much pressure, so I told her to keep practicing. I explained that preventing the cause (tilting head forward) is part of it, but she will need to get very proficient at trigger-point therapy.
We then discussed the prevention therapy by using the “towel” treatment technique. The towel treatment needs to be limited to 25 minutes, because the stretch of the front neck muscles, mainly the sternocleidomastoid (SCM) muscle, will spasm to protect itself after 25 minutes and the treatment will be counter effective. Additionally, if done longer than 25 minutes, the neck muscles will become stiff and will take three to four days to loosen up. I told her never to fall asleep on the towel.
RCP (Rectus Capitis Posterior) Muscles
Causes foggy/pressure headaches with pain to the forehead. You will know when you are touching the correct trigger point when it radiates to the forehead. The trigger point is located at the very back at base of the skull. Feel around until you feel the pain radiate to the front and hold it for 15 seconds. Then move around until you feel another trigger point causing radiating pain.
Figure 1
Trapezius Muscle Trigger point
Pinching the trapezius muscle closest to the shoulder is one of my favorite trigger points. I have helped most of my patients with this one trigger point. Feel around until you feel the pain radiating to the headache in the forehead or base of skull. Keep the pressure on for 15 seconds. There will be multiple trigger points in this region. Keep feeling for more radiating points until pressure headache is relieved.
Figure 2
The Towel Treatment:
Self-Treatment for Occipital Foggy/pressure Headaches:
The towel was a self-treatment technique that I developed during a trip to Toulouse, France. From the thirteen-hour plane ride to France, I suffered severe tightness at the base of my skull that was causing a low-grade headache and causing a lot of pressure in my head with significant fogginess. My ears also felt “plugged up” as well. I rolled up a towel and laid it between my shoulder blades with the top edge at the base of my skull. This applied pressure on the trigger points of the rectus capitis muscles. It felt very tender and produced a mild radiation to my forehead. It took three treatments at 25 minutes apiece to relieve the pressure and fogginess.
She said she would not do the towel technique longer than 25 minutes.
I also told her if the pressure, pain, and fogginess is worse than normal, to use the edge of the bed to help gently push the atlas (first vertebra in the neck) forward. I showed her the atlas on a skeleton and how it moves back with head tilt forward. I also showed how the edge of the bed can apply some pressure to the atlas and the weight of her head will urge the atlas forward. Like the towel, the bed should be at the base of the skull while on your back. It will apply more pressure and provide relief of pressure and fogginess headaches in more severe cases. The pressure should be on the rectus capitis posterior muscles. There is a specific time for this treatment. It is very easy to overdo this treatment. Absolutely no more than six minutes.
Towel treatment technique
This is by far the best treatment for shoulder, neck, and upper back problems. I have more patients doing this one self-treatment than any other. The towel position is extremely important. Place towel on floor or bed and lie down on it. It needs to be between shoulder blades and just below the skull. If placed correctly, you will feel pressure at base of skull and it will relieve foggy/pressure headaches. Limit to 25 minutes. Do every night to relieve stress and pressure, especially if you have a desk job. This will be your best friend. It helps so many problems. You may feel it radiate to forehead if edge of towel is on trigger points.
Figure 3
I treated her using a gentle technique on atlas and axis and applied acupressure (trigger point therapy) to the muscles at the base of skull and trapezius muscles.
She stated the pressure was less and the headache pain was also less. She didn’t think the fogginess was any better. I told her the three things she was to take from this treatment were:
1.Foggy/pressure headaches come from prolonged head tilt forward and it could be from work, sleep, lying in bed, reading in bed, reading, etc. for long periods of time.
2.Use the towel each night for 25 minutes to relieve the pressure and fogginess. While lying on your back, put the towel between the shoulder blades along the spine with the top edge at the base of the skull. The towel runs down the spine. It doesn’t run across the spine but rather with the spine between the shoulder blades. Many patients get this wrong.
3.If the pressure/foggy headaches are worse, use the edge of the bed to help the atlas move forward. While lying on your back, the edge of the bed should be at the base of the skull for no more than six minutes.
TAKEAWAY REVIEW:
Occipital-type Headaches
The occipital headache is the most common type of headache. Symptoms include:
1.Fogginess
2.Pain or pressure at base of skull
3.Pressure in forehead (mimics sinus headaches)
4.Ear fullness with slight loss of hearing
Possible causes
1.Tilting head forward by looking down at a desk job
2.Reading in bed
3.Looking down while reading in chair
4.Tucking chin into chest while sleeping on side
5.Sleeping with too many pillows while on back
6.Driving on long car trips
7.Watching television in bed
8.Sleeping or lying in recliners
9.Forward head position while working at desk
Prevention
Lying flat on a rolled up towel placed along the spine between the shoulder blades with the top of the towel at the base of the skull for up to 25 minutes. Perform nightly in order to prevent future occipital