A woman with blonde hair sitting in front of a laptop holding the back of her neck.
There are 18 different fibromyalgia trigger points.

What Are Fibromyalgia Trigger Points?

Doctors used to count trigger points to make a fibromyalgia diagnosis. If a patient had at least 11 trigger points that caused pain for at least three months, they would be diagnosed with fibromyalgia. But what are fibromyalgia trigger points and how are they related to this chronic illness?

Fibromyalgia Trigger Points Explained

Trigger points are generally attributed to chronic myofascial pain, which is when pressure on sensitive points in the muscles cause muscular pain. In fibromyalgia, trigger points tend to be referred to as tender points, but we’ll refer to them as trigger points in this article, as they are points that are triggered by touch. Trigger points are areas on the body that feel more sensitive to those with fibromyalgia than those without.

Fibromyalgia patients already have a reduced threshold to pain, and an increased sensitivity to touch. Fibromyalgia trigger pain points are near the joints (not inside them) and are tiny—about the size of a penny. If you press, poke, or touch these areas, a person with fibromyalgia trigger points experiences pain. This pain may become referred pain, which radiates outward and causes long-term pain in a larger area.

Where Are Trigger Points Located?

Trigger points aren’t random throughout the body. There are 18 trigger points for fibromyalgia. They’re paired symmetrically, with nine pairs of trigger points in total. The pairs of points are located near the:

  • Back of the head where the neck muscles attach to the base of the skull
  • Front of the lower neck above the collarbone
  • Edge of the upper breast
  • Crease of the elbow
  • Back of the neck but not quite to the shoulder
  • Back of the shoulder where the back muscles attach to the shoulder blade
  • Bony part of the hip on the outer upper leg
  • Upper part of the buttock farthest from the spine
  • Inside of the knee

Fibromyalgia Trigger Point Symptoms

Fibromyalgia symptoms, as well as trigger point symptoms, come and go. They may be incredibly bothersome one day and less so the next, or different trigger points may be more active than others. Trigger point symptoms may be concentrated localized pain or may occur with other conditions or symptoms. Symptoms of trigger points include:

  • Muscle knots that cause pain
  • Muscular pain that radiates into body pain in other areas
  • Headaches
  • Fatigue
  • Poor sleep
  • Difficulty concentrating
  • Depression
  • Anxiety
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What Causes Trigger Points?

Experts haven’t quite determined what causes trigger point sensitivity. They speculate it may be tied to muscle spasms. Muscles that involuntarily contract usually have lower levels of oxygen and blood. Lower levels of oxygen and a buildup of acid and carbon dioxide (which is usually removed by blood cells) cause more muscular pain, which contributes to additional muscle spasms. It’s a repetitious and uncomfortable cycle.

The Trigger Point Exam to Diagnose Fibromyalgia

Years ago, doctors would diagnose fibromyalgia by counting active trigger points on patients. They would press the trigger points with enough pressure that their fingernails would whiten. If pain was felt in this particular trigger point, it was counted. If 11 trigger points were active, a diagnosis of fibromyalgia would be reached. There were a couple major problems with using this test:

  • Fibromyalgia was being underdiagnosed. Fibromyalgia patients weren’t meeting the 11-point count criteria because fibromyalgia pain, duration, severity, and reaction to trigger points can change constantly. A patient could meet the criteria one day but not the next. Fibromyalgia symptoms can’t be seen visually, or even with blood tests or x-rays.
  • Other conditions, such as rheumatic diseases, also cause widespread pain and tenderness. When conditions have similar symptoms, there is the possibility of misdiagnosis.

Eventually, the flaws in using this test were found, and it’s no longer used as a diagnostic tool.

How to Avoid Trigger Points

There isn’t a cure for fibromyalgia, but there are some ways to avoid activating your trigger points. First is to be vocal about your fibromyalgia; if you’re in close contact with others, make them aware of your sensitivity to touch. The awareness of your trigger points also goes with how you move your body. Try to avoid putting yourself in positions or activities that increase the possibility of your trigger points activating.

Treatment Options

Treatment isn’t specific to trigger points; it involves treating the whole condition. Connect with a doctor who has lots of experience with fibromyalgia, who may come recommended by your general practitioner.

Some fibromyalgia treatments they may recommend are:


Many prescriptions can help fibromyalgia pain and flare-ups. In some cases, over the counter pain medication may relieve discomfort. Your doctor will assess your individual symptoms and overall health and prescribe medication. Medications may include antidepressants, anti-seizure medication, non-steroidal anti-inflammatory drugs, steroid injections, or other medications.


It may hurt at first, but keeping active helps with your fibromyalgia pain in the long run. Your doctor or another certified professional can help you design an exercise regimen that keeps you active and helps keep your body strong. Exercise has been shown to help with pain, depression, fatigue, stress, and anxiety.

Physical Therapy

Seeing a physical therapist helps when you start to incorporate more activity into your lifestyle. They assess your abilities and suggest exercises that help with strength, flexibility, and endurance.

Occupational Therapy

An occupational therapist helps with lifestyle adjustments. They can assist with redesigning areas around your home or work to help minimize pain and trigger point activation. They can also suggest different ways to perform tasks to ease the impact on your body.

Alternative Therapies

In addition to other types of therapy, some fibromyalgia patients find additional relief with alternative therapies. If your doctor gives you the green light, some therapies to try include acupuncture, massage, acupressure, cognitive behavioral therapy, and yoga.

In Review

Activated trigger points can put you down for the count. Being aware of the location of your trigger points can help you avoid putting pressure on them, saving you from some unnecessary pain.