One of the great benefits of being a Yoga Tune Up® teacher is the shared knowledge constantly crossing the globe from YTU teacher to YTU teacher – literally! This latest question posed by YTU teacher Nathania Apple received such detailed and differently nuanced responses from multiple teachers that they each deserve their own blog post.

Here’s Nathania’s original question:

“I have a couple of students who experience nausea and headache after using the YTU Therapy Balls on upper shoulders. Sometimes the effect is immediate, sometimes it occurs later in the day. One student tells me it sometimes triggers a migraine. Can anyone shed any light on what’s happening physiologically?”

Our first responder is Lillee Chandra, with her input on the suboccipital muscles:

It is not uncommon to fall head over heels for the Therapy Balls, with their powerful ability to decrease pain, increase joint mobility and improve performance.  What is painfully ironic, however, is to have your love affair with Therapy Ball rolling abruptly end because you feel worse than when you started.  When wicked body responses like headaches and/or migraines strike after rolling the upper back, what are the reasons? Ball rolling is supposed to be therapeutic after all, right? How could releasing trigger points TRIGGER a headache?

In order to uncover what is really happening beneath the many layers of the upper back and decode the headache mystery, we must “deepen” our relationship with anatomy, specifically the attachment points of some key head and neck muscles.

There are many muscles in our upper back and neck that make up our physical depth. Many of these muscles (and their corresponding myofascial meridians) share ONE common attachment site: the posterior inferior skull known as the occiput.

The neighborly muscles that merge and converge onto this similar real estate of the head are the upper trapezius, levator scapula, any muscle with the word capitis in it (since capitis means head) and the suboccipitals. Luckily, these shared attachment points mean that if we aim for the deepest of these muscles, the suboccipitals, we can create a generally positive affect in them all! And since headache sufferers frequently hold chronic tension in their suboccipitals, intelligent ball rolling moves in these areas are imperative to a positive therapeutic outcome and long lasting change.

The small suboccipitals at the base of your skull need their own self-massage routine.

The suboccipitals are four small muscles located deep in the back of the head at the junction where the skull meets the top of spine.  Anatomically, these four short muscles attach from various places along C-1 and C-2 in the cervical neck to the occiput of the skull.  Their major role is to provide proprioceptive information about the head and upper cervical position.  In other words, the suboccipitals control finer movements of the head and neck.

The health of the upper back relies heavily on the cooperation of these smaller and deeper postural muscles. If these areas remain un-rolled, they can become tighter and even spasm whenever changes that loosen and lengthen have ensued downtown or in the larger superficial muscles. These tightening effects can be reflexive either way – meaning, headaches can be caused by tangles in the suboccipitals OR headaches can CAUSE tangles in the suboccipitals!

So either way you roll it, one must address the relationships between completely different muscles from superficial to deep as well as within a single muscle itself.  For example, rolling out a single muscle from end to end in the case of the trapezius involves more than just two attachment points.  But thorough anatomically driven efforts pay off well, especially in folks who commonly fall victim to headaches and migraines.  Leave extra time in your ball rolling session for techniques that integrate the multiple muscle layers as well as address the entire muscle itself.

A side note: I am not advocating digging a road to China by using incredibly deep pressure on the balls to get to the occipital muscles of the head. Rather, to work deeply means to work specifically. And to work specifically means to know where the muscles you are rolling attach down to bone and how those muscles may relate to other muscles with similar attachment sites or how they may relate to attachment points on the same muscle.

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Read “Stop Migraines Before They Start With YTU Therapy Balls”

Lillee Chandra

Lillee Chandra, L.M.T. is a former competitive gymnast, dancer and acrobat who specializes in teaching injury rehabilitation, prevention and self-care. She is a licensed massage therapist, a certified Yoga Tune Up® Teacher, the lead Anatomy Yoga Tune Up® teacher trainer for nationally recognized yoga schools and has assisted Jill Miller for several years. Known for her keen intuition, she compassionately leads anyone to become healthfully aligned in their life adventure.

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Ann Donachey

Thanks for this great article! I am curious to know if someone has more information on the aponeurosis that covers the skull and it’s relation to the connective tissues of these muscle groups? I am curious to know if this is a resource for all headaches/migraines or if this is specific to those felt in the occipital region? Phrased differently- would rolling this area have an impact for those with temple headaches?

