Issue link: https://www.massageandbodyworkdigital.com/i/68175
MYOFASCIAL TECHNIQUES we'll focus on ways to help mitigate migraines and vascular headaches. Let's begin by looking at ways to distinguish musculoskeletal from vascular headaches, summarized in the table on page 111. Although comingled headaches are common, making the distinction between musculoskeletal and vascular headaches is important, because the pain from vascular headaches (such as many migraines) can be made worse by the same techniques that are so effective at relieving musculoskeletal headache pain. TECHNIQUE: SUPERFICIAL AND DEEP FASCIAS OF THE SCALP The superficial fascia of the scalp (Image 1, page 110, and 2, at right) is directly continuous with the superficial fascial membranes of the back of the neck, and by extension, the superficial fascia of the rest of the body. Its position on the crown of the head gives it the unique role of connecting front of the body to the back, and left side to right. As such, it is a mediator and transmitter of fascial stresses and compensations elsewhere in the body. Also known as the subcutaneous fibro-adipose layer, it lies between the outer layers of skin and the underlying galea aponeurotica or epicranium. Although this deeper layer is also mainly membranous, it contains the occipitofrontalis muscles. Because the galea is continuous laterally with the temporal fascia overlying the temporalis muscle, it is particularly sensitive to jaw tension. Deep to the galea is the pericranium on the bones of the skull themselves (Image 2). Besides transmitting strain and referred pain from the rest of the body's fascias, the cranial layers play a direct role in headaches associated with face, neck, and eye strain, as well as mental A stepped dissection of the cranial fascial layers. From bottom to top, the visible layers include the arachnoid mater (thin, red layer just superficial to the brain), the dura mater, the bony cranium, pericranium, galea aponeurotica (with the muscle fibers of frontalis and occipitalis visible anteriorly and posteriorly), and the superficial fascia of the scalp (continuous with the skin, and forming the outer layer in this view). Image courtesy of Primal Pictures. Used with permission. exertion or stress. The adaptability and pliability of these layers is essential to free motion of the underlying sutures and cranial bones. Suture restrictions can play a role in both musculoskeletal and vascular headaches, and so insuring the cranial fascias' differentiation and freedom is a logical first step in working with headaches. To release the cranial fascias, use your fingertips to move the various layers against each other and against the skull. We're not scrubbing the surface of the scalp or shampooing the hair; we're sliding, shearing, and freeing the fascial layers themselves. Imagine loosening the rind of a cantaloupe around the flesh of the melon: use firm, deep transverse pressure to assess and release adhesions, pulls, and thickenings. Use a decisive but sensitive touch; be patient and thorough. Spend at least several minutes with this technique, working the various layers over the entire head, adding active movements of the eyes, face, and eyebrows once the outer layers have been released (Images 3–7, page 113). NUCHAL WINDOW TECHNIQUE Working the suboccipital muscles is a well-known way to relieve tension headaches. The Nuchal Window Technique is a variation on this approach. With your client supine, place your fingertips longitudinally 112 massage & bodywork july/august 2010