SET TALK
By Don McCann, MA, LMT, LMHC
MA3267 MH705 MM3717
HEADACHE RELIEF
If you are a practicing massage therapist, it’s almost
certain that you have clients who are suffering from full blown headaches, or
who come in for stress relief or some other symptoms leading to headache
patterns or chronic headaches. Most clients who come in with a headache already
established want immediate relief. Our clients have been educated by the media
and the drug industry that headache pain should not exist in their lives. The
truth is that headaches are often the result of the clients’ lives, especially
when stressed.
When a client walks into the office for a session, often
there have been several stressful occurrences just in the process of getting to
the office. We take for granted when we get into a car that everything is going
to be okay, and that we will arrive at our destination safely in a reasonable
amount of time. This fantasy does not always live up to reality. We have our
lives threatened daily in vehicle travel, and can be caught in traffic or
rerouted making it next to impossible to maintain on-time schedules. Driving to
a massage is no different, and a type "A" personality, who is normally
highly stressed, will absolutely be even more stressed after traveling through
traffic in a car.
There are several different kinds of headaches – some easy
to treat, and some quite difficult. The ones that are easily treated generally
are due to stress and tension, and are usually successfully treated with a
relaxation massage. Other types of headaches resulting from structural
imbalances, or injuries, car accidents, and trauma, are more difficult to treat.
Stress seems to be a trigger for the onset of just about any
type of headache. It is important for the massage therapist to be able to
recognize and effectively release the areas of soft tissue and muscle
contractions involved with the headache. The back of the neck and tops of
shoulders are normally tight and are typical areas of complaint in almost any
headache situation. However, if you only work the back of the neck and
shoulders, you will in essence be facilitating the structural imbalance which is
often the culprit. Since the head and neck are usually already protruding
forward in 90% of the people with headaches, the cervical vertebrae is not
effectively supporting the head, which forces the muscles in the back of the
neck to contract tightly to hold up a 13 lb head. So, if we are to successfully
address the headache triggers on the tops of the shoulders and the back of the
neck, we need to initially apply massage techniques that will move the head,
neck, and shoulders back into structural alignment before working extensively on
the contracted muscles on the top of the shoulders and back of the neck. When
the head, neck, and shoulders are released back into an improved structural
alignment, the musculature in the back of the neck and tops of shoulders will
have already relaxed because it is no longer compensating for the forward head
posture. The work on the soft tissue of the back of the neck and tops of
shoulders can then be deeper and more effective with less sensation for the
client. Clients like this.
When the headaches are the more severe type such as clusters
and migraines, the structural improvement resulting from working the front of
the chest and the neck first, followed by treating the back of the neck and tops
of shoulders has a two-fold effect. Not only will the triggers found in the
spasmed muscles of the levator scapula, splenius capitus, supraspinatus,
trapezius and rhomboids dissipate, but the structural improvement increases the
flow of cerebral spinal fluid and circulation of blood to the cranium and brain,
often with long-term positive effects on the relief of the client’s migraine
or cluster headache syndromes.
As I have mentioned, we want to relieve the stress, but also
a promote significant structural shifting that will take the stress off the back
of the neck and shoulders. The most effective way I have found for releasing the
soft tissue is the 3-step approach that has been described in previous articles
(Massage Magazine, November/December 2001, or you can read a copy of that
article on the website.) The following is the sequence of application that I
have found to be most effective in accomplishing the structural changes. First,
have the client lie supine and work the pectoralis major and minor, then the
subclavius directly under the clavicle, followed by working the SCM and all
three scalene muscles. This allows the cervical vertebrae to shift back into
alignment. I also find that rotating the head as you work the individual strokes
on the scalenes, starting at the front and working progressively toward the
back, will restore full range of motion in the rotation of the head, and allow a
more direct release from the stroke on the tightened musculature. Caution:
Massage therapists must always be aware of the contraindications for treating
these areas.