Sun Kim

Thank you Lillee for this interesting article! Upper back & neck is my spot 🙂 But I have never experienced any headache response after my rolling session. Though I will keep your advice in mind to target the whole area of the muscle ( from origin to attachments)- not just a local spot of it.


Thanks Lillee for the detailed article. Working with the Therapy Balls really puts a spotlight to the connections within our bodies.


Wow! Thank you for this very well written article! I have not experienced migraines or any of the symptoms from rolling the balls on the back of my head, but if I do, I will know what not to do!

Amanda Shepherd

So, I looked up “Migraines caused by Neck Massage”, as in a massage done with hands (not balls), on google and didn’t find much support for hand massage causing migraines (not that it couldn’t happen). I did find this chart for massage trigger points, which might help people figure out where to try and release during their ball rolling. Honestly, if I was getting migraines from ball rolling, I would not do it.

Catherine de Marin

I got a terrible long lasting headache after resting on the balls placed just at the sub occipital ridge. Perhaps the key is to watch the duration of the session and incorporate movement.

Claudia Blasimann

I had a headache after rolling the rotator cuff twice today. What might not seem to have a connection to the neck muscles, in my opionion does have one. You mention the upper trapezius in your blog post, and that lies on top of the supraspinatus, so it is rolled as well in a rotator cuff sequence. Even though the headache might also have come from something completely different, I will try to remember to roll the neck as well afterwards and see how that goes.

Andree-Anne Gagnon

I also have had a client complain to me about terrible headaches or stiffness that lasted several days after she rolled the base of the skull at home. I have suggested that she switch to a Coregeous ball or an Alpha for more superficial work and see if that also triggers the headache before going back to Therapy balls. I got the impression from her description of the events prior to the migraine that she was going too hard, too long, too soon after years of chronic tension in the area. Does that make sense?


Thank you for clarifying the anatomy and the connected tissues to give a full picture of why a migraine may occur. I also appreciate exploring the muscles from superficial to deep and attachment points in order to gain more information about the body.


This post is fantastic. I’ve suffered from headaches due to tension in the suboccipitals (which I think actually began with my TMJ). Rolling with the Yoga Tune Up therapy balls on my suboccipitals, masseter and upper traps has been a game changer!


Thank you for this article. I know exactly what I’m going to do the next time a headache strikes and why.


Thanks Lillee for reminding that rolling is supposed to be therapeutic. We always recognize the obvious ones and forget there is even deeper. The subocciptial are almost always a chronic point in individuals today because of technology. How we hold our head daily, the proprioception must shift and change due to head positioning. It makes sense that releasing other areas may unleash somewhere else.

Erika Belanger

I have gotten headaches also rolling my shoulders and upper back… Thanks for the info. Next time I do my upper back and shoulders, I will do the base of the skull too and see how that feels.

Cathy Corkery

I noticed that I was getting a headache after rolling the upper back and neck. But if I ended with doing the occ. area, I wouldn’t. I thought I was imagining it! Thanks for the confirmation.

Michelle Officer

wow! so much fantastic information here! I too have had clients reference the occasional headache being triggered.
what a wonderful resource for future reference…thank you so much!

Tara K

On the second day of our training one of the other students commented that he was getting headaches after rolling out his shoulders and upper back. The response given by the instructors was the same, but in less detail. I’m glad to have this resource to return to for some of the technical terms.

Alexandra L

Thank you for this article, especially for your last mention about intelligent ball rolling. Deep pressure will not necessarily provide the same satisfying relief as placing the ball in strategic areas.


Fantastic article. Especially when discussing working all the attachment points of that muscle, and from there I could imagine that you could focus on the muscles that attach at the same point as the muscle you first focused on. Five hours later and you have suddenly rolled your entire body. OMG everything is connected!! One issue could be coming from a different part of your body. I am totally inspired to take a muscle connection point road trip, see ya in a few hours.

Elaine Cheong

I have been rolling out my suboccipitals the last couple of days and it could be quite intense in the beginning. The good thing though is I feel like some of my negative thoughts are being rolled out, even if it is just in my head, pun intended. I do remind myself though as I roll out to breath slowly, evenly and not grind my teeth.


Thank you so much for drawing attention to the need for balance in our practice and teaching. I have had minor headaches after rolling, I also carry a lot of tension in my upper back and shoulders. I am thankful to have found this post and to incorporate this into my practice.


