Migraine headaches, or migraines, are recurrent headaches that may be severe and, in some cases, completely incapacitating. More than 29 million persons have migraines. Women are affected more than men (4 : 1 ratio). The average age of onset is between 25 and 55 years, but migraines can occur in children. Massage can help.
Migraine pain is moderate to severe, often described as pounding, pulsing, or throbbing. Migraines are often accompanied by nausea, vomiting, and extreme sensitivity to light, smells, and sounds. Migraine attacks can last from 4 hours to 3 days, and the pain can be so severe it interferes with daily activities. Migraine headaches are also called vascular headaches. Tension and cluster headaches are discussed in this blog post.
The exact cause of migraines is unknown, they appear to be related to imbalances in brain chemicals, including serotonin and neuropeptides. Chemical imbalances cause changes in nerve responses and dilation of intracranial blood vessels. Migraine headaches are often provoked by a trigger factor. These triggers include hunger as well as certain foods (carbohydrates, iodine-rich foods, cheese, chocolate), alcohol (usually red wine), bright lights, loud noises, hormonal changes (menstrual, ovulation, contraceptives), atmospheric changes, and the period of relaxation after physical or emotional stress.
Migraine headache pain is often described as severe throbbing or a pulsing sensation, usually on one side of the head, but can be both sides; pain is aggravated by physical activity. The person may feel nauseated and vomit, and/or experience extreme sensitivity to light and sound. . Before the onset of the migraine, many people experience a visual aura such as sparkling flashes of light, dazzling zigzag lines, or a slowly expanding blind spot in the visual field. Other symptoms include sensitivity to smell and touch, loss of appetite, and stomach upset or abdominal pain. After a migraine (post-drome period), the person may feel exhausted for up to a day.
When the migraine headache begins (called an attack), the person is given medications to reduce pain, produce sleep, and constrict dilated blood vessels. Medication to control nausea and vomiting (antiemetics) also may be prescribed. The person is asked to rest in a dark, quiet room during the attack. Between attacks, avoidance of triggers is recommended and adequate sleep, regular eating habits, and daily meditation are encouraged. Nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants, and beta blockers may be used to reduce the frequency and severity of migraines. Botox injections may be useful to reduce occurrence.
Massage and Migraine Headaches – Screen headache clients for the presence of red flags using SNOOP. If a client states the headache is different from a typical migraines and has one of the red flags described in the acronym, urge the client to seek medical attention.
- S: Systemic symptoms or disease (fever, weight loss, cancer, HIV infection)
- N: Neurologic symptoms (mental confusion, impaired alertness, lack of coordination)
- O: Onset that is sudden (thunderclap headache) or after recent head trauma
- O: Older age 50 years (new onset and progressive pain is headache)
- P: Previous headache history (first, worst, or different kind of headache)
Massage is postponed until the client’s pain has subsided. Additionally, a client with a migraine or a cluster headache is not likely to want a massage. Afterward, focus on soft tissues of the scalp, suboccipitals, posterior neck, and shoulders. Use moderate-to-deep pressure over trigger points. Consider incorporating foot reflexology and PROM into the session to improve treatment outcomes.
For clients who have migraines without pre-migraine auras, consider recommending the application of menthol-infused products (10% solution) to the forehead and temporal regions to reduce pain, nausea, and sound and light sensitivity (Borhani Haghighi, et al, 2010).
While not specifically for migraines, this video features an effective routine to reduce headache pain.
Research. Individuals who received two 30-minute massages twice weekly for 5 weeks reported fewer distress symptoms, less pain, more migraine headache-free days, fewer sleep disturbances and they had increased serotonin levels (Hernandez-Reif et al, 1998). The massage focused on soft tissues of the posterior neck and base of the skull. Migraine sufferers who received weekly 45-minute massages for 5 weeks experienced decreased headache frequency and improved sleep quality. Massage also reduced perceived stress and increased coping efficacy. During the massage, decreases in anxiety, heart rate, and cortisol were also noted (Lawler & Cameron, 2006).
