How to Overcome Chronic Myofascial Headaches: Insights From a Case Report

Chronic headaches can involve more than one contributing factor, especially when previous trauma, scar tissue, muscular tension, or neck dysfunction is involved. This case report follows Jane, who sought care for persistent headaches and neck pain six years after a significant injury caused a laceration and fracture near the right occipital region of her skull. During the two years following the trauma, she gradually developed complete numbness along the distribution of the greater occipital nerve on one side of her scalp. The numbness eventually progressed into recurring head pain.

By the time she sought treatment, Jane was experiencing daily headaches that wrapped around her entire head, along with separate episodes of sharp, stabbing pain extending from the back of the skull to just above her eye. The original injury site remained extremely sensitive to pressure. Multiple MRI examinations had produced normal findings, while previous chiropractic treatment, exercise- and stretching-based physical therapy, and massage had provided only mild, temporary improvement.

Her physical examination provided additional clues. Pressure over the old scar reproduced the shooting sensation and revealed reduced mobility in the surrounding fascia. Tenderness and movement limitations were also found in the neck and upper back. Neurological testing did not reveal problems involving the spinal nerve roots, spinal cord, or cranial nerves, and her cardiovascular examination was unremarkable. Taken together, these findings suggested that myofascial restrictions associated with the old injury, combined with cervical muscle and joint dysfunction, were contributing to her symptoms.

The case demonstrates why persistent headaches sometimes require looking beyond where the discomfort is actually felt. When imaging does not reveal an obvious explanation, examining previous injuries, scar mobility, fascia, muscular function, and cervical mechanics may provide additional information about factors associated with an individual’s headache pattern.