So true! Our bodies never work in isolation – It’s important to look at the full picture rather than just isolating specific muscles. Great explanation and logical approach for such a sensitive area.

Maya Gil-Cantu

Thank you Nathania for posing that questions, and Lilee for providing a much appreciated response. I am new to using the YTU Therapy Balls and would like to eventually become comfortable enough to teach. I didn’t know that nausea was a possible side effect after rolling out on the therapy balls, and it is a great piece of knowledge for me to be mindful of as I move forward. The connection between different muscles is something I am excited to research and understand at a deeper level.

Rachelle Gura

During class we see the relief for the most part, but sometimes what we do has a delayed affect. The therapy balls create change, they are powerful tools and this is an example of the change they create. One of my students was rolling out their rotator cuff muscles yet experienced more pain the day after. She was not rolling out her pec minor to balance the entire shoulder girdle. I also suggested some strengthening exercises so it’s not just about the release.


I now understand why I had such a terrible headache last night. This was the first time I have used balls in the muscles of my upper back. Clearly, I have a lot of tension and tightness that caused referred pain to the head. Next time I will spend more time properly and deeply rolling my upper back and neck muscles (or even rolling against the wall first!).

Lara Weithorn

Thanks for the detailed and concise explanation. I’m always looking for resources my bodywork clients can read, to back up what I tell them or the work I do with them. Too often clients want me to drill into the one “tight” muscle, or they repeatedly go to town on that one muscle with balls or another tool, and wonder why it doesn’t work or makes it worse. Oh heck, I’ve done it myself if the spot is bad enough 😉 So great to read clearly, and be reminded why “the whole picture” is so important.

Barbie Levasseur

I often get referred pain into my head when I roll out my neck and tension in my neck when I roll out my upper back. It’s the same thing if I go in for a massage. I’m going to try this advice to focus on rolling out whole muscles from end-to-end and giving the suboccipitals some love. Thanks!

Michele Klink

Thank you for this info on the suboccipitals. Using the YTU Therapy Balls has helped in releasing this tense muscles so I can create more length in my neck spine. I spend so much of my time in some way looking down at my private clients on the floor that countering with neck extension and muscle release is very important to me.

Jennie Cohen

Thanks for the detail-specific illustration of the “it’s all connected” concept. The more I learn about anatomy, the more I realize that sensation experienced in a given body part may result from or cause sensation in a body part at some at-first-unobvious remove.


I LOVE rolling these neck and spine muscles out wen I have a headache. It is the only thing that really helps me with these headaches. I do not get them often but when I do, this ball rolling knocks in out right away.

Clare Chura

If a student experiences a migraine or nausea after using the therapy balls, it could be a result of the balls affecting a particular nerve, too. Nerves cause specific sensations, sending messages to and from the brain to elicit a specific response to a stimulus. If using the massage balls feels too intense, the student should try using them against the wall as a modification. For me, using the balls against the walls takes away pressure that I find while using them on the floor. It also allows me to control the intensity of the massage because I can determine… Read more »


Really interesting about the health of the upper back relating to cooperation of the suboccipitals. Makes perfect sense but have not heard it this way until now. This really adds another layer to how I view the whole upper back/head and neck area and how I can communicate with students. And myself!


Deeply appreciate the clear and simple explanation of many many benefits of rolling just the neck. Especially when attention to detail can result in preventing headaches and the consumption of all the over the counter medication normally associated with it.


Interesting! My husband always complains about headaches and how much better he feels after a deep tissue massage of his neck and upper back! Definitely sharing this with him.

For Therapy Ball Neck Treatment, Position Your Head Well! | Yoga Tune Up

[…] 2013 | Comments 0 Category: Neck Pain, Pain Relief, trigger point therapy | Continuing our discussion of Therapy Balls and headaches from last week, Alexa Kim weighs in on potential positioning […]


Thanks for the reminder, Lillee, that so many muscles and nerves converge and have to be handled with care and understanding.


Thanks for the post. I had a similar reaction a few months ago. After rolling I felt nauseated I thought I had released something from my muscles to cause the reaction. I guess it was from not completely rolling the muscle properly.


Lillee, what a great reminder to treat the “whole” and resist spot-treating only the noisiest, tightest muscles. Especially around the head and neck! Thank you for responding Nathania’s inquiry about headaches and migraines via YTU blog post for all to enjoy.