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Trigger points in the suboccipital muscle group are the most common cause of tension headaches.]

Trigger points in the suboccipital muscle group are the most common cause of tension headaches.

updated 12/17/09

Massage Therapy for Tension Headaches

Perfect Spot No. 1, in the suboccipital muscles of the neck

by Paul Ingraham, Vancouver, Canada MORE

Credentials and qualifications

I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.

For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.


Trigger points (muscle knots) are the world’s most common cause of aches and pains. The Perfect Spots series of articles teaches you how to self massage the most satisfying and therapeutically significant places on the human body to apply pressure. Each Perfect Spot article focuses on a specific location. For a complete, advanced tutorial that walks you through every possible self-treatment option for muscle pain, see Save Yourself from Trigger Points & Myofascial Pain Syndrome!

This may be the single most popular spot to apply pressure in the human body. No other spot gets such rave reviews from my clients. And no wonder: without these muscles, your head would fall off. They feel as important as they are.

Along with lots of other neck muscles, the suboccipital group — usually just called “the suboccipitals” — work overtime to keep your head balanced on top of your spine. In particular, they initiate and control fine movements. This is no small task: your head may weigh as much as a 10-pin bowling ball, if you’re a big person, and it is resting on a foundation only about one third as wide. Consequently, these muscles never really stop working.

Your head may weigh as much as a 10-pin bowling ball.

The suboccipitals are also partly “antagonized” (balanced) by the jaw muscles. This is an odd arrangement. Generally speaking you’ve got one muscle or group of muscles that pulls one way, and then muscles on the other side of the joint that pull the other way. But the jaw muscles do not affect the spinal joints, and cannot directly work against/with the suboccipitals to balance the head. Nevertheless, they do: muscle studies have shown that the jaw muscles behave much like they would in a truly balanced working relationship with the suboccipitals. If the jaw muscles tighten, the suboccipitals tighten. Both of these muscle groups routinely harbour trigger points that cause headaches (among other things), and together they are the source of most tension headaches.

If I could have only one group of muscles to get massaged regularly, this is the one I’d choose!

What does Perfect Spot No. 1 feel like?

In addition to generally producing the best quality of the “deep sweet ache” that most people crave from massage, trigger point referral into the head has a sedative effect that can’t be beat. Just as trigger point referral elsewhere in the body tends to feel “paralyzing,” creating a deadening or heavy feeling that usually spreads downwards like a heavy blanket, trigger point referral from the suboccipitals does this too — but that feeling spreads into the head. With the right pressure, in the positive context of therapeutic massage, that sensation is deliciously soporific.

An incredibly high proportion of the population consistently report these positive sensations in this location — even many people who aren’t otherwise especially “triggery,” and who may have the idea that massage is kind of pointless.

Many times while working on a quiet client — someone who is either really zoned out, or seemingly unaffected and taciturn — I have been interested to see how they react to pressure in the suboccipitals. Clients who haven’t made a sound for fifty minutes suddenly groan with relief and say, “Oh, that’s a good spot.”

How do you treat Perfect Spot No. 1?

The suboccipital group is easy to find. It lies just underneath the back of your skull, in a line from ear to ear. Each person’s personal version of Perfect Spot No. 1 will be found somewhere in that range. While the entire group responds positively to pressure in most cases, there is some variation in quality from one location to another along the ridge.

Is the centre safe?

That hollow spot at the exact centre of the back of the skull at the top of the neck is sometimes included in lists of places where massage caution is required, called “endangerment sites.” Endangerment sites are not necessarily “dangerous,” but simply locations that require extra alertness.

In this case, there are nerves and arteries that are somewhat exposed in the hollow. However, nerves and arteries are pretty tough. I have never heard of an artery or vein being lesioned — which would cause massive bruising — by any massage, ever. And nerve have a built-in warning system: they’ll yell at you long before they get damaged.

If you exercise any caution at all, it’s a perfectly safe place to massage.

The exact centre is the one spot where you might not get a positive reaction. There is a small hollow there, right at the top of the spine. To some people, pressure on this spot — which is not actually even muscular — will be sweet bliss. To others, while there is no actual danger, it feels too vulnerable, too “spine-y.” It’s a love-it-or-hate it spot, with roughly 75% of people loving it, 25% feeling uneasy with it. Note that some people can learn to love it, if they feel safe enough.

There is no actual danger, but to some people the exact centre spot feels too vulnerable.

The rest of the region is all predictably pleasurable, but your partner’s favourite spot might be in the thinner roots of the tissue more on the actual skull, or deeper into the muscle bellies further under the ledge. They might prefer pressure on the thick bands of muscle exactly on either side of the centre, or they might prefer it way out on the sides, just behind the bump of bone under the ear.

To massage someone’s suboccipitals, have them lie down face up. Reach under the base of the skull and press upwards with your fingertips. Start slow, but most people will be able to tolerate strong pressure here. Beware: they won’t want you to stop.

The “Octipet” is a self-massage tool that works well in the suboccipital muscle group.

The “Octipet” is a self-massage tool that works well in the suboccipital muscle group.

How do you self-treat Perfect Spot No. 1?

It’s a bit tricky to effectively massage your own suboccipital muscles without a tool like the Octipet (shown at right), but it is awfully nice to just lie down with this muscle group resting on a tennis ball. To some extent you can roll back and forth on that and get some satisfaction. A smaller, more accurate ball might work better for you, or you might want to try rest the centre point on the pointy end of a “Kong”-style dog toy (probably through a layer of fabric to soften it and keep the rubber from pulling your hair).

Stretching may also help to relieve trigger points in the suboccipitals. Slowly and respectfully pull your head downwards with your hands, but gently straighten and lift your lower neck at the same time — that is, only tilt the skull forward, not the whole neck. Another excellent therapeutic exercise for this muscle group is Neck Circles.

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All The Perfect Spots for Trigger Point Massage

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perfect spot!

Or, for general information and advanced tips about trigger point therapy, see Save Yourself from Trigger Points!

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Is trigger point therapy too good to be true?

Trigger point therapy isn’t too good to be true: it’s just ordinary good. It can relieve some pain cheaply and safely in many cases. The existence of trigger points is not controversial. You can measure their electrical activity, take samples of their highly acidic tissue chemistry, and now a new MRI-like technology can now show them as well.

The Perfect Spots are based on a decade of my own clinical experience, and on the research and writing of Drs. Janet Travell and David Simons, pioneers of myofascial pain syndrome research. They produced “the Big Red Books” (a massive pair of texts).

Trigger points are clinically significant, but unfortunately obscure. As Dr. Simons wrote, “Muscle is an orphan organ. No medical speciality claims it.”