Massage Therapy for Headaches

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One area that is being explored is the use of massage therapy to decrease the individual’s headache frequency, intensity, duration and acute medication requirements.

One area that is being explored is the use of massage therapy to decrease the individual’s headache frequency, intensity, duration and acute medication requirements.

Massage Therapy for Headaches

Massage therapy as a therapeutic intervention is being embraced by the medical community. This is in part because it is a non-pharmacological therapeutic intervention that is simple to carry out, economical, and has very few side effects (Busse et al. 2017).

There research that suggests the nerves that innervate the scalp, head and neck contributes to the complex clinical picture of headache pain. This is why clinicians should be thoughtful and skilled in managing headaches through a number of rehabilitation considerations including, but are not limited to:
• Manual Therapy (nerve mobilization, soft tissue massage, triggerpoint)
• Education on Psychosocial Factors Such as Fear Avoidance
• Mindfulness-Based Stress Reduction

Why Does Massage Therapy Work for Headaches?

A biopsychosocial framework helps put into context the interconnected and multidirectional interaction between: physiology, thoughts, emotions, behaviors, culture, and beliefs. In terms of clinical responses to massage therapy there are a couple of proposed mechanisms of action, including but not limited to: neurodynamics, contextually aided recovery, neuromodulation, social grooming and mechanotherapy.

Structures to be Aware of When Treating Headaches

A massage therapy treatment plan should be implemented based on patient-specific assessment findings and patient tolerance. Structures to keep in mind while assessing and treating patients suffering from cervicogenic headaches may include neurovascular structures and investing fascia of:

  • Suboccipitals
  • Upper trapezius
  • Splenius Cervicis
  • Splenius Capitis
  • Levator Scapula
  • Rhomboids
  • Temporalis
  • Occipitofrontalis
  • Corrugator Supercilii
  • Masseter
  • Sternocleidomastoid
  • Temporomandibular joint
  • Scalene Muscle Group.

More to Explore

Massage Therapy: Injury Specific Treatments
As the body of knowledge to support the use of massage therapy continues to grow, understanding the basic science behind what we do and the guiding principles of adaptability enable us to apply this work to a number of conditions including, but not limited to:
• Sports Related Aches and Pain
• Overhead Athletes
• Shoulder Pain
• Carpal Tunnel Syndrome 
• Osteoarthritis of The Knee
• Post-Operative Patients
• Compartment Syndrome
• Dupuytren's Disease
• Low Back Pain 
• Neck Pain
• Migraines and Tension Headaches
• Post-Concussion Syndrome
• Temporal Mandibular Disorder (TMD)
• Scar Management 

Research Links
Arendt-Nielsen, L., Castaldo, M., Mechelli, F., & Fernández-De-Las-Peñas, C. (2016). Muscle Triggers as a Possible Source of Pain in a Subgroup of Tension-type Headache Patients? The Clinical Journal of Pain.
https://www.ncbi.nlm.nih.gov/pubmed/26550960

Berchtold, V., Stofferin, H., Moriggl, B., Brenner, E., Pauzenberger, R., Konschake, M. (2017). The supraorbital region revisited: An anatomic exploration of the neuro-vascular bundle with regard to frontal migraine headache. J Plast Reconstr Aesthet Surg.
https://www.ncbi.nlm.nih.gov/pubmed/28712884/

Bendtsen, L., Ashina, S., Moore, A., Steiner, T.J. (2016). Muscles and their role in episodic tension-type headache: implications for treatment. Eur J Pain.
https://www.ncbi.nlm.nih.gov/pubmed/26147739/

Busse, J.W., Craigie, S., Juurlink, D.N, ... Guyatt GH. (2017). Guideline for opioid therapy and chronic noncancer pain. CMAJ.
https://www.ncbi.nlm.nih.gov/pubmed/28483845

Chaibi, A., & Russell, M. (2014). Manual therapies for primary chronic headaches: A systematic review of randomized controlled trials. The Journal of Headache and Pain.
https://www.ncbi.nlm.nih.gov/pubmed/25278005

Chen, L., Michalsen, A. (2017). Management of chronic pain using complementary and integrative medicine. BMJ.
https://www.ncbi.nlm.nih.gov/pubmed/28438745

Fernández-de-las-Peñas C, Cuadrado ML, Arendt-Nielsen L, Simons DG, Pareja JA. (2007). Myofascial trigger points and sensitization: an updated pain model for tension-type headache. Cephalalgia.
https://www.ncbi.nlm.nih.gov/pubmed/17359516/

Fernández-de-Las-Peñas, C., Courtney, C.A. (2014). Clinical reasoning for manual therapy management of tension type and cervicogenic headache. J Man Manip Ther. (OPEN ACCESS)
https://www.ncbi.nlm.nih.gov/pubmed/24976747

Fernández-de-Las-Peñas, C.. Myofascial Head Pain. (2015). Curr Pain Headache Rep.
https://www.ncbi.nlm.nih.gov/pubmed/26049772

Fernández-De-Las-Peñas, C., Arendt-Nielsen, L. (2017). Improving understanding of trigger points and widespread pressure pain sensitivity in tension-type headache patients: clinical implications. Expert Rev Neurother.
https://www.ncbi.nlm.nih.gov/pubmed/28745080

Ferragut-Garcías, A., Plaza-Manzano, G., ... Oliva-Pascual-Vaca, Á. (2017). Effectiveness of a Treatment Involving Soft Tissue Techniques and/or Neural Mobilization Techniques in the Management of Tension-Type Headache: A Randomized Controlled Trial. Arch Phys Med Rehabil.
https://www.ncbi.nlm.nih.gov/pubmed/27623523

