Occipitalis Trigger Points

Introduction

The occipitalis is a key scalp muscle responsible for moving the scalp, supporting facial expressions, and contributing to head posture. When trigger points develop in this muscle, they can cause headaches, upper neck tension, and eye strain, often mimicking tension headaches, migraines, or sinus pain.

Name and Area

  • Name: Occipitalis

  • Area: Located at the back of the head, running from the occipital bone to the galea aponeurotica (scalp fascia).

Indications

Occipitalis trigger points may contribute to:

  • Pain at the Base of the Skull That Spreads to the Forehead (Mistaken for Tension Headaches or Migraines)

  • Pain That Extends to the Top of the Head or Behind the Eyes (Can Mimic Sinus Pressure or Eye Strain)

  • Tightness in the Back of the Head, Especially After a Long Day of Work or Stress

  • Pain or Tenderness in the Scalp That Worsens with Touch or Hair Brushing

  • Sensitivity to Light or Screens (Common in Those Who Work at Computers for Long Hours)

  • Pain That Worsens with Stress, Jaw Clenching, or Poor Sleeping Posture

Pain from this muscle is often mistaken for tension headaches, migraines, or neck stiffness.

Muscle Action

  • Moves the Scalp Backward: Works with the frontalis muscle to create facial expressions and forehead movement.

  • Supports Head and Neck Posture: Helps stabilize the occipital region and prevent excessive strain.

The occipitalis is essential for head movement, scalp mobility, and tension distribution in the upper neck and head.

Signs and Symptoms

Individuals with occipitalis trigger points often report:

  • Pain at the Base of the Skull That Spreads Toward the Forehead or Eyes

  • Pain That Feels Like a Band Around the Head (Common in Tension Headaches)

  • Sensitivity in the Scalp (Can Make Hair Brushing or Ponytails Uncomfortable)

  • Pain That Increases with Eye Strain, Stress, or Poor Posture

  • Headaches That Are Worse After a Long Day at the Computer or After Sleeping in a Poor Position

Pain worsens with prolonged screen time, stress, jaw tension, or poor sleeping posture.

Perpetuating Factors

Common causes of occipitalis trigger points include:

  • Chronic Stress or Anxiety (Leads to Increased Head and Neck Tension)

  • Excessive Screen Time (Looking at Monitors for Long Hours Without Breaks)

  • Forward Head Posture (Common in Desk Workers, Gamers, and Smartphone Users)

  • Teeth Clenching or Grinding (Increases Overall Head and Jaw Tension, Contributing to Headaches)

  • Sleeping on a Pillow That Does Not Support the Neck Properly

Trigger Point Referral Pattern

Trigger points in the occipitalis refer pain to:

  • The back of the head and upper neck (Can Mimic Cervicogenic Headaches or Neck Stiffness)

  • The forehead and behind the eyes (Mistaken for Tension Headaches or Eye Strain)

  • The top of the head (Can Resemble Migraines or Scalp Sensitivity Issues)

Pain from this muscle is often confused with tension headaches, sinus headaches, or upper cervical dysfunction.

Differential Diagnosis

Occipitalis trigger points may be mistaken for:

  • Tension Headaches (Dull, Aching Pain That Wraps Around the Forehead and Temples)

  • Migraines (Severe, Pulsating Headaches That May Include Light Sensitivity and Nausea)

  • Cervical Spine Dysfunction (Neck Pain with Radiating Symptoms Into the Head and Shoulders)

  • Trigeminal Neuralgia (Sharp, Shooting Facial Pain That Can Resemble Nerve Compression)

  • Sinus Headaches (Pain and Pressure in the Forehead, Often Accompanied by Congestion)

A thorough neck, head, and posture assessment is necessary to rule out these conditions.

Associated Trigger Points

Occipitalis trigger points often co-exist with:

  • Frontalis (Forehead Pain and Tension, Common in Stress and Postural Imbalances)

  • Temporalis (Side Headaches and Jaw Pain, Can Resemble Migraines or Sinus Pressure)

  • Sternocleidomastoid (SCM) (Neck and Head Pain, Can Mimic Sinus Pressure or Tension Headaches)

  • Upper Trapezius (Shoulder and Neck Tension, Common in Postural Strain and Stress-Related Pain)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Occipitalis Occipital bone (superior nuchal line) Galea aponeurotica (scalp fascia) Facial nerve (CN VII)

The occipitalis is innervated by the facial nerve (cranial nerve VII), which also controls facial expressions and forehead movement.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the back of the head and upper neck.

  • Head and Neck Mobility Testing: Assess pain or tightness when tilting the head forward or backward.

  • Light Sensitivity and Screen Exposure Testing: Determine if prolonged screen time worsens symptoms.

  • Postural Assessment: Rule out forward head posture, which increases upper neck strain.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the occipitalis, reducing muscle tightness and improving head mobility.

Manual Therapy

  • Trigger Point Release: Apply gentle sustained pressure along the base of the skull and scalp.

  • Facial and Scalp Massage: Helps improve circulation and reduce muscle tension.

Stretching

  • Neck Extension Stretch: Tilt the head backward gently to relieve tension in the occipitalis.

  • Scalp Massage and Hair Brushing Techniques: Can help reduce scalp sensitivity and improve circulation.

Strengthening Exercises

  • Chin Tucks (Deep Neck Flexor Activation): Helps reduce forward head posture and improve neck stability.

  • Postural Strengthening Drills: Encourages proper head and neck alignment.

Postural and Behavioral Adjustments

  • Avoid Prolonged Screen Time Without Breaks (Follow the 20-20-20 Rule: Every 20 Minutes, Look 20 Feet Away for 20 Seconds)

  • Use Proper Pillow Support While Sleeping (Maintain a Neutral Neck Position to Prevent Muscle Tightness)

  • Practice Stress Management and Relaxation Techniques (Deep Breathing, Meditation, or Jaw Relaxation)

Conclusion

The occipitalis plays a crucial role in scalp movement, facial expressions, and posture, but trigger points in this muscle can cause significant headaches, neck stiffness, and eye strain. By incorporating dry needling, manual therapy, stretching, and posture correction, individuals can reduce pain, improve mobility, and prevent tension-related dysfunction.

➡️ Learn more about Trigger Points

➡️ Explore our Trigger Point Index

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.