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YOU CAN SEE THESE TECHNIQUES IN MASSAGE & BODYWORK'S DIGITAL EDITION, WHICH FEATURES A VIDEO CLIP FROM ADVANCED-TRAININGS.COM'S ADVANCED MYOFASCIAL TECHNIQUES DVD AND SEMINAR SERIES. THE LINK IS AVAILABLE AT MASSAGEANDBODYWORK.COM AND ABMP.COM. There may be other neurological factors as well. A 2007 study at Harvard Medical School showed differences in migraineurs' physical brain structure. In the long-term migraine sufferers studied, the area of the somatosensory cortex corresponding to the trigeminal nerve (which supplies the head and the face) was thicker than normal.8 It is unclear whether this is a cause or an effect of migraine pain, but the authors of the study suggest that the sensory cortex's differences may help explain why some migraine suffers also experience back pain, jaw pain, skin sensitivity, and other sensory problems along with their headaches. CLUSTER HEADACHES Cluster headaches may be among the most painful experiences known. According to mothers who experience cluster headaches, they can surpass even the pain of childbirth.9 Characterized by unilateral, sudden, and severe eye, face, or orbital pain, they can last from 15 minutes to three hours. They tend to recur in clusters of activity, interrupted by pain-free periods; hence their name. They are also known as "suicide headaches," due to their severity. Cluster headaches are less common than migraines, with about 1/25th the number of "clusterers" as migraineurs.10 Like migraines, cluster headaches have a vascular component, as dilation of cranial blood vessels is thought to put pressure on the trigeminal nerve. Also like migraines, the underlying cause of cluster headaches is unknown, but hormones, neurotransmitters, and abnormal hypothalamus activity are suspected factors. Cluster headaches have a vascular component, as dilation of cranial blood vessels is thought to put pressure on the trigeminal nerve. Some cluster headaches are relieved by fresh air, or by vigorous aerobic exercise (which can worsen a migraine); increased oxygenation is the suspected mechanism. Probably because of the trigeminal nerve relationship, hands-on work around the zygomatic arches (through the upper cheek, or intraorally), or careful but firm pressure directly on the rim of the orbit, can both be welcome first-aid measures. In terms of other hands-on techniques, cluster headaches can be addressed like migraines, in accordance with the intentions and techniques I'll describe in the next installment. Trainings.com faculty, which offer continuing education seminars throughout the United States and abroad. He is also a Certified Advanced Rolfer and teaches for the Rolf Institute. Contact him via info@ advanced-trainings.com and Advanced- Trainings.com's Facebook page. Til Luchau is a member of the Advanced- NOTES 1. D. W. Dodick and J.J. Gargus, "Why Migraines Strike: Biologists are Finally Unraveling the Medical Mysteries of Migraine, from Aura to Pain," Scientific American Magazine (August 2008): 56–63. 2. The fact that vasodilation happens only before a migraine may also explain why hands-on work with the suboccipital muscles can sometimes worsen migraine pain, and at other times relieve it. Since working the suboccipitals may further increase cranial blood flow, it could exacerbate any symptoms related to vasodilation; but since vasodilation doesn't accompany all migraines—and if it does, seems to occur only before the pain begins—there are times when suboccipital work would be relieving instead. 3. Although caffeine reportedly helps some migraineurs if used early enough, others report fewer migraines when regular caffeine use is discontinued. 4. L.J. Stovner et al., "Epidemiology of Headache in Europe," European Journal of Neurology 13, no. 4 (April 2006): 333–45. 5. M. Gervil et al., "The Relative Role of Genetic and Environmental Factors in Migraine Without Aura," Neurology 53, no. 5 (September 1999): 995–9. 6. Documented migraine triggers include alcohol, dehydration, physical exertion, menses and hormone fluctuations, physical or emotional stress, strong odors, flashing lights, weather changes, allergies, sleep deprivation, hunger, florescent lights, and tension headaches. D. Kantor, "Migraine," MedlinePlus Medical Encyclopedia. Available at www.nlm.nih.gov/medlineplus/ency/ article/000709.htm (accessed June 2010). 7. D. W. Dodick and J.J. Gargus, "Why Migraines Strike: Biologists are Finally Unraveling the Medical Mysteries of Migraine, from Aura to Pain." 8. F.M. Alexandre et al., "Thickening in the Somatosensory Cortex of Patients with Migraine," Neurology 69 (November 2007): 1990–95. 9. M. Matharu and P. Goadsby, "Cluster Headache— Update on a Common Neurological Problem," Practical Neurology 1 (October 2001): 42–9. 10. M. Fischera et al., "The Incidence and Prevalence of Cluster Headache: A Meta-Analysis of Population-Based Studies," Cephalalgia 28, no. 6 (June 1, 2008): 614–618. connect with your colleagues on massageprofessionals.com 113