Tackling Migraines Head-On

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Tackling Migraines Head-On
Katie M. Golden, May 23, 2017
Nobody likes to be in pain, and for people who suffer from migraines, pain can be debilitating, disrupting both their personal and professional lives. Whether migraine hits once in a while or on a regular basis, finding relief—preferably relief that can be counted on—is a top priority.

Massage therapy has shown some success in helping people who suffer from migraine better manage the pain. To help your clients who get migraines, you’ll need to understand the condition and what massage therapy has to offer in terms of pain relief.

Breakdown of a Migraine Attack
Migraine is a neurological disease, not a vascular issue as previously thought. Peter Goadsby, M.D., who is a neurologist and headache specialist at the University of California San Francisco, describes the disease as “an inherited tendency to have headaches with sensory disturbance. It’s an instability in the way the brain deals with incoming sensory information, and that instability can become influenced by physiological changes like sleep, exercise and hunger.”1

Migraine is a complex condition that can be activated by a variety of factors, but also mitigated by a range of interventions.

First, let’s explore how migraines develop. Each migraine cycles through four phases.2 The accompanying symptoms in each phase can vary dramatically among people who suffer from migraines.

Phase 1—Prodrome. Up to 72 hours before the pain hits, there can be warning signs that a migraine is imminent. These signs can include severe exhaustion or hyperactivity, difficulty
concentrating, food cravings, sleepiness and neck pain.

Phase 2—Aura. The most commonly reported aura is visual, although it only occurs in onethird of the migraine population. A person’s vision can be interrupted by sparkly spots, zigzag lines or tunnel vision, lasting between 20 to 60 minutes. An aura can present in other ways, too, such as vertigo, tinnitus (ringing in the ears) and even temporary paralysis on one side of the body.

Phase 3—Headache. The pain during this phase is often described as throbbing, piercing or pulsating. The client may also be sensitive to light, sound and smell. Physical activity usually makes the symptoms worse. This phase can be debilitating for hours or days. Most seek refuge in a quiet, dark room.

Phase 4—Postdrome. Once the pain has subsided, the body requires a recovery period. A person might feel exhausted, sluggish, confused and even depressed.

The Science of Massage and Migraine
Dawn Buse, Ph.D., Associate Professor of Neurology at Albert Einstein College of Medicine and the Director of Behavioral Medicine at the Montefiore Headache Center in New York, says that although firm scientific data is lacking, patients still find value in massage therapy.

“Data on the efficacy of massage for migraine are somewhat limited. This does not mean that massage is not helpful for migraine, but rather that there have been few studies, and they have had smaller samples and less rigorous designs, so we do not have the scientific evidence necessary to make a conclusive statement about its efficacy. This is due in large part to the fact that there is less funding available to support research on massage and other non-pharmacologic treatments than there is to support the testing of new medications,” she explains. “However, many patients find massage therapy helpful, in which case I encourage them to make it a regular part of their treatment plan along with other healthy lifestyle habits, relaxation and self-care activities.”3

Though limited, there have been a few studies that point to a positive connection between massage and migraine relief:

A randomized, controlled trial of massage therapy as a treatment for migraine.4 Participants either received no massage or two 30-minute traditional massages for five weeks. Before and after each session, each participant’s heart rate, anxiety level and salivary cortisol were measured. The massage group reported a decrease in the frequency of migraine attacks compared to the control group. Heart rates, anxiety level and salivary cortisol levels also decreased by the end of each massage session.
Myofascial trigger point-focused head and neck massage for recurrent tension-type headache: a randomized, placebo-controlled clinical trial.5 Participants with tension-type headache, a related headache disorder, received either no massage, ultrasound or 12 myofascial trigger-point massage sessions within a sixweek period. This type of massage focuses on releasing abnormal skeletal muscles, often a contributing factor in triggering tension-type headaches and migraine. The massage group reported the highest positive change in headache frequency as well as perceived headache pain. The massage group also experienced greater improvement in their pressure-pain threshold than the placebo and control groups.
Effects of Thai traditional massage on pressure pain threshold and headache intensity in patients with chronic tension-type and migraine headaches.6 Participants with chronic tension-type and migraine headaches either received ultrasound or nine sessions of Thai traditional massage in a three-week period. This type of massage uses compression, stretching, pulling and rocking motions as opposed to rubbing of muscles. The pain pressure threshold increased for those in the massage group, while it decreased in the placebo group. However, both groups reported a significant reduction in the intensity of their migraine attacks.
How Massage Can Help Migraine
Jamie Valendy and Anna Eidt suffer from chronic migraine. Both women have 15 or more migraine
days a month. Only 8 percent of the migraine population in the United States have migraines this frequently or this severe—roughly 4 million people.7

Valendy schedules a massage every 4–6 weeks to help her manage her migraine attacks. Her therapist is trained in deep tissue, trigger point and Swedish massage. Valendy says that she knows it’s time to schedule a massage session when her “shoulders become so tight that they start lifting
upward and [she has] a difficult time getting them to relax back into a normal posture.”8

Eidt, who schedules a massage every two weeks, believes finding the right massage therapist is essential. “It takes a very special, knowledgeable and responsive practitioner for massage therapy to be an effective form of migraine prevention,”9 she says. She prefers gentle myofascial trigger point massage, noting that anything too rough or hard is often too much to bear and can trigger a migraine attack.

