Treating Chronic Headaches & Getting Restorative Sleep

This interview is with Mary Jo Smiley CMTPT, LMT, CMMT

Mary Jo is a nationally Certified Myofascial Trigger Point Therapist, a Professional Member of the National Association of Myofascial Trigger Point Therapists and on the board of the NAMTPT.

In her own words: “My main training was at the Pittsburgh School of Pain Management, the only 650 hour program in the USA that teaches the entire Travell and Simons ‘Myofascial Pain and Dysfunction the Trigger Point Manual’ medical text in a one year diploma program. This training prepares the student well to sit for the national exam and to go out into the world to help others eliminate their trigger points and referred pain!”


Naomi:Hi, this is Naomi. I’m calling from Firstly, could you please tell me a little bit about your story and how you first started having chronic pain?Mary: Probably started when I was elementary school, got worse through high school, no real reason. Probably a lot of fall here and falls there and flying over bicycles and falling out of trees, things that kids do or at least used to do, and you’re not bleeding and you’re not broken so no big thing.

But the older I got, even into high school, I had to stop going backpacking, which I really liked to do, because it just hurt me too much to carry the backpack. That’s the very basics of it. The older I got, the worse it got, and in the email I sent, I kind of thought about the years that these things happened and wrote those in there.

I already knew about trigger point therapy. I had run into somebody and was getting treatment occasionally. I was in a car accident, and I was able to get a good bit of it and it made so much difference. And that person that had introduced me to it as trigger point therapy, actually created a school near where I live and had been trying to get me to go to school. He says, “You know this stuff. I’ve taught you a lot. You know this stuff.” But I had a good job, and nice benefits and didn’t really want to go to school.

After I was in that accident and it made so much difference, I kind of thought, “Yeah, I’m going to do it. I’m going to go to school, and then we’ll see what happens.”

And it helped so much. I got rid of my, they weren’t constant headaches but I would get them and they would last for days. You call that a migraine, you call that a headache, whatever you call it. Finally I got Imitrex, which was one of the first good migraine medicines, I got that from my doctor and that helped, but it wasn’t getting rid of what was causing them. But the trigger point therapy did, and now I don’t get headaches hardly ever.

Naomi:Right. Could you tell me a little bit about which specific muscles you treat for headaches?

Mary: Each headache is different. When you’re doing Myofascial Trigger Point therapy, one of the big things that you’re looking at is where does the person experience the pain. With headaches, can we pinpoint where the pain is or where it’s worse?

Sometimes that’s really hard to do, and other people will say, “Oh yeah, it starts at my neck, I get the pain up my neck and then it goes into my temple and it’s all on this side of my head,” and they can be really specific.

Other people, they have a lot harder time being specific, but I also think that a lot of the reason for that is because there’s a lot of muscles involved, and each muscle has its own distinct pain pattern. It’s usually not where the pain is. The trigger point is usually not where the pain is. 75 percent of the time it is not where the pain is. That’s why it’s missed most of the time by most people.

Massage therapists are taught, “Oh, this is what a trigger point feels like, and if you push on it, it will go away.” It’s a lot harder than that. It doesn’t work that easily.

Plus, they’re only finding the trigger point. They’re not looking at where the pain pattern is and addressing those muscles, your basic, really classic tension headache. Most people will say, “Yeah, it kind of starts in my shoulder, goes up the back of the neck and up into the temples,” and that’s the pattern of the upper trapezius trigger point. If you’re standing behind somebody and grab the top of their shoulders, near their neck, you can feel the upper trapezius. It’s really easy to find.

Naomi:Yeah, trapezius is an interesting one, because I think it’s one of the most common places for a trigger point, but it’s quite a big muscle, surprisingly hard to treat sometimes. What do you find?

Mary: I don’t think that it’s all that hard to treat, if you know how to do it. If you’re doing everything wrong, of course it’s not going to work. It’s not magic and it’s not a deep, dark secret. I can show most people, in a very short period of time, how they can get rid of their friend’s headache. It’s a little bit trickier trying to get rid of your own headache when it’s there. It’s actually a little bit harder.

But do it right, it’s not really all that hard. You can do it with the person sitting in a chair, they can be laying down face up or/and face down, and then you need to stretch that muscle. And the reason why it gets trigger points in it, at least one of the big reasons, is when we’re angry, when we’re upset, when we’re startled, when we’re afraid, all of those postures are very similar. Our shoulders go up around our necks, and our head and our face go forward and down.

