Massage Therapy for Headaches and Migraines

One area that is being explored is the use of massage therapy to decrease the individual’s headache frequency, intensity, duration and acute medication requirements.

One area that is being explored is the use of massage therapy to decrease the individual’s headache frequency, intensity, duration and acute medication requirements.

Massage Therapy for Headaches

Massage therapy as a therapeutic intervention is being embraced by the medical community. This is in part because it is a non-pharmacological therapeutic intervention that is simple to carry out, economical, and has very few side effects (Busse et al. 2017).

Turns out that there is good supporting literature for the use of massage therapy for patients who suffer headaches (Ferragut-Garcías et al. 2016Nahin et al. 2016, Varatharajan et al. 2016).

Structures to be aware of when treating headaches

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:

  • Suboccipitals
  • Upper trapezius
  • Splenius Cervicis
  • Splenius Capitis
  • Levator Scapula
  • Rhomboids
  • Temporalis
  • Occipitofrontalis
  • Corrugator Supercilii
  • Masseter
  • Sternocleidomastoid
  • Temporomandibular joint
  • Scalene Muscle Group.

Why Does Massage Therapy Work for Headaches?

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:

• Neurodynamics - A clinical concept that uses movement (1) to assess increased mechanosensitivity of the nervous system; and (2) to restore the altered homeostasis in and around the nervous system.

• Contextually Aided Recovery - The way we present ourselves and present our techniques is tied to clinical outcomes, the magnitude of a response may be influenced by mood, expectation, and conditioning.

• Neuromodulation - Massage has an effect on peripheral and central processes - input from large sensory neurons may prevent the spinal cord from amplifying nociceptive signaling.

• Social Grooming - Nervous system regulated by touch (social grooming) helps modulate the activity of neural circuits important for maintaining resting state. This reduced physiological and behavioural reactivity to stressors results in improved mood/affect.

• Mechanotherapy - Any intervention that introduces mechanical forces with the goal of altering molecular pathways and inducing a cellular response that enhances tissue growth, modeling, remodeling, or repair.

    More to Explore

    Massage Therapy: Injury Specific Treatments
    As the body of knowledge to support the use of massage therapy continues to grow, understanding the basic science behind what we do and the guiding principles of adaptability enable us to apply this work to a number of conditions including, but not limited to:
    • Sports Related Aches and Pain
    • Overhead Athletes
    • Shoulder Pain
    • Carpal Tunnel Syndrome 
    • Osteoarthritis of The Knee
    • Post-Operative Patients
    • Compartment Syndrome
    • Dupuytren's Disease
    • Low Back Pain 
    • Neck Pain
    • Migraines and Tension Headaches
    • Post-Concussion Syndrome
    • Temporal Mandibular Disorder (TMD)
    • Scar Management 

    Research Links
    Arendt-Nielsen, L., Castaldo, M., Mechelli, F., & Fernández-De-Las-Peñas, C. (2016). Muscle Triggers as a Possible Source of Pain in a Subgroup of Tension-type Headache Patients? The Clinical Journal of Pain.
    https://www.ncbi.nlm.nih.gov/pubmed/26550960

    Berchtold, V., Stofferin, H., Moriggl, B., Brenner, E., Pauzenberger, R., Konschake, M. (2017). The supraorbital region revisited: An anatomic exploration of the neuro-vascular bundle with regard to frontal migraine headache. J Plast Reconstr Aesthet Surg.
    https://www.ncbi.nlm.nih.gov/pubmed/28712884/

    Bendtsen, L., Ashina, S., Moore, A., Steiner, T.J. (2016). Muscles and their role in episodic tension-type headache: implications for treatment. Eur J Pain.
    https://www.ncbi.nlm.nih.gov/pubmed/26147739/

    Bialosky, J.E., Bishop, M.D., Penza, C.W. (2017). Placebo Mechanisms of Manual Therapy: A Sheep in Wolf's Clothing? J Orthop Sports Phys Ther.
    https://www.ncbi.nlm.nih.gov/pubmed/28459190

    Bishop, M. D., Torres-Cueco, R., Gay, C. W., Lluch-Girbés, E., Beneciuk, J. M., & Bialosky, J. E. (2015). What effect can manual therapy have on a patient's pain experience? Pain Management.
    https://www.ncbi.nlm.nih.gov/pubmed/26401979 (OPEN ACCESS)

    Busse, J.W., Craigie, S., Juurlink, D.N, ... Guyatt GH. (2017). Guideline for opioid therapy and chronic noncancer pain. CMAJ.
    https://www.ncbi.nlm.nih.gov/pubmed/28483845

    Chaibi, A., Tuchin, P. J., & Russell, M. B. (2011). Manual therapies for migraine: A systematic review. The Journal of Headache and Pain.
    https://www.ncbi.nlm.nih.gov/pubmed/21298314

