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Myofascial pain patterns of the sternocleidomastoid muscle

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The sternal and clavicular divisions of the sternocleidomastoid muscle have their own characteristic symptoms. Essential (solid red) and spillover (stippled red) referred pain from sternocleidomastoid muscle trigger points (x's) include face and cranial pain, often prompting the diagnosis of atypical facial neuralgia, or tension headache. (A) Referred pain from sternal division trigger points projects to the vertex, occiput, cheek, over the eye, to the throat, and the sternum. Autonomic concomitants of trigger points in the sternal division include excessive lacrimation, conjunctival reddening, ptosis from orbicularis oculi spasm, and visual blurring. Ipsilateral maxillary sinus congestion, coryza, and hypoacusis have been reported. (B) Clavicular division trigger points refer pain to the frontal region, which when severe becomes bilateral, and can refer pain deep into the ipsilateral ear and postauricular region, and less often to the maxilla and molars. (From: Travell JG, Simon DG. Myofascial pain and dysfunction, sternocleidomastoid muscle, the trigger point manual. Volume 1. Baltimore: Williams & Wilkins, 1983:203, with permission.)