So it’s making that muscle work really hard and holding tension in it. It’s so very, very common with everybody. If you grab hold of that spot, they’re going to say, “Ow.”

Naomi:So you were able to find that trigger points made a big difference to your chronic headaches, and now do you do trigger point therapy on other people or teach people how to do it to themselves?

Mary: I took the 650-hour course, two full days over a year, and then I took a national certification exam. I’m nationally certified in the modality, and yes, it’s been my livelihood, basically since the middle of ’99 when I graduated. It’s how I’ve supported myself ever since. I massage too, because most don’t know what trigger point therapy is, so you can’t convince them that they need it if they don’t
have a clue.

I drag them in with a massage and talk a lot about pain management and treatment for pain. You know, that’s how I advertise. I don’t advertise that I do relaxation massage. I can, but I’m not all that great at it. What I do, it hurts a little bit, I stretch you around and people do fall asleep, but that’s not the intention.

Naomi:What specific techniques? Like do you do pressure point or ischemic pressure or dry needling? What do you find is the most effective way?

Mary: It’s mostly hands on, so it’s squeezing and pressing on the trigger point and then stretching. Pressure is basically, you’re pushing on an area and the area around it turns white, because you’re inhibiting the blood flow. They used to think that that had nothing to do with it and maybe it does.

So it’s mostly hands on. I do use an electronic device. It’s classified as a TENS Unit. It’s also made to treat acupuncture point, electric acupuncture. So it doesn’t puncture the skin at all. It just delivers a very fine point of electricity. It’s classified as a TENS Unit. You can also use the Spray and Stretch. It’s a very tight stream of cold substance that you spray on the body and stretch.

Naomi:Yes, that was what Kenneth Travell used originally, I think.

Mary: It’s a distraction. Some people use that a lot. I don’t use it very much. I’m more hands on. I’m not allowed to do dry needling. It’s basically restricted to physicians, nurses. PTs are fighting to be allowed to do it. The acupuncture people are kind of fighting against it, because they think that nobody else should be able to use their tool, even if they’re doing something totally different. Only a chef is allowed to use a chef’s knife. That’s basically what they’re saying. It’s our tool, and you’re not allowed to use it, although they’re not trained to do dry needling and these PTs are going through a very long, expensive course if they’re doing it right.

Some doctors are doing trigger point injections. And the PTs in this state, Pennsylvania, aren’t permitted to do that dry needling, so there really isn’t anybody around that’s doing it. I’ve had it done, and it’s very effective.

Naomi:Interesting. Jonathan Kuttner, the doctor who is the resident expert on Life After Pain, he does a lot of dry needling and some injections as well, and I think he’s found it to be very effective as well.

Mary: He knows what he’s doing. But when you have a background and you can find a trigger point, the dry needling and even the injections are very effective. It’s all in whether the practitioner knows what they’re doing or not.

Naomi:Yeah, definitely. Aside from doing the trigger point releases on people who come to you, is there any other aspect that you find very effective in helping them prevent trigger points from reoccurring?

Mary: Well, we look at the perpetuating factors. If you have a desk job and you’re at the computer for eight hours a day and your computer is not set up ergonomically correct or if you’re sitting in a really bad position, it’s going to cause you problems. I just had my teeth cleaned the other day and I’m like thinking about the person who does that tiny little scraping work cleaning your teeth.

They’re holding the instrument tightly and their forearms are up tight and they’re making these tiny little movements, and it could be [a problem] too. I mean, somebody who does heavy lifting. Anything that can cause trigger point is going to perpetuate them, if you don’t stop that activity or change the way you do it.

At a computer desk, sometimes a track ball will work much better for somebody than themouse that you have to move and you’re holding tension in your arm the whole time. Most people, if you tell them they have to change their job, that’s not as easy as it sounds. It’s very difficult. Somebody’s been trained to do something, and they don’t just walk away and find another job. So people need to find a different way to do things.

If they have a tendency to hold the phone with their shoulder, get a headset. It got worse whenever people started using cell phones, because the cell phone was so little and thin. If you’re holding your phone to your ear with your shoulder it’s even worse, but mine has a speaker on it and that’s awesome and that solves the problem.

But we have to look at what caused the person’s pain problems to begin with, if we can figure it out, what makes it worse, what makes it better. Sometimes they need to change their sleeping position. Sometimes you need to buy a different car. I had two cars that were the same kind of truck and driving that thing for an hour would make my hip ache something terrible because of the way the seat was built. No other cars made my hip hurt, and when I changed brand of car my hip doesn’t hurt. I can drive two or three hours and it doesn’t hurt. The way that that seat was built put my hips at an awkward angle. Oh, it hurt a lot.