    Chaibi, A., & Russell, M. (2014). Manual therapies for primary chronic headaches: A systematic review of randomized controlled trials. The Journal of Headache and Pain.
    https://www.ncbi.nlm.nih.gov/pubmed/25278005

    Chen, L., Michalsen, A. (2017). Management of chronic pain using complementary and integrative medicine. BMJ.
    https://www.ncbi.nlm.nih.gov/pubmed/28438745

    Courtney, C.A., Fernández-de-Las-Peñas, C., Bond, S. (2017). Mechanisms of chronic pain - key considerations for appropriate physical therapy management. J Man Manip Ther.
    https://www.ncbi.nlm.nih.gov/pubmed/28694674

    Fernández-de-las-Peñas C, Cuadrado ML, Arendt-Nielsen L, Simons DG, Pareja JA. (2007). Myofascial trigger points and sensitization: an updated pain model for tension-type headache. Cephalalgia.
    https://www.ncbi.nlm.nih.gov/pubmed/17359516/

    Fernández-de-Las-Peñas, C., Courtney, C.A. (2014). Clinical reasoning for manual therapy management of tension type and cervicogenic headache. J Man Manip Ther. (OPEN ACCESS)
    https://www.ncbi.nlm.nih.gov/pubmed/24976747

    Fernández-de-Las-Peñas, C.. Myofascial Head Pain. (2015). Curr Pain Headache Rep.
    https://www.ncbi.nlm.nih.gov/pubmed/26049772

    Fernández-De-Las-Peñas, C., Arendt-Nielsen, L. (2017). Improving understanding of trigger points and widespread pressure pain sensitivity in tension-type headache patients: clinical implications. Expert Rev Neurother.
    https://www.ncbi.nlm.nih.gov/pubmed/28745080

    Ferracini, G.N., Florencio, L.L., ... Fernández-de-Las-Peñas, C. (2017). Musculoskeletal disorders of the upper cervical spine in women with episodic or chronic migraine. Eur J Phys Rehabil Med.
    https://www.ncbi.nlm.nih.gov/pubmed/28118694

    Ferragut-Garcías, A., Plaza-Manzano, G., ... Oliva-Pascual-Vaca, Á. (2017). Effectiveness of a Treatment Involving Soft Tissue Techniques and/or Neural Mobilization Techniques in the Management of Tension-Type Headache: A Randomized Controlled Trial. Arch Phys Med Rehabil.
    https://www.ncbi.nlm.nih.gov/pubmed/27623523

    Fumal, A., & Schoenen, J. (2008). Tension-type headache: Current research and clinical management. The Lancet Neurology.
    https://www.ncbi.nlm.nih.gov/pubmed/18093564

    Giamberardino, M.A., Tafuri, E., ... Mezzetti, A. (2007). Contribution of myofascial trigger points to migraine symptoms. J Pain.
    https://www.ncbi.nlm.nih.gov/pubmed/17690015

    Happe, S., Peikert, A., Siegert, R., & Evers, S. (2016). The efficacy of lymphatic drainage and traditional massage in the prophylaxis of migraine: A randomized, controlled parallel group study. Neurological Sciences.
    https://www.ncbi.nlm.nih.gov/pubmed/27338942

    Horwitz, S., Stewart, A. (2015). An Exploratory Study to Determine the Relationship between Cervical Dysfunction and Perimenstrual Migraines. Physiother Can.
    https://www.ncbi.nlm.nih.gov/pubmed/25931651

    Louw, A., Zimney, K., Puentedura, E.J., Diener, I. (2016). The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiother Theory Pract.
    https://www.ncbi.nlm.nih.gov/pubmed/27351541

    Lucas, S., Blume, H.K. (2017). Sport-Related Headache. Neurol Clin. 
    https://www.ncbi.nlm.nih.gov/pubmed/28673412/

    Luedtke, K., Boissonnault, W., Caspersen, N., Castien, R., Chaibi, A., Falla, D., . . . May, A. (2016). International consensus on the most useful physical examination tests used by physiotherapists for patients with headache: A Delphi study. Manual Therapy.
    http://www.ncbi.nlm.nih.gov/pubmed/27183831

    Luedtke, K., Starke, W., May, A. (2017). Musculoskeletal dysfunction in migraine patients. Cephalalgia.
    https://www.ncbi.nlm.nih.gov/pubmed/28641450

    Madsen, B.K., Søgaard, K., Andersen, L.L., Tornøe, B., Jensen, R.H. (2017). Efficacy of strength training on tension-type headache: A randomised controlled study. Cephalalgia. 
    https://www.ncbi.nlm.nih.gov/pubmed/28750588/

    Martin, P. R. (2016). Stress and Primary Headache: Review of the Research and Clinical Management. Current Pain and Headache Reports.
    https://www.ncbi.nlm.nih.gov/pubmed/27215628

    Millstine, D., Chen, C., Bauer, B. (2017). Complementary and integrative medicine in the management of headache. BMJ.
    https://www.ncbi.nlm.nih.gov/pubmed/28512119

