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Massage Therapy and Headaches

Chronic Daily Headaches

Headaches plague an increasing number of North Americans, affecting quality of life and productivity. There are two main categories of headaches Primary and Secondary. Primary headaches are a pathology unto themselves whereas secondary headaches result from an under lying pathology. There are three common types of Primary headaches, Tension, Cluster and Migraine. Some patients suffer from more than one type of headache at the same time. Headaches range in severity from life threatening disease to a minor annoyance. Less than 0.004% of these headaches are due to a serious pathology.

Chronic daily headaches are headaches that occur 15 or more days a month. They include all types of non threatening headaches and are characterized by constant chronic daily or near daily headaches that fluctuate in intensity. The head pain can be caused by post traumatic headaches, migraines, drug associated headaches, fibromyalgia, spinally mediated headaches and temporomandibular headaches. Chronic headaches that began as migraines are called transformed or chronic migraines and tension headaches that evolve into daily headaches are called chronic tension headaches. All of the preceding can also be aggravated by medication overuse. Patients suffering from transformed migraines usually have a previous history of intermittent migraines by the age of 20 to 30. In 80% of cases this evolution is triggered by analgesic overuse and psychological factors. In the other 20% it is most likely linked to a head or neck trauma operation or flu like illness. The patient experiences similar characteristics to a migraine intermittently or continuously. Chronic tension type headaches are characterized by an over contraction of the skeletal muscle covering the scalp, the anterior and posterior neck. The most common symptom other than pain is a lack of deep or restorative sleep. Much like other chronic pain syndromes the patients suffer from a lowered quality of life.

Migraine headaches are a neurological disorder and patients suffering from migraines are considered to have a hypersensitive nervous system. When the nervous system is stimulated a neurochemical change is provoked. This change affects the trigeminal nerve; there is a release of vasoactive amines and substances that cause inflammation of the meningial arteries and stretching of the trigeminal afferent branches.

The migraine is self-perpetuating because a feed-back loop is initiated into the trigeminal nerve.

Triggers

• Hormones – menstrual cycle and birth-control
• Food – chocolate, msg., caffeine and food coloring (especially red) and aspartame ** skipping meals
• Stress – whether it is perceived or not

Signs and Symptoms

Lasting 4-72 hours

With nausea without vomiting or phonophobia and photophobia

• Unilateral throbbing pain
• Increased pain on movement
• Moderate to severe
• Aura – visual disturbances blinking is present in 1/5 migraines

Tension-type headaches are the most common type of primary headaches. They can be chronic or episodic, vary in intensity. There are no traditional laboratory tests to diagnose a tension headache. Therefore diagnosis is based primarily on signs and symptoms presenting.

Triggers

• stress, anxiety, fatigue or anger

Signs and Symptoms

• pressing headache
• no pulsations
• mild or moderate
• absence of any combination nausea with vomiting, phono and photophobia
• pain on both sides, back of the head and neck
• gradual onset
• does not usually affect sleep however they usually present shortly after waking

Statistics

• 5 % of all adults of 1st world nations suffer from CDH
• more common in women than in men
• 50 % are tension
• 35 % are transformed migraines

In the US alone there is a loss of productivity of up to 1.7 billion $ due to CDH. Most do not consult their physicians.

Poor Posture and Headaches

Poor posture and poor biomechanics can contribute to CDHs. Poor posture puts excessive stress on muscles which leads to imbalance and neurovascular problems. As explained above these are contributing factors and causes of both migraine and tension headaches. These headaches can transform into a chronic daily headache if the cause is not remedied. The stress from poor posture and poor biomechanics can cause the formation of Trigger Points (TrP) in muscles of the head, neck and thorax that radiate pain into the head. Travell defines a trigger point as ‘a hyperirritable spot in the skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. The spot is painful on compression and can give rise to referred pain, referred tenderness, motor dysfunction and autonomic phenomena.’ Many people who believe that they suffer from tension headaches or migraines are suffering from a headache caused by a TrP. Head forward posture found in many North Americans can create, activate and perpetuate TrPs. Common locations for TrPs that cause headaches are: the scalene muscles, the sternocleidomastoid muscles, the suboccipitals, the splenius capitis, splenius cervicis, occipitofrontalis, trapezius, the muscles of mastication and semispinalis capitis. All of these muscles have referral patterns into the head and left untreated can turn into a CDH.

Massage Therapy

Registered Massage Therapists can help alleviate headaches. The technique used depends on the source and type of the headaches. We at Everest Therapeutics use a number of modalities when treating patients that suffer from headaches. Craniosacral Therapy, Myofascial Therapy, Musculatedonous attachment release, soft tissue massage, Trigger Point Release and postural retraining have all proven to be beneficial for patients suffering from headaches.

Cautions

Some headaches are warning signs for serious medical conditions. Headaches that are associated with fever, neck rigidity, nausea vomiting and pain behind the eyes could signal meningitis. A new type of headache in the second trimester of pregnancy that is continuous with pain localized in frontal or occipital areas combined with visual disturbances could indicate pregnancy induced hypertension. Abrupt, explosive pain accompanied by transient loss of consciousness are symptoms associated with a stroke. The pain linked to a brain tumor is less severe with neurological symptoms such as loss of coordination, weakness, dizziness, double vision, nausea and personality change. The possibility of meningitis, pregnancy induced hypertension, stroke or a brain tumor should be reported to a physician immediately. The location of headache pain will vary depending on the underlying condition. The key subjective pieces of information are new, severe pain, ‘all of a sudden’ and unlike any they have had before. Other associated signs and symptoms are nuchal rigidity, fever, nausea, vomiting, photophobia, and transient rash, swelling in the extremities, sweating, and slurred speech, transient loss of consciousness, tachycardia, impaired motor function, diminished temporal pulse, nasal discharge and sleep disturbances. All of the above are precautions or contraindications for massage therapy. Many are indications to be reported immediately to a physician.

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