Massage Therapy and Post-Concussion Headaches

Persistent symptoms’ does not reflect a single pathophysiological entity, but describes a constellation of non-specific post-traumatic symptoms that may be linked to coexisting and/or confounding factors, which do not necessarily reflect ongoing physiological injury to the brain (McCrory et al. 2017).

Persistent symptoms after concussive injuries often includes headaches and neck pain. 

With the high impact nature of most concussive injuries, the assessment and rehabilitation of cervical spine may decrease the likelihood that an individual will develop persistent headaches and neck pain (Kennedy et al. 2017).  

Post-Concussion Headaches are Often Classified as Migraine or Tension-Type Headaches

It is proposed that a portion of post-concussion headaches are cervicogenic in nature, due in part to the concomitant whiplash injury suffered at the same time of the concussive force. Researchers classify these post-traumatic headaches as migraine headaches or tension-type headaches (Lucas et al. 2017). 

In these demographics soft tissue irritation and subsequent nerve sensitization may be a major contributor to symptoms (Fernández-De-Las-Peñas et al. 2017, Luedtke et al. 2017). There is also evidence that for some patients temporomandibular disorder may be a contributing factor to headaches (von Piekartz & Hall 2013).

What role can massage therapists play?

In the past the primary management strategies for headaches and chronic pain was a pharmacological approach, but over time some of these treatments evolve into a health care crisis of their own. Early in 2016 The Center for Disease Control, expressed the need to move beyond a pharmacological approaches for symptom management.

Physicians, now more than ever are recommending conservative treatment including manual therapy, acupuncture, education and exercise as part of a multi-modal approach for patients suffering from headaches and neck pain.

Why Does Massage Therapy Work?

With massage therapy the goal is to decrease the individual’s headache frequency, intensity, duration and acute medication requirements.

A biopsychosocial framework helps put into context the interconnected and multidirectional interaction between: physiology, thoughts, emotions, behaviors, culture, and beliefs. In terms of clinical responses to massage therapy there are a couple of proposed mechanisms of action, including but not limited to: affective touch, contextual factors, endogenous pain modulation and mechanical factors.

Post-concussion headaches are multifactorial with evidence for the contributions of muscles and other structures surrounding the cervical spine. A massage therapy treatment plan should be implemented based on patient-specific assessment findings and patient tolerance. Structures to keep in mind while assessing and treating patients suffering from cervicogenic headaches may include neurovascular structures and investing fascia of:

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