    Minerbi, A., Ratmansky, M., Finestone, A., Gerwin, R., Vulfsons, S. (2017). The local and referred pain patterns of the longus colli muscle. J Bodyw Mov Ther.
    https://www.ncbi.nlm.nih.gov/pubmed/28532868

    Mesa-Jiménez, J.A., Lozano-López, C., Angulo-Díaz-Parreño, S., Rodríguez-Fernández, Á.L., De-la-Hoz-Aizpurua, J.L., Fernández-de-Las-Peñas, C. (2015). Multimodal manual therapy vs. pharmacological care for management of tension type headache: A meta-analysis of randomized trials. Cephalalgia.
    https://www.ncbi.nlm.nih.gov/pubmed/25748428

    Moore, C.S., Sibbritt, D.W., Adams, J. (2017). A critical review of manual therapy use for headache disorders: prevalence, profiles, motivations, communication and self-reported effectiveness. BMC Neurol. (OPEN ACCESS)
    https://www.ncbi.nlm.nih.gov/pubmed/28340566

    Moraska, A.F., Stenerson, L., ... Mann, J.D. (2015). Myofascial trigger point-focused head and neck massage for recurrent tension-type headache: a randomized, placebo-controlled clinical trial. Clin J Pain.
    https://www.ncbi.nlm.nih.gov/pubmed/25329141/

    Nahin, R. L., Boineau, R., Khalsa, P. S., Stussman, B. J., & Weber, W. J. (2016). Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States. Mayo Clinic Proceedings.
    https://www.ncbi.nlm.nih.gov/pubmed/27594189

    Nöbel, M., Feistel, S., Ellrich, J., & Messlinger, K. (2016). ATP-sensitive muscle afferents activate spinal trigeminal neurons with meningeal afferent input in rat – pathophysiological implications for tension-type headache. The Journal of Headache and Pain. (Open Access)
    https://www.ncbi.nlm.nih.gov/pubmed/27565510

    Palacios-Ceña, M., Castaldo, M., ... Fernández-de-Las-Peñas, C. (2017). Relationship of active trigger points with related disability and anxiety in people with tension-type headache. Medicine (Baltimore).
    https://www.ncbi.nlm.nih.gov/pubmed/28353618

    Park, S.K., Yang, D.J., Kim, J.H., Heo, J.W., Uhm, Y.H., Yoon, J.H. (2017). Analysis of mechanical properties of cervical muscles in patients with cervicogenic headache. J Phys Ther Sci.
    https://www.ncbi.nlm.nih.gov/pubmed/28265168

    Pelletier, R., Higgins, J., Bourbonnais, D. (2015). Addressing Neuroplastic Changes in Distributed Areas of the Nervous System Associated With Chronic Musculoskeletal Disorders. Phys Ther.
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    Perry, C.J., Blake, P., Buettner, C., Papavassiliou, E., Schain, A.J., Bhasin, M.K., Burstein, R. (2016). Upregulation of inflammatory gene transcripts in periosteum of chronic migraineurs: Implications for extracranial origin of headache. Ann Neurol. (OPEN ACCESS)
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    Quintner, J., Bove, G., & Cohen, M. (2015). A critical evaluation of the trigger point phenomenon. Rheumatology.
    https://www.ncbi.nlm.nih.gov/pubmed/25477053

    Rabey, M., Hall, T., Hebron, C., Palsson, T.S., Christensen, S.W., Moloney, N. (2017). Reconceptualising manual therapy skills in contemporary practice. Musculoskeletal Science and Practice.
    https://www.ncbi.nlm.nih.gov/pubmed/28286240

    Ranoux, D., Martiné, G., Espagne-Dubreuilh, G., Amilhaud-Bordier, M., Caire, F., Magy, L. (2017). OnabotulinumtoxinA injections in chronic migraine, targeted to sites of pericranial myofascial pain: an observational, open label, real-life cohort study. J Headache Pain.
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    Schwedt, T. J. (2014). Chronic migraine. BMJ. 
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    Varatharajan, S., Ferguson, B., ... Taylor-Vaisey, A. (2016). Are non-invasive interventions effective for the management of headaches associated with neck pain? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur Spine J.
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    Vigotsky, A. D., & Bruhns, R. P. (2015). The Role of Descending Modulation in Manual Therapy and Its Analgesic Implications: A Narrative Review. Pain Research and Treatment. 
    https://www.ncbi.nlm.nih.gov/pubmed/26788367 (OPEN ACCESS)

    von Piekartz, H. V., & Hall, T. (2013). Orofacial manual therapy improves cervical movement impairment associated with headache and features of temporomandibular dysfunction: A randomized controlled trial. Manual Therapy.
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    Watson, D. H., & Drummond, P. D. (2012). Head Pain Referral During Examination of the Neck in Migraine and Tension-Type Headache. Headache: The Journal of Head and Face Pain.
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