Shiatsu for Migraine
“Shiatsu has a profound effect on the nervous system, and I think that is why it is so effective for migraine,” says Leisa Bellmore, a Shiatsu therapist from Toronto.10 Shiatsu technique focuses on pressure points along muscle lines, nerve pathways and blood vessels, along with gentle stretching.

When a client is having an active migraine during a session, Bellmore focuses first on pressure points on the head and neck, then moves to the neck and shoulders. Pressure should start lightly and increase based on the client’s tolerability. Stretching the neck is also a key technique in addressing pain stemming from this area during an attack. Bellmore suggests performing the “forward flexion” technique on migraine clients, as outlined below:

Foward Flexion of the Neck

Support client’s head with left hand.
Slip right hand under client’s head, placing hand on left shoulder so that the head rests in crook of arm.
Place left hand on right shoulder.
Gently stretch head forward by straightening right arm while supporting the side of the head with the left arm, rising up slightly while you do so.
Hold for 10 seconds, then lower the head.
Support the head with the left hand while removing arm.
Let Cooler Heads Prevail—Using Cold Stones
Kelly Lott11 is a massage therapist and educator with 20-plus years of experience. Although Lott does not suffer from migraines, she has made it her mission to assist clients who need help managing migraine pain. “Migraine patients yearn for cold, not heat,” says Lott.

Lott has observed that active massage therapy can increase blood flow and cause inflammation in some migraine clients. She has developed a set of marble stones designed to be used on the forehead, temples, sinus area and back of the scalp. The stones are refrigerated at 36 degrees Fahrenheit until used.

The placement of the stones includes the area where the trigeminal nerves (found in the face and temples) and the occipital nerves (found at the base of the skull) are located. These two sets of nerves are known to cause migraine attacks if they become inflamed. The soothing coolness of the stones can help to calm these nerves. She recommends that cold stone therapy can be used once a week for prevention of migraine attacks or during an active attack.

Lott recommends the following four myofascial trigger points to relieve pressure in the face. This can be performed in conjunction with cold stone therapy or on its own.12

Place thumb pads under the orbital ridge (under the eyebrow bone) close to the bridge of the nose. Press up and inward to the bones, to a comfort level. This exercise tends to provide the fastest relief, say Lott.
Using your index fingers, press into the orbital ridge bone (eyebrow bone), one place at a time, from inside to outside. Hold for 20 seconds.
Using your index fingers, press into the sinus area (just beside the nostril) to a comfort level. Hold for 20 seconds.
Massage the sinus area in a circular motion to break up the mucus and pressure.
Related: Read more in “Cold Stone Therapy for Migraine Headaches”

Self-care at Home for Migraine Clients
Bellmore also emphasizes the importance of teaching self-care techniques to massage clients with migraine.13 Those experiencing chronic migraine can often feel they have no control over their own body. Self-care can help clients increase body awareness, thereby regaining feelings of control, explains Bellmore. Valendy agrees with this approach. Her husband gives her regular massage at home to prolong the effects of massage between appointments.

Related: Self-care Tips for Massage Clients

Here are some additional suggestions massage therapists can incorporate into their practice as well as teach their clients for self-care:

Lace thumb pads under the orbital ridge (under eyebrow bone) close to the bridge of the nose. Press up and inward to the bones, to a comfort level. Lott believes this is a natural place for people with migraine to carry tension. Focusing on this area first can jump-start the healing process.
Using hand reflexology, use two fingers to pinch the fleshy area between the thumb and pointer finger, feeling your way around for any sore areas.
Using foot reflexology, place a tennis ball under the foot while in a seated position. Roll the ball around, focusing on tender areas, and apply pressure. Repeat on the other foot.14
An area not instinctively thought of when treating migraine is to focus on the masseter muscle (chewing muscle). Many patients grind their teeth. Locating trigger points around the jaw can also relieve pressure.15 Some therapists pinch this muscle using the index finger inside the mouth and the thumb on the surface of the face.
Research has demonstrated that self-management interventions increase feelings of control and mastery. Giving your clients these tools can improve their overall health and perception of pain.

Establishing Boundaries
When working with a person who suffers from migraine, there are several key factors to address before beginning a session:

Some migraine patients experience allodynia, a condition in which one or several areas is extremely sensitive to touch. The pain is so intense that clients may say their hair hurts, a sensation caused by allodynia. Ask the client about any sore areas that should be avoided (especially the scalp).

Sensitivity to smell, or hypersomnia, is a common symptom for people with migraine. If using essential oils is part of your practice, make sure to ask the client before using any fragrance products.

Be on the same page regarding the firmness of massage. Some migraine clients want you to more aggresively work out those knots, while others just need a soothing touch.

Encourage your client to hydrate. Bellmore insists that her clients stay well-hydrated, as dehydration is a common trigger for a migraine attack.

Ask anyone who suffers from migraine and you’ll know that pain relief is one of their primary objectives—and massage therapy is starting to be recognized as a way for migraine sufferers to better manage pain and practice better self-care. Massage therapists who understand migraine can help people who experience it find relief faster and, perhaps, stay pain-free longer.

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