Case Study: Shoulder Muscle Primary Contributor To Headaches - Northwest Physiotherapy Group

Case Study: Shoulder Muscle Primary Contributor To Headaches


Mrs D is a 38 year old researcher who presented recently with a long history of headaches and migraines.

She had suffered some trauma to her head and neck region when she was 15 years old, and she had traced the start of her problems to after this event.Mrs D suffered with 2 migraines a month generally, but lately she had been experiencing headaches on a daily basis around this. Her symptoms were usually aggravated by stress.

Her headaches and migraines were in similar areas, usually around the left eye and into the back of the skull on the left, and she had associated pain into her left shoulder and the top of her arm.

Mrs D had been under the care of a neurologist, and had seen other Physios and Chiropractors with good but short to medium term relief only.Her good result was:

What we found

  1. Reduce or eliminate the constant headaches.
  2. Reduce migraine frequency, duration and intensity.
  3. Feel less stiff in the neck and shoulders.
  4. Improve energy levels.

We took Mrs D through a whole body assessment, because we know through experience and research that where your pain is may not be where the cause of your problem is.

What we did

Summary of assessment findings:

  1. Muscle tension/knots in many of the neck and shoulder muscles on both sides.
  2. Adverse nerve tension in the upper limbs.
  3. Stiffness in many joints around the neck, thoracic spine and lumbar spine.
  4. Restricted passive neck flexion/rotation test, worse to left.
  5. Weakness in the deep neck flexors and scapular stabilizers.
  6. Poor pattern of shoulder movements, left worse than right.

We trialed treatment on the the unhappy muscles and joints that we had found on the initial assessment, and used a single test movement(passive flexion/rotation of the neck) to measure the response of each intervention. we also monitored other key movement tests related to Mrs D’ condition, especially shoulder and neck range/quality of movements.
From this we made a list of structures that had made good changes to Mrs D movements tests.


We then worked on that list to narrow down further the main dysfunctions that were contributing to Mrs D’s condition. This involved a process of elimination and clinical reasoning.

We finally narrowed down to the left infraspinatous muscle in her shoulder, that was continuing to make differences to all of Mrs D’s relevant movement signs. Working to release this muscle also improved the stiffness in many of the neck joints.


The graph below shows the improvement in Mrs D’s key movement tests over the course of treatment, which involved 7 x 1 hr treatment sessions.

The objective improvement matched improvements in Mrs D’s symptoms:

  1. General headaches were largely eliminated between migraines, except for times of high work related stress. In these cases headaches were much less severe, and of shorter duration.
  2. Migraines were also less frequent, less severe and shorter duration, on average 1 very 4-6 weeks.
  3. Mrs D was very satisfied with her results, feeling more energetic and more in control of her condition. she had simple tests she could use to self monitor her body, to know when muscle and joint tension was increasing, and a range of strategies that she could use to manage her condition long term.

Why was the left shoulder contributing to Mrs D’s condition?
The left shoulder had a large trigger point/knot in the infraspinatous muscle. This was adding to the level of noxious input to her central nervous system, sensitising the main receptor nuclei(trigemeni cervical nucleus) in the brainstem that trigger headaches. Reducing tension in this muscle reduces the level of this noxious input, thus making it harder for a headache/migraine to be triggered.

This shoulder dysfunction related to weakness to of the shoulder stabilisers, poor posture in sitting at her desk, and poor movement control, problems we addressed as part of a long term solution for Mrs D.

This case study highlights the importance of looking beyond the neck in the management of headaches.

It is unlikely that such a result would have been achieved by treatment of the neck alone, as the shoulder release work improved the neck stiffness when re- assessed immediately afterwards.

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