So sometimes you can use a special cushion, a device of some sort to change whatever the perpetuating factor is. That’s very important. A person’s not going to get a whole lot better. You might get rid of it, but it’s going to come back if they don’t
change what’s causing it.

And then I also teach them stretches to do, because that’s part of re-educating the muscle to stay in the lengthened position, because it thinks all tight is normal. So you have to retrain it and allow it to find normal again, what is truly normal, not what it has thought was normal for the last six years or six months. There’s stretches that a person can do, and I ask them to do it often. Like not sit down and do your exercises for an hour or half an hour, but sneak them into your daily routine. You go through a doorway and you stretch your arm. You sit at your desk, you move away for it for a three-minute break and do your stretches for your neck and for your back.

And there’s also a lot of self-care tools that I will either suggest, or I have the Backnobber that I sell. I’ll give somebody a tennis ball. A tennis ball is a great tool. It works very well, and if you go to the dog toy department they have tennis balls that are on a strap. You can toss it over your shoulder and work your back up against the wall, as opposed to trying to roll around on the floor, which some people you tell them you want them to get on the floor and they look at you like you’re crazy. You know, that’s not an easy thing for them to do, especially if they’re really hurting. But if they get the ball between them and the wall and work the trigger points in their back, that works out well.

Sometimes it means they have to change a pillow. All kinds of things. It’s taking a history and asking the person the right questions so that you know what’s causing their problem and how you can help them fix it.

Naomi:Well that makes perfect sense. Your story, which is fantastic, about how you solved your chronic headache problems, over the years of treating people, do any particular stories stand out to you as being very memorable, of people that you’ve helped?

Mary: There’s a guy I saw last week, a teenage boy in high school, got whacked in the head playing baseball. He turned and his temple and the other guy’s helmet met. It didn’t knock him unconscious, but about an hour after that he got a headache and basically it’s been there ever since, and that was in June.

His family has been taking him the medical route and they’re doing a kinds of things. He’s on medications, he’s on medications for his headaches, he’s on medication for pain, he’s on medication for depression because he’s starting to get really depressed because he can’t do anything because he’s got a headache all the time.

And his mom found me, and I probably spent an hour and-a-half talking to him a little bit and treating him, and whenever we were done I said, “Well, I know they’ve been asking you about what number it is, that you understand that.” He said, “It’s probably a one, and it’s hardly there.” And I said, “Really?” And he said, “The first time it has been that low since I got whacked in the head.”

It’s not the first time that I’ve been able to get rid of peoples’ migraines right there on the table. There was another young girl that I used to go to her house, they would call me when they were desperate. It’s like, if we can get me up to the house, it’s either that or I’m going to the ER, and the ER wasn’t good because they’d make her sit in this bright light in a waiting room for a long time because a headache is not going to kill you and she had been there before, and then they bother you with, “Are you a drug seeker?” It’s not a very effective way to treat a headache.

But I’ve been out there and spent an hour, hour and-a-half with her treating her headaches, and they would be gone and they would stay gone.

If you’re doing the right thing and you’re eliminating the cause of the headache, you can make it go away. It shows somebody that you know what you’re doing when you can get rid of their headache on the table. It depends on what the cause was. Often it’s a whiplash issue. They’ve in a car accident and got some whiplash, and the sooner after an accident like that the better. Sometimes their doctor will send them to this, that and the other thing, and then they’ll finally find me a year later and it’s harder to fix if it’s been longer.

If you can find the cause, and it’s usually pretty obvious to the person, because when you’re pressing on that trigger point it will make the pain more and it will feel really good. People describe it as good pain. They know that it’s the right place.

And it’s kind of hard to describe, but animals will react the same way. They’ll be hurting and you’ll touch them in the right place and they’ll kind of like jerk because it hurt, but they’ll let you do it and then they feel better. They comprehend it. So you don’t even have to explain it. But a person will say, “Oh yeah, it hurts but it hurts good. I know you’re doing the right thing.”

And then of course there’s lots of causes for headaches and migraines, and if I’m not getting anywhere with somebody the next thing I try and convince them to do is go and have allergy or sinus sensitivity testing. I had somebody that within a week of not eating wheat—

Naomi:She had a food sensitivity test, and she tested positive for wheat. And then she cut out wheat and a week later her migraines stopped.

