A headache is described as a pain experienced in the head. Often times they appear to be felt over the eyes, in the temple, or at the base of the skull. The majority of headaches are classified as tension headaches due to spasm coming from the muscles of the head, face, or neck. Muscles that encase the skull, sinuses, eyes, ears, and meninges that cover the surface of the brain and spinal cord, arteries, veins, and nerves can become inflamed or irritated to cause a pain in the head. The pain may be dull, sharp, throbbing, constant, mild, or intense.

Causes and Symptoms

Clenching and Grinding

A large number of headaches are related to overuse of the temporalis and masseter muscles due to unconscious clenching or grinding of the teeth. Both clenching and grinding can be habitual and done for various known and unknown reasons either while awake or asleep. Clenching has been measured to generate a force up to 1200 pounds per square inch! This results in muscle spasm, and the enlargement of both the masseter and the temporalis muscles. Other factors that create muscle spasm and the resulting headaches can be obsessive gum and pencil chewing and fingernail biting which can be emotional releases from stress.

Poor Posture

A “forward head and rounded shoulders” posture puts chronic tension on the neck muscles, which then refer pain up into the head. When combined with activities such as computer use, driving, reading, knitting, playing a musical instrument, a “slouching” posture can add to the chronic tension on the upper back, shoulders, head, and neck thus heightening the likelihood of tension headaches.


Multiple physical therapeutic modalities are utilized to resolve the muscle spasms that cause headaches. Massage, moist heat (not ice!), myofascial release, dry needling, ultrasound, electrical stimulation, kinesiotape, stretching routines, therapeutic exercises, and patient education are all useful for relieving headache pain. Depending upon the severity, treatments are typically 2–3 times per week, for several weeks. Our goals for such treatment are the reduction of muscle spasm, an increased range of motion in both the jaw and the neck, and an increase in muscle relaxation. Increasing the relaxation of the involved muscle(s) allows increased circulation, allowing for a “warmer muscle”. Remember: a warm muscle is a happy muscle!


Vertigo is a feeling of spinning or whirling when you are not moving. It can also be an exaggerated feeling of motion when your body is still. Vertigo is different from passing dizziness or light-headedness. Some individuals describe it as “swimming in the head” due to head position changes like bending forward, looking up, lying in bed and turning your head or standing and walking.

Causes and Symptoms

There are many causes of vertigo. Two causes found most often are discussed below.

  1. The ear normally contains tiny crystals that can shift into one of the ear canals and cause you to be sensitive to gravity. Women are twice as susceptible than men.
  2. Trigger points in the sternocleidomastoid (SCM) muscle cause the feeling that the head and the body are not being oriented normally due to complex neurological pathways used to maintain equilibrium, resulting in the feeling of vertigo, dizziness, light-headedness or “swimming in the head”.

It is often useful to be evaluated by an Ear, Nose and Throat (ENT) Physician to assure that there are no underlying pathologies. Once cleared by your physician, physical therapy is the next step to resolving vertigo.


  1. The canalith repositioning procedure is a series of simple, gentle head movements taught and performed in our office and also done at home.
  2. Multiple physical therapy modalities can be very useful to alleviate vertigo if the SCM muscle is the cause.
  3. Modalities include: myofascial release, electrical stimulation, ultrasound, moist heat, dry needling, and a neck stretching and postural program for the home.