Massage & Bodywork

November/December 2013

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International Headache Society Classification ICHD-II Part I: The Primary Headaches 1. Migraine 1.1 Migraine without aura 1.2 Migraine with aura 2. Tension-type headaches 2.1 nfrequent episodic tension-type headache I 2.2 Frequent episodic tension-type headache 2.3 Chronic tension-type headache 3. luster headaches and other trigeminal autonomic C cephalalgias 4. Other primary headaches Part II: The Secondary Headaches 5. Headache attributed to head and/or neck trauma 6. Headache attributed to cranial or cervical vascular disorder 7. eadache attributed to nonvascular intracranial H disorder 8. Headache attributed to a substance or its withdrawal 9. Headache attributed to infection 10. Headache attributed to a disorder of homeostasis 11. eadache or facial pain attributed to disorder of H cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structures 11.1 Cervicogenic headache 12. Headache attributed to psychiatric disorder Part III: Cranial Neuralgias, Central and Primary Facial Pain, and Other Headaches 13. ranial neuralgias and central causes of facial C pain 14. Other headache, cranial neuralgia, central or primary facial pain 46 massage & bodywork november/december 2013 Cervicogenic Headaches As the name suggests, CGHs arise from problems with the neck that then refer, by way of the cervical nerves, up over the head. In addition, fibers from the trigeminocervical nucleus, a region of the upper spinal cord, interact with sensory fibers from the upper cervical nerves, which creates more referred pain pathways. Three major features of CGHs include restricted neck movement, painful palpation of the cervical joints, and weak neck flexors. Involved muscles include the upper trapezius, the sternocleidomastoid, scalenes, levator scapulae, and the suboccipital extensors.2 The symptoms of CGHs include neck and shoulder pain, sometimes with pain going down one arm. The pain may start with a sudden movement of the head, like a cough or a sneeze. It is usually unilateral, and is often focused in the forehead or behind one eye. Blurred vision, dizziness, nausea, and sensitivity to light are common. DOES MASSAGE HELP? The research on manual therapies for headaches suggests that massage may have a positive impact in many situations. Massage appears to be especially helpful for chronic headaches (both migraine and TTHs), and the myofascial component of CGHs also suggests that massage would be a useful intervention. Some evidence suggests that peripheral issues like muscle tightness or irritation can trigger migraines.3 Further, multiple headache types can occur concurrently—that is, a person could have the musculoskeletal components of CGHs, along with the trigeminal neurogenic features of TTHs; these patients are good candidates for massage, and with skilled work they are likely to have an excellent response. Many headache patients pursue massage along with other interventions.4 Patients with a pattern of severe and chronic headaches tend to report more positive responses to manual therapies compared to patients with milder forms.5 This is exciting, because headache chronicity suggests the establishment of central-sensitization patterns. If massage can be helpful in reducing severity and frequency of headaches, this could be generalizable to other central-sensitization syndromes, many of which are difficult to treat. The effectiveness of massage for headache pain is relevant for the many people who would like to minimize or avoid pharmaceutical intervention. Drug sensitivities, cumulative toxicity, pregnancy, fear of addiction, a desire

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