Mary: As soon as she stopped eating wheat. She stopped eating wheat because he told her and explained to her [more] than I had, because I had suggested that she may be allergic to wheat, but she didn’t want to hear it from me. But this guy had proof.

He had a machine that said she was allergic to wheat. He told her that, and she stopped eating wheat. It’s kind of a hard thing to do, but if you’re eating no processed foods and no grain products it’s not too hard, so you start eating vegetables and no more wheat and she didn’t have a headache for a whole week after she stopped eating it. And it probably took a day or two, but that was what was causing her migraines.

Naomi:Interesting. Yeah, when it’s something that that’s dramatic then you may want to eat wheat, but you probably stop eating.

Mary: And now with a lot of people discovering that they have gluten intolerance and celiac and stuff, there’s a lot more gluten and wheat-free products and they’re marked that way, so it’s not quite as hard when there’s alternatives. Maybe after a while you can have that little bit of something and it won’t give you the migraine because you’re not consuming it all the time, but wheat is a big nasty one because it’s in everything, unless they’re eating a diet without any pasta in it or really payingattention.

Almost everybody eats wheat every day. It’s there. we eat bread, we eat this, we eat that, we eat this, that and the other thing, pasta, it’s very prevalent in our diet. It could be other things, too. It could be anything.

Naomi:Trigger points are often overlooked as a cause of headaches, and they can even trigger a migraine as well.

Mary: It depends on how you describe migraine. The purest, that it has to be this, this, this and this, the general public says it’s a really bad headache or a headache that doesn’t go away. Come on, if Excedrin Migraine gets rid of your migraine, you didn’t have a migraine, because all it is, is Ibuprofen or Tylenol or whatever.

Naomi:If you have a very, very bad headache, whether it’s a proper sort of ocular migraine or if it’s caused by trigger points, it’s still very debilitating.

Mary: Yeah, but a girl that I used to treat, she was going to the ER and they were going to give her some really strong drugs, after making her wait in the waiting room for four hours, and then her headache would go away. She was at her wits end by the time she would do that, but instead I could get rid of it in an hour and-a-half or so on the table.

Naomi: Yeah, and so much healthier, too.

Mary: Yes. She could drive home after I worked on her. She can’t drive home after they drug her.

Naomi:Yes, absolutely. Is there anything that I should have asked you?

Mary: I think that everybody should know about trigger point therapy, and I wish that there was a person on every block, like there is a chiropractor on every block, that is training as well as doing it, so that it would be the first thing that you’d think of if you had chronic headaches or tension headaches. Even if taking some over-the-counter pain medicine will kind of get it to go away, you haven’t really
eliminated the cause. And I think everybody should know about it.

There’s a lot of things that you can do yourself. It’s not quite as effective, but if you don’t have anybody to do it for you it’s better than nothing, and I think it should be the first thing that people try, not the last. And the medical profession doesn’t usually suggest it.

Naomi:Yes, well I guess it’s not widely known, which is odd since it’s been around for a long time in various forms.

Mary: Yes, but there’s not very many people that are well trained. The testing association that I had my certification exam with, they changed their website. It’s much better now. It actually means something to people. There’s only 75 active, certified Myofascial trigger point therapists that are listed with them. There’s a couple other teaching programs that *** (20:14) trigger point therapist or a similar word, but the gold standard has 75 people in the world. All the massage therapists are being trained, you know, with 10 or maybe 20 hours within their classes, and they’re generally doing it wrong. They’re not doing it well.

It’s a disservice almost, that all these schools are teaching people and telling them that they know about it, they know enough about it to say, “Oh, I do trigger point. I do trigger point massage.” And they don’t know the background. They learned out of books that are meant for the public, the Clair Davies books. I’ve read articles that were written about trigger points, and they cite the Clair Davies book as their main source of information.

We learned out of Travell and Simon, and if you didn’t go through the books you don’t really know very much. You don’t know enough.

Naomi:They’re beautifully illustrated, extremely detailed. They’re the bible, definitely, of trigger points. It’s interesting that you say what you say about the general state of education of trigger points, because we get questions on the site of people wanting to know what the difference between trigger point therapy and myofascial therapy, and I think there’s just some confusion of what trigger point
therapy is and how to define it. It’s quite interesting.

Mary: So Myofascial release. People will call it Myofascial release. The only thing that’s really the same is the word Myofascial. That just means the muscle and the connective tissue that is part of the muscle. But they’re releasing a totally different thing. They’re not addressing the trigger points as such, and I have taken their courses. They’re quite extensive. But one of my friends did take several of those courses and then took the trigger point full course.

