Massage & Bodywork

November/December 2013

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PATHOLOGY PERSPECTIVES to avoid developing medication-overuse headaches, and other reasons may prompt people with headaches to seek nonpharmacologic options. These patients may look for a variety of acupuncture, behavioral therapies, biofeedback, and manual therapies as alternatives to medication. Fortunately, research suggests that manual therapies may be about as effective as drugs to manage headache pain for some populations.6 Strategies for massage therapists working with clients who have headaches must be determined by what type of headache is present, whether it is acute or not, and the client's goals. TTHs may call for trigger point work or myofascial release in the neck and facial muscles, while CGHs will respond better to work with the muscles that support the head and determine how the cranium balances on the spine (although care must be taken not to irritate the vulnerable occipital nerves at the back of the head). Clients with migraines may appreciate attention to the myofascial and postural contributors to their condition, when they are not in pain. If a client with an active migraine does seek massage, research shows that neck massage, along with spinal manipulation, can be effective.7 It is quite possible for a skilled massage therapist to build a practice based on expertise with headache management. A network that includes neurologists and chronic-pain specialists is helpful, but the best testament to the effectiveness of massage therapy is most likely to come from satisfied and grateful clients. Notes 1. "International Classification of Headache Disorders 2nd edition," Cephalalgia (2004) 24: S1, accessed September 2013, 2. D. Biondi, "Cervicogenic Headache: A Review of Diagnostic and Treatment Strategies," The Journal of the American Osteopathic Association 105, no. 4 (2005): 16S–22S. 3. C. Fernandez-de-Las-Penas et al., "Myofascial Disorders in the Trochlear Region in Unilateral Migraine: A Possible Initiating or Perpetuating Factor," The Clinical Journal of Pain 22, no. 6 (2006): 548–53. 4. B. Haque et al., "Precipitating and Relieving Factors of Migraine Versus Tension Type Headache," BMC Neurology 12 (2012): 82. 5. R. F. Castien et al., "Clinical Variables Associated with Recovery in Patients with Chronic Tension-Type Headaches After Treatment with Manual Therapy," Pain 153, no. 4 (2012): 893–9. 6. A. Chaibi, P. Tuchin, and M. B. Russell, "Manual Therapies for Migraine: A Systematic Review," The Journal of Headache and Pain 12, no. 2 (2011): 127–33. 7. Y. J. Noudeh, N. Vatankhah, and H. Baradaran, "Reduction of Current Headache Pain Following Neck Massage and Spinal Manipulation," International Journal of Therapeutic Massage and Bodywork 5, no. 1 (2010): 5–13. Ruth Werner is a writer and educator approved by the National Certification Board for Therapeutic Massage & Bodywork as a provider of continuing education. She wrote A Massage Therapist's Guide to Pathology (Lippincott Williams & Wilkins, 2012), now in its fifth edition, which is used in massage schools worldwide. Contact her at or Resources Freitag, F. "Managing and Treating Tension-Type Headache." Medical Clinics of North America 97, no. 2 (2013): 281–92. Hopper, D. et al. "A Pilot Study to Investigate the Short Term Effects of Soft Tissue Massage on Upper Cervical Movement Impairment in Patients with Cervicogenic Headache." Journal of Manual and Manipulative Therapy 21, no. 1 (2013): 18–23. Medscape Reference. "Muscle Contraction Tension Headache." Accessed September 2013. http://emedicine. NYU Langone Medical Center Division of Pain Management. "Cervicogenic Headache." Accessed September 2013. Page, P. "Cervicogenic Headache: An Evidence-Led Approach to Clinical Management." International Journal of Sports Physical Therapy 6, no. 3 (2011): 254–66. Peters, M. et al. "Migraine and Chronic Daily Headache Management: Implications for Primary Care Practitioners." Journal of Clinical Nursing 16, no. 7B (2007): 159–67. See what benefits await you. 47

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