Massage for Headaches

Definitions:  Pain in and around the head.
Types of:

1. Migraines
   Definition- A paroxysmal (occurring repeatedly and without warning) neurological disorder with many signs and symptoms.

            – Trigeminovascular may involve serotonin

   Causes – Unknown; possible central nervous system disorder that produces secondary intracranial vasoconstriciton followed by vasodilation. 

        – triggers: stress, food, allergies, medication weather changes, auditory or olfactory stimuli, hormones, postural dysfunction or abberrations

   Signs/Symptoms – Family history -(70%)

      – Moderate to intense pain 4-72 hours
   – early morning onset common
   – hypersensitivity to sound, light and smell
   – nausea, vomiting
   – cold extremities and sweating
   – withdraw to dark, quiet room
   – fatigued and drained afterwards
   – with or without an aura (visual disturbance) found more in women

   Special Tests/Contraindications

   During Migraine, massage may be contraindicated depending on symptoms.   Do not cause vasodilation (no heat or deep work)  Avoid music, bright lights and fragrance

   Treatment Plan – Increase Relaxation, decrease pain.  Prone may be poorly tolerated.  Cold hydrotherapy to head and neck.  Hand and foot massage may be tolerated.  Manual lymph drainage. Release sub-occipitals.  Triggerpoint therapy.  

   Between attacks decrease sympathetic nervous system firing, hot hydrotherapy, essential oils (peppermint and lavender)

2. Tension Headaches:  

   Definition –  Muscle contraction type headache

   Causes – Myofascial triggerpoints, myofascial pain syndromes, facilitation, trauma, acute muscle overload, postural imbalances (forward head posture), referred pain and emotional stress, TMJD (temporal manibular joint dysfunction.)
   Signs/Symptoms – Bilateral, diffuse and constant, dull or vise- like.  Location is often in the referral pattern of the specific muscles. Chronic daily headache may have associated neck and shoulder pain, tenderness and stiffness.  If SCM is involved, may experience nausea, vertigo and tinnitus.
   Special Tests/Contraindications – Differential diagnosis.  Rule out other types of headaches that can be more serious.  No deep work or vigorous techniques that could create kick-back. Treatment plan – Massage is best for tension headache.  Reduce sympathetic nervous system firing, reduce pain, hypertonicity, triggerpoints and joint dysfunction.  Increase Range of Motion, Tissue health. Pre-tx with heat to affected muscles During tx – use diaphragmatic breathing Prone or supine may not be tolerated well – use sidelying. Work Pectoral muscles and posterior neck. Reduce triggerpoints in upper trapezius, splenius capitis, splenius cervicis, Occiptialis, Frontalis, Suboccipitals, SCM, Temporalis, traction

   (see anatomy)

3. Sinus
   Definition – Acute or chronic inflammation of the paranasal sinuses Causes – Infection, increase in pressure, Predisposing factors like deviated septum, allergies, upper molar abscess Signs/Symptoms – Pain, tenderness over the affected sinus, fullness, pressure, difficulty breathing Special Tests/Contraindications – Acute infection no manual lymph drainage.  Avoid prone positioning as it may increase drainage and pressure. Treatment Plan – Increase breathing, decrease pain. Manual lymph drainage to neck and face, massage to facial muscles and neck, static pressure on sinuses, eucalyptus steam.
4. Trigeminal Neuralgia
5. Cluster
   Definition – Group of headaches often once a day for several weeks: more men than women.

   Causes- Unknown;  tobacco use is more prevalent than with other types of headaches

   Signs/Symptoms –  Unilateral; 1-6 per day; 30 minutes – 3 hours.  Onset 1-3 hours after person goes to sleep.  Nasal congestion, swelling, drooping of eyelid and pupil constriction.

   Special Tests/Contraindications – Differential diagnosis   

   Causes:

1. Migraines: mostly unknown (by medical community), cranial circulation problem, misalignment of neck vertebrae, food or chemical sensitivities (environmental), hormonal changes (female, thyroid), blood sugar imbalances
2. Tension: muscle spasm, TMJ problems, neck alignment
3. Sinus: allergies (can be food, pollen, etc.), bacterial or viral, neck misalignments
4. Trigeminal Neuralgia – 5th Cranial Nerve irritation

Signs/Symptoms:

1. Migraines:  bilateral or unilateral pain, pain mild to severe lasting for hours or days, nausea, vomiting, distorted or blurred vision, sensitive to light and sound, cold extremities
2. Tension: pain, referred pain, muscle spasm and tension, triggerpoints, duration 1 hour to 1 day, TMJ, frontal, temporal and occipital regions often affected
3. Sinus: pressure around eyes, nose, cheeks or back of head, congestion, excess mucous,
4. Trigeminal Neuralgia -triggerpoints in face, lips, tongue, jaw, more common in older people (50+)

Treatment Goals:

• be aware of clients tolerance: may need dark room, soft touch depending on stage and type of headache
• decompress neck, facial bones, occipital area
• massage may sometimes cause headache to become worse
• most kinds of headaches can be relieved by working the back of the neck, occipital area, SCM, upper back, trapezius, levator scapula.
• treat triggerpoints on top of head, back of head, neck
• ice to back of neck, forehead; heat to feet/hands.
• traction to neck

Possible Triggers Include:

• Birth Control Pills
• cheese
• chocolate
• dairy products
• bananas
• alcohol
• sensitivities to wheat
• caffeine

Touch Research Institute :

What the Research Says:

Systematic Reviews:

Manual therapies for primary chronic headaches: a systematic review of randomized controlled trials. Chaibi A, Russell MB.

Manual therapy has an efficacy in the management of CTTH that equals prophylactic medication with tricyclic antidepressant. At present no manual therapy studies exist for chronic migraine or chronic cluster headache. Future manual therapy RCTs on primary chronic headache should adhere to the recommendation of the International Headache Society, i.e. primary end point is headache frequency and secondary end-points are duration and intensity. Future manual therapy studies on CM with and without medication overuse is also warranted, since such studies do not exist today.

Manual therapies for migraine: a systematic review Aleksander Chaibi, Peter J. Tuchin,and Michael Bjørn Russell

Conclusion: Current RCTs suggest that massage therapy, physiotherapy, relaxation and chiropractic spinal manipulative therapy might be equally efficient as propranolol and topiramate in the prophylactic management of migraine. However, a firm conclusion requires, in future, well-conducted RCTs without the many methodological shortcomings of the evaluated RCTs on manual therapies. Such studies should follow clinical trial guidelines from the International Headache Society

Randomized Control Trials

Ann Behav Med. 2006 Aug;32(1):50-9. A randomized, controlled trial of massage therapy as a treatment for migraine. Lawler SP¹, Cameron LD.

CONCLUSIONS:

The findings provide preliminary support for the utility of massage therapy as a nonpharmacologic treatment for individuals suffering from migraines.

When to see a doctor.

You may want to see a doctor if the headache persists and massage therapy does not help. See a doctor to get a prescription for massage therapy.