Changing Direction

Consider the Less Obvious

By Douglas Nelson
[Table Lessons]

“Wait—how long?” I asked, thinking I misheard my client’s answer to my question.
 “I’ve had a headache every day for at least eight years, but it might actually be ten,” she replied. “I don’t remember a day without a headache in all these years.”
Mrs. E. was my new client that day, and her facial expression revealed a resignation of her current circumstance.
“I’m sure you must have tried various treatment strategies over the years. Can you share with me what treatments you have explored?”
I could tell by the way Mrs. E. glanced to the floor before answering that she must have repeated this list of failed strategies to many other health-care providers.
“I have done just about everything you could imagine. My regular doctor and I have used a litany of different medications. Each has some small benefit, which is outweighed by the side effects or the fact that they just don’t seem to help very much. In addition, I have tried physical therapy, chiropractic, and acupuncture. The latest thing I have tried is Botox, and that has seemed to help a bit. But, in the end, I still have a headache each day.”
“Could you tell me about the chiropractic and physical therapies?” I asked. “What did they do, and where was it directed?”
“I have lots of shoulder and neck discomfort,” she replied. “I’m pretty sure they thought that if my shoulders and neck were better, it would solve the headaches. The chiropractor focused primarily on my neck using adjustments. I have seen three different physical therapists, and all of them directed treatment to this area,” pointing to her upper trapezius.
“What can you tell me about the quality of the headaches?” I asked.
“I get true migraines, primarily on the left, about three or four times a month. The daily headaches are tension headaches in the back of my head and neck, and down my shoulders.”
I instructed her to lie supine on the massage table. I began by exploring the cervical musculature, starting with the splenius and semispinalis muscles. She reported these muscles as quite sensitive. While I could tell by her response that she wanted me to stop and direct my focus there, I informed her that I would rather take an inventory of multiple muscles first, before concentrating on any one area. As I moved to the shoulders, I could sense her shift, in either pain or anticipation.
“I know you are going to find lots of problems there,” she stated, as I moved toward the upper trapezius.
I indeed found multiple areas of sensitivity in the right trapezius. In fact, too many. Examining the left trapezius, I found just as many sensitive areas as I did on the right. Resisting the urge to focus on the obvious, I went a different direction.
Palpating carefully and slowly, I examined the masseter attachments under the maxilla. Mrs. E. winced noticeably.
“Wow, that’s surprisingly tender,” she said with surprise in her voice.
Finding several areas of sensitivity in the masseter, I moved to fully explore the temporalis. Several areas were exquisitely tender, all of which were surprising to Mrs. E.
“Why is that so tender?” she asked. “Do you think that has anything to do with my headaches?”
“It very well may,” I responded. “With your permission, let’s try something. I’d like to treat the muscles of your jaw very thoroughly, first inside the mouth* and then repeat the external treatment again.”
Mrs. E. agreed, and I could tell she was very intrigued by the process. We found several very sensitive areas of the masseter and temporalis during the intraoral treatment, but the improvement was remarkable.
After repeating the external treatment of the masseter and the temporalis, I returned to the neck and shoulder muscles, which were markedly better. Mrs. E. had a surprised look on her face.
“I’ve never had less tenderness in my neck and shoulder muscles. Why is that?” she asked.
“While it is well known cervical muscles can cause headaches, it is less well known that muscles of the jaw can cause sensitivity in the neck. That is quite possibly true for you, as your neck sensitivity diminished without directly treating it. There is good science behind this, but the proof is in the pudding. Let’s not treat anything else today and see what happens.”
The results were indeed stunning. I saw Mrs. E. 10 days later; she had not had a single headache since our initial session, and that progress has been sustained. She experiences an occasional migraine, but the daily tension-type headaches have almost completely disappeared—a significant change in her quality of life.

Douglas Nelson is the founder and principal instructor for Precision Neuromuscular Therapy Seminars, president of the 16-therapist clinic BodyWork Associates in Champaign, Illinois, and president of the Massage Therapy Foundation. His clinic, seminars, and research endeavors explore the science behind this work. Visit, or email him at