Migraines that involve eye symptoms can be incredibly difficult to treat. Standard neurological approaches sometimes fall short, leaving patients discouraged and still in pain. One reason is that the muscular system, particularly the cervical muscles, is often left out of the conversation.
The sternocleidomastoid muscle, which connects the head, neck and upper spine, has direct neurological relationships with both the trigeminal system and upper cervical nerves. When irritated or tight, this muscle can mimic or drive migraine symptoms – headache, eye redness, drooping eyelids, and restricted neck movement.
This case demonstrates how important it is to assess and treat the musculoskeletal system in patients whose migraines don’t respond to conventional care.
Patient Profile
- Age: 44-year-old female
- Chief Complaint: Severe right-sided headache with eye symptoms, lasting four weeks
- Previous Care: Consulted multiple neurologists; tried medications with little benefit and significant side effects
- Recent Consultation: Neuro-ophthalmologist who discouraged further treatment, specifically dismissing acupuncture
Initial Presentation
On arrival, the patient reported an 8/10 right-sided headache, constant redness in the right eye, and noticeable eyelid drooping. She also had limited neck rotation and significant functional impairment due to pain.
Assessment & Diagnosis
The combination of a one-sided headache, eye involvement and limited cervical movement suggested a musculoskeletal cause, rather than purely a neurological one. The sternocleidomastoid muscle stood out as the likely driver of symptoms, due to its anatomical links and the patient’s pattern of complaints.
Working Diagnosis: Chronic migraine secondary to sternocleidomastoid trigger-point syndrome with cervical dysfunction.
Treatment Approach
The treatment strategy aimed to relieve immediate symptoms and restore balance to the neck muscles. Three primary steps were used:
- Dry needling of three trigger points in the right SCM
- Balancing treatment with contralateral SCM and levator scapulae
- Ongoing structural rebalancing to prevent recurrence
Outcomes & Results
First Session: Pain dropped by 50% (from 8/10 to 4/10) within minutes; eye redness improved by 80% in the same session; and eyelid drooping improved by 90%.
Follow-up: At the four-day follow-up, 80% of the improvements held. The patient reported being able to function much more easily in her daily life.
Treatment Completion: After three total sessions, the patient’s migraines and eye symptoms had completely resolved and did not return during the follow-up period.
Discussion
This case emphasizes the importance of considering the muscular system in migraine care. The rapid and dramatic response after treating the SCM suggests this muscle was not a secondary factor – it was the main driver of her symptoms.
By treating both the dysfunctional side and the compensating muscles, we were able to provide lasting relief. This approach shows that musculoskeletal interventions should not be an afterthought in chronic headache cases, but considered early in the treatment process.
This patient’s complete recovery after three treatments demonstrates how powerful targeted musculoskeletal work can be. For patients who have tried standard neurological approaches without success, addressing the cervical muscles – especially the sternocleidomastoid – can be life-changing.
Key Takeaways
- Always include cervical muscle assessment in treatment-resistant migraines.
- One-sided headache with matching eye symptoms should raise suspicion of SCM involvement.
- Immediate symptom change after treatment can confirm the muscular source.
- Treat both sides to address compensation in chronic cases.
- Even after discouraging experiences, persistence and advocacy can lead to full resolution.
Clinical Note: This case study is presented for educational purposes. Each patient is unique, and treatments must always be tailored to the individual. Patient consent was obtained for this report.