They’re not the same at all. They’re very, very different, and people call it the same thing. It’s very confusing to people that don’t know what the difference is, and sadly whenever somebody says, “Oh, I’m doing trigger point massage,” and they don’t really know what they’re doing, they’re not educated, then people say, “Oh I’ve tried that, and it didn’t work.” Well, you didn’t go to somebody with a
good training for it. I can cook. That does not make me a chef.

Naomi:This is true, yeah, absolutely. Yeah, and it’s interesting, too, talking to Jonathan about trying to build an evidence base for trigger point therapy, because it’s a very difficult thing to get credibility within Western medicine, which is basically you need to have studies and with good studies, with double blind placebo effect taken out studies, and it’s difficult to do that because it’s difficult to do an objective test on whether trigger point release has been done correctly or not, exactly define a trigger point in a way that doesn’t involve interfering with the trigger point and thus altering it.

There’s one very famous picture of a trigger point, I think a microgram image of it, and they don’t really show up on any scans that I know of. It’s interesting.

Mary: You can’t feel all of them, but the muscles that are close to the surface and stuff, you can feel those pretty easily. But if you’re not trained in feeling for them, then you don’t know that there’s a trigger point being treated. It is kind of sad that there’s not an imaging study that really shows, yes it’s definitely there, that there’s an imaging study that anybody can afford to have done. A lot of research is being done on *** (23:45), and they are able to do these imaging studies and show electrical differences. Still, that’s hard to prove, and a study like that is very expensive to do. I’m not going to work for free and treat 100 people.

So it’s very expensive to do, and if you don’t have somebody who’s well trained doing it, if you’re using massage students, you’re not going to get a very accurate response to it. If you’re using people that are willing to give their time and energy for free, you’re not going to get the results. There’s not really anybody that is going to benefit by doing an expensive study.

Drug companies, they do these expensive studies and they have to, but they get a huge financial gain by putting their drug on the market. And there’s not really anybody who can do that. I could see 25 people and write up really detailed reports on it, but that’s not going to mean anything to anybody really. It’s not going to prove anything. I mean, somebody might believe me a little bit more, but it’s not going to be looked at as a scientific double blind study.

Naomi:That’s developing. It will be interesting to see what it does in the next few years. Well, thank you so much. You’ve been extremely generous with your time.

Mary: Oh, you’re welcome.

Naomi:You shared some fantastic knowledge. We hear a lot of stories, some amazing ones, about stuff like people who get lots of dental work for tooth pain and jaw pain and it turns out to be trigger points. So just really unexpected stuff, abdominal pain or pelvic pain, and after testing for – getting all their different organs tested, they just get given a diagnosis of abdominal pain and left to their own devices, and sometimes it does turn out to be trigger points. It’s sad that some people are suffering needlessly, but it is fantastic that there is something that you can do about it.

Thank you so much, again, and I really appreciate this.

Mary: Okay.



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(5) comments

Jason Thomas January 12, 2014

This is a little off topic, however several months ago you sent out an email talking about the possibility of being able to visualise your trigger point charts on an I Pad. Is this going to happen?


Jason Thomas

Carole Pritchard February 12, 2014

Dear Jonathan, I have had TMJ for five years and your advice is inspirational and so helpful. I am a person with high pain and low disability and your sharing continues to be a massive support in my life. Thank you so so much for sharing your knowledge and supporting me in my endeavours to overcome chronic pain. Kind regards Carole

    Carmen March 2, 2015

    For chronic pain sufferers, I strongly recommend reading the following book; Full Catastrophe Living by Jon Kabat-Zinn.
    I also recommend practising “mindfulness” on a daily basis. The book explains what mindfulness is.
    Kind Regards,

jezeera July 20, 2015

Dear Dr .Jonathan; I having gainedvalot from your emails on trigger pain on my upper back its trigger point is on my shoulder on the same I am on the bed and I have put a tennis ball in a sock so that I can roll it against he wall.I sleep on it and roll on my pain when I get the stops. Long ago I had a the terrible hip pain I did all what I could but I did not go.suddenly my slipper slipped then it made me to think that that slippers were not original not medically made cheep one .from that day I stopped using it and the terrible pain stopped.thank you for all your advice I am benifitting more and more.I still get the pain but know thet ican chase it off by Dr.jona Hans help..

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