Massage Therapy for Tension-Type Headaches

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.

The RMT Education Project is an initiative to promote the benefits of massage therapy to an international audience, here I have to put together a list of research papers relevant to tension-type headaches.

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 few side effects (Busse et al. 2017).

Clinicians should be thoughtful and skilled in managing headaches through a number of rehabilitation considerations including, but are not limited to:
• Manual Therapy (nerve mobilizationsoft tissue massage, triggerpoint therapy)
• Education on Psychosocial Factors Such as Fear Avoidance
• Mindfulness-Based Stress Reduction

Why Does Massage Therapy Work for Headaches?

The responses to massage therapy are multifactorial - physiological and psychological factors interplay in a complex manner. The biopsychosocial model provides a practical framework for investigating the complex interplay between massage therapy and clinical outcomes.

Based off the biopsychosocial model, investigation into mechanisms of action should extend beyond local tissue changes and include peripheral and central endogenous pain modulation. An observed favorable outcome may be explained by a number of overlapping mechanism in the periphery, spinal cord, and brain  represented in the image below.

Proposed Mechanism of Action for Massage Therapy.

The Complex Clinical Picture of Headaches

A massage therapy treatment plan should be implemented based on patient-specific assessment findings and patient tolerance. Soft tissue irritation and subsequent nerve sensitization may be a major contributor to symptoms (Fernández-De-Las-Peñas et al. 2017). Structures to keep in mind while assessing and treating patients suffering from tension-type 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
• Trigeminovascular Nociceptive Pathway

More to Explore

Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia.

Arendt-Nielsen et al. (2016). Muscle Triggers as a Possible Source of Pain in a Subgroup of Tension-type Headache Patients? The Clinical Journal of Pain.

Bendtsen et al. (2016). Muscles and their role in episodic tension-type headache: implications for treatment. Eur J Pain.

Blanpied et al. (2017). Neck Pain: Revision 2017. J Orthop Sports Phys Ther

Busse et al. (2017). Guideline for opioid therapy and chronic noncancer pain. CMAJ.

Chaibi, A. & Russell, M. (2014). Manual therapies for primary chronic headaches: A systematic review of randomized controlled trials. The Journal of Headache and Pain.

Chen, L. & Michalsen, A. (2017). Management of chronic pain using complementary and integrative medicine. BMJ.

Cumplido-Trasmonte et al. (2018). Manual therapy in adults with tension-type headache: A systematic review. Neurologia.

Fernández-de-las-Peñas et al. (2007). Myofascial trigger points and sensitization: an updated pain model for tension-type headache. Cephalalgia.

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)

Fernández-de-Las-Peñas, C. (2015). Myofascial Head Pain. Curr Pain Headache Rep.

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.

Ferragut-Garcías et al. (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.

Falsiroli Maistrello et al. (2018). Effectiveness of Trigger Point Manual Treatment on the Frequency, Intensity, and Duration of Attacks in Primary Headaches: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Neurol.

Fumal, A., & Schoenen, J. (2008). Tension-type headache: Current research and clinical management. The Lancet Neurology.

Gerber, L.N. & Kumbhare, D. (2018). Physiatry Reviews for Evidence in Practice Second-Order Peer Review: Does Massage Therapy Have Value in the Treatment for Tension Type Headache? Am J Phys Med Rehabil.

Lucas, S. & Blume, H.K. (2017). Sport-Related Headache. Neurol Clin.

Luedtke et al. (2016). International consensus on the most useful physical examination tests used by physiotherapists for patients with headache: A Delphi study. Manual Therapy.

Madsen et al. (2017). Efficacy of strength training on tension-type headache: A randomised controlled study. Cephalalgia.

Martin, P. R. (2016). Stress and Primary Headache: Review of the Research and Clinical Management. Current Pain and Headache Reports.

Millstine et al. (2017). Complementary and integrative medicine in the management of headache. BMJ.

Minerbi et al. (2017). The local and referred pain patterns of the longus colli muscle. J Bodyw Mov Ther.

Mesa-Jiménez et al. (2015). Multimodal manual therapy vs. pharmacological care for management of tension type headache: A meta-analysis of randomized trials. Cephalalgia.

Moraska et al. (2015). Myofascial trigger point-focused head and neck massage for recurrent tension-type headache: a randomized, placebo-controlled clinical trial. Clin J Pain.

Moraska et al. (2017). Responsiveness of Myofascial Trigger Points to Single and Multiple Trigger Point Release Massages: A Randomized, Placebo Controlled Trial. Am J Phys Med Rehabil.

Nahin et al. (2016). Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States. Mayo Clinic Proceedings.

Negro et al. (2017). Headache and pregnancy: a systematic review. J Headache Pain.

Palacios-Ceña et al. (2018). Trigger points are associated with widespread pressure pain sensitivity in people with tension-type headache. Cephalalgia.

Palacios-Ceña et al. (2017). Relationship of active trigger points with related disability and anxiety in people with tension-type headache. Medicine (Baltimore).

Park et al. (2017). Analysis of mechanical properties of cervical muscles in patients with cervicogenic headache. J Phys Ther Sci.

Scripter C. (2018). Headache: Tension-Type Headache. FP Essent.

Varatharajan et al. (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.

Vickers et al. (2018). Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. The Journal of Pain.

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.

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.