A massage lasting approximately 55 minutes administered once a week for 5 weeks combined with 3 minutes of postural correction counseling reduced the frequency of headaches in migraine patients (Vahtrik et al, 2018). The massage was performed over the neck and shoulder areas using strong pressure, according to patients’ pain tolerance. The postural correction counselling included instructions for patients to maintain good upper body alignment during sitting, standing or walking in everyday activities. Six massage sessions over trigger points combined with stretching of the upper back and suboccipital regions administered over 2 weeks reduced migraine headache frequency, intensity, and duration, medication use, and increased functional ability and the pain pressure threshold. The placebo group received superficial massage only (Rezaeian et al, 2019).
Both foot reflexology and massage reduced migraine headache pain and its intensity, frequency and duration of the attacks in females (Wojciech et al, 2017). Participants in the reflexology group received a 30-minute session twice weekly for 5 weeks (10 treatments). Participants in the massage group received a 20-minute massage to the upper body and base of the skull 3 times a week for 5 weeks (15 treatments). Foot reflexology administered twice on the great toes of both feet for 20 minutes (the second application was 3 hours after the first one) reduced the intensity of a nitroglycerin-included migraine headache (Imani et al, 2018). Traditional Thai massage reduced pressure pain threshold and headache pain intensity in persons with migraine headaches and chronic tension-type (Chatchawan et al, 2014). Neck and upper thoracic massage combined with spinal manipulation of these areas significantly reduced pain intensity in males with acute onset of a migraine headache. All of the patients reported satisfaction with the intervention (Noudeh et al, 2012).
Borhani Haghighi A., Motazedian, S., Rezaii, R., Mohammadi, F., Salarian, L., Pourmokhtari, M., Khodaei, S., Vossoughi, M., Miri, R. (2010). Cutaneous application of menthol 10% solution as an abortive treatment of migraine without aura: a randomised, double-blind, placebo-controlled, crossed-over study. Int J Clin Pract, 64(4), 451-456.
Chatchawan, U., Eungpinichpong, W., Sooktho, S., Tiamkao, S., Yamauchi, J. (2014). Effects of Thai traditional massage on pressure pain threshold and headache intensity in patients with chronic tension-type and migraine headaches. J Altern Complement Med, 20(6), 486-492.
Hernandez-Reif, M., Dieter, J., Field, T. M., Swerdlow, B., Diego, M. A. (1998). Migraine headaches are reduced by massage therapy. International Journal of Neuroscience, 96(1-2), 1-11.
Imani, N., Shams, S.A., Radfar, M., Ghavami, H., Khalkhali, H.R. (2018). Effect of applying reflexology massage on nitroglycerin-induced migraine-type headache: A placebo-controlled clinical trial. Agri, 30(3), 116-122.
Lawler, S.P., Cameron, L.D. (2006). A randomized, controlled trial of massage therapy as a treatment for migraine. Ann Behav Med, 32(1), 50-59.
Noudeh, Y.J., Vatankhah, N., Baradaran, H.R. (2012). Reduction of current migraine headache pain following neck massage and spinal manipulation. Int J Ther Massage Bodywork, 5(1), 5–13.
Rezaeian, T., Mosallanezhad, Z., Nourbakhsh, M., Ahmadi, M., Rostami, M., Nourozi, M. (2019). The effect of selective neck muscle release techniques on clinical indicators of patients with migraine headache: a randomized controlled trial. Journal of Rehabilitation, 20(4), 384-397.
Vahtrik, D., Bergmann, M., Vanahunt, I., Braschinsky, M. (2018). Effect of postural correction and orthopedic massage therapy on the frequency of headaches and tenderness of muscles in migraine patients. J Musculoskelet Disord Treat, 4(2), 046.
Wojciech, K., Pawel, L., Halina, R.Z. (2017). Effects of feet reflexology versus segmental massage in reducing pain and its intensity, frequency and duration of the attacks in females with migraine: a pilot study. J Tradit Chin Med, 37(2), 214-219.
Dr. Susan Salvo is a massage therapist, author, educator, researcher, explorer, and perpetual student. To learn more, check out the “About Susan” tab. You can contact Susan at firstname.lastname@example.org.