After releasing this musculature on the front of the
shoulders and neck, I will then have the client lie one side. While tractioning
the shoulder, release the top of the shoulder and supraspinatus working from the
coracoid process to the superior angle of the scapula. It is important not to
put a shearing pressure on the cervical vertebrae in this position. Then
work the posterior fibers of the neck - splenius capitus, levator scapula, and
trapezius - working from the base of the cranium into the tops of the shoulders.
I use fingertips or thumbs, and again I’m very careful not to put a shearing
pressure on the cervical vertebrae – the pressure is directed toward the feet.
After working the large fibers of these muscles, I now work the small tightened
fibers directly under the ridge of the occiput. This will often further release
C1, atlas/axis, and occiput. It is not uncommon for the clients to identify this
area as causing their headaches. I will then repeat the shoulder and posterior
neck on the opposite side.
After releasing the musculature of the neck and shoulders, I
will then work the soft tissue that encapsulates the entire cranium, being
careful not to pinch any of the cranial nerves between the thin soft tissues and
the bones of the cranium. It is important to release the tissue around the
sutures which I find are often sore. Another important area I pay special
attention to is the temporalis over the temporal bones and the nerve pathways
that are imbedded there. Oftentimes, having the clients open and close their
mouths while working this area increases the effectiveness, and allows me to use
less pressure. I usually finish with lengthening strokes down the whole back to
further reduce pressure that may be pulling on the back of the neck and
shoulders.
I have also found cranial/structural or craniosacral work to
be incredibly effective in reducing the headache symptoms as well as supporting
the client’s structural improvement and overall well-being. It has been my
observation that, in the majority of headaches, the occiput is usually jammed.
The techniques of both cranial/structural and craniosacral will mobilize the
occiput. This is important for two reasons: 1) the tightened soft tissue at the
base of the occiput will often greatly restrict the motion of the relationship
between the occiput and the atlas/axis (C1, C2), which most certainly
contributes to chronic and long-term headache patterns; and 2) it increases the
mobilization of the dura down the spine to the sacrum, producing a sense of
well-being and an increase in the flow of cerebral spinal fluid.
The combination of the cranial/structural or craniosacral
with the soft tissue work along the base of the occiput will facilitate the
mobilization of the occiput and normalize its relationship to C1 and C2. Many
clients who have severe neck and back problems will be so locked up in this area
that it may take more than one treatment to restore this mobilization. However,
I have found that without mobilizing this area, a major contributor to many
types of headaches will not be addressed. The degree of mobilization is directly
proportional to the reduction of symptoms.
There are other cranial relationships that I have also found
to be present with headache syndromes. They are generally related to the
immobilization of cranial sutures or specific cranial bones. Some of the
symptoms relate directly to the palatine, the occipital/mastoid suture, and C1.
Once the mobilization of these sutures is restored, the headache symptoms
usually disappear.
Massage therapists who have had cranial/structural or
craniosacral training will have the techniques for mobilizing the cranium. If
you haven’t had that training, I suggest you release all the restrictions in
the soft tissue that covers the entire cranium like a skull cap. The resulting
increase in mobility of all the cranial sutures will have a very positive effect
and will help to reduce the headache symptoms.
For those of you who have learned my Quick Release Technique,
I strongly recommend that you apply this prior to doing any soft tissue work.
The Quick Release Technique addresses the head/neck/shoulders, the stress, the
trapped energy, the structural imbalance, and the cranial jamming found in most
headache situations. The quicker the symptoms of the headache can be relieved,
the more confidence a massage client will have in the massage therapist, and the
more successful the therapist will be. The Quick Release Technique will
dissipate the majority of stress headaches within 10-15 minutes. (The Quick
Release Technique can be found in book Relief from Head, Neck, and Shoulder
Pain available through the website.)
I hope I have given you some additional ideas on how to
successfully treat headaches. There is a great deal of written information on
the causes and types of headaches in medical literature, but very little on
effective treatment. Therefore, this article focuses on treatment protocols that
I have found to be effective in treating most types of headaches. There is no
shortage of headache clients.
I hope the information in this article will increase your
awareness of effective treatment for supporting your clients. Keep up the good
massage therapy.
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