Fumal, A., & Schoenen, J. (2008). Tension-type headache: Current research and clinical management. The Lancet Neurology.
https://www.ncbi.nlm.nih.gov/pubmed/18093564

Lucas, S., Blume, H.K. (2017). Sport-Related Headache. Neurol Clin. 
https://www.ncbi.nlm.nih.gov/pubmed/28673412/

Luedtke, K., Boissonnault, W., Caspersen, N., Castien, R., Chaibi, A., Falla, D., . . . May, A. (2016). International consensus on the most useful physical examination tests used by physiotherapists for patients with headache: A Delphi study. Manual Therapy.
http://www.ncbi.nlm.nih.gov/pubmed/27183831

Luedtke, K., Starke, W., May, A. (2017). Musculoskeletal dysfunction in migraine patients. Cephalalgia.
https://www.ncbi.nlm.nih.gov/pubmed/28641450

Madsen, B.K., Søgaard, K., Andersen, L.L., Tornøe, B., Jensen, R.H. (2017). Efficacy of strength training on tension-type headache: A randomised controlled study. Cephalalgia. 
https://www.ncbi.nlm.nih.gov/pubmed/28750588/

Martin, P. R. (2016). Stress and Primary Headache: Review of the Research and Clinical Management. Current Pain and Headache Reports.
https://www.ncbi.nlm.nih.gov/pubmed/27215628

Millstine, D., Chen, C., Bauer, B. (2017). Complementary and integrative medicine in the management of headache. BMJ.
https://www.ncbi.nlm.nih.gov/pubmed/28512119

Minerbi, A., Ratmansky, M., Finestone, A., Gerwin, R., Vulfsons, S. (2017). The local and referred pain patterns of the longus colli muscle. J Bodyw Mov Ther.
https://www.ncbi.nlm.nih.gov/pubmed/28532868

Mesa-Jiménez, J.A., Lozano-López, C., ... Fernández-de-Las-Peñas, C. (2015). Multimodal manual therapy vs. pharmacological care for management of tension type headache: A meta-analysis of randomized trials. Cephalalgia.
https://www.ncbi.nlm.nih.gov/pubmed/25748428

Moraska, A.F., Stenerson, L., ... Mann, J.D. (2015). Myofascial trigger point-focused head and neck massage for recurrent tension-type headache: a randomized, placebo-controlled clinical trial. Clin J Pain.
https://www.ncbi.nlm.nih.gov/pubmed/25329141/

Nahin, R. L., Boineau, R., Khalsa, P. S., Stussman, B. J., & Weber, W. J. (2016). Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States. Mayo Clinic Proceedings.
https://www.ncbi.nlm.nih.gov/pubmed/27594189

Nöbel, M., Feistel, S., Ellrich, J., & Messlinger, K. (2016). ATP-sensitive muscle afferents activate spinal trigeminal neurons with meningeal afferent input in rat – pathophysiological implications for tension-type headache. The Journal of Headache and Pain. (Open Access)
https://www.ncbi.nlm.nih.gov/pubmed/27565510

Palacios-Ceña, M., Castaldo, M., ... Fernández-de-Las-Peñas, C. (2017). Relationship of active trigger points with related disability and anxiety in people with tension-type headache. Medicine (Baltimore).
https://www.ncbi.nlm.nih.gov/pubmed/28353618

Park, S.K., Yang, D.J., Kim, J.H., Heo, J.W., Uhm, Y.H., Yoon, J.H. (2017). Analysis of mechanical properties of cervical muscles in patients with cervicogenic headache. J Phys Ther Sci.
https://www.ncbi.nlm.nih.gov/pubmed/28265168

Perry, C.J., Blake, P., Buettner, C., Papavassiliou, E., Schain, A.J., Bhasin, M.K., Burstein, R. (2016). Upregulation of inflammatory gene transcripts in periosteum of chronic migraineurs: Implications for extracranial origin of headache. Ann Neurol. (OPEN ACCESS)
https://www.ncbi.nlm.nih.gov/pubmed/27091721

Quintner, J., Bove, G., & Cohen, M. (2015). A critical evaluation of the trigger point phenomenon. Rheumatology.
https://www.ncbi.nlm.nih.gov/pubmed/25477053

Ranoux, D., Martiné, G., Espagne-Dubreuilh, G., Amilhaud-Bordier, M., Caire, F., Magy, L. (2017). OnabotulinumtoxinA injections in chronic migraine, targeted to sites of pericranial myofascial pain: an observational, open label, real-life cohort study. J Headache Pain.
https://www.ncbi.nlm.nih.gov/pubmed/28733943

Varatharajan, S., Ferguson, B., ... Taylor-Vaisey, A. (2016). Are non-invasive interventions effective for the management of headaches associated with neck pain? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur Spine J.
https://www.ncbi.nlm.nih.gov/pubmed/26851953

von Piekartz, H. V., & Hall, T. (2013). Orofacial manual therapy improves cervical movement impairment associated with headache and features of temporomandibular dysfunction: A randomized controlled trial. Manual Therapy.
https://www.ncbi.nlm.nih.gov/pubmed/23415640

Watson, D. H., & Drummond, P. D. (2012). Head Pain Referral During Examination of the Neck in Migraine and Tension-Type Headache. Headache: The Journal of Head and Face Pain.
https://www.ncbi.nlm.nih.gov/pubmed/22607581