Massage for Headaches

Definitions:  Pain in and around the head.
Types of:

  1. Migraines

    Definition- A paroxysmal (occurring repeatedly and without warning) neurological disorder with many signs and symptoms.

             – Trigeminovascular may involve serotonin

    Causes – Unknown; possible central nervous system disorder that produces secondary intracranial vasoconstriciton followed by vasodilation. 

         – triggers: stress, food, allergies, medication weather changes, auditory or olfactory stimuli, hormones, postural dysfunction or abberrations

    Signs/Symptoms – Family history -(70%)

       – Moderate to intense pain 4-72 hours
    – early morning onset common
    – hypersensitivity to sound, light and smell
    – nausea, vomiting
    – cold extremities and sweating
    – withdraw to dark, quiet room
    – fatigued and drained afterwards
    – with or without an aura (visual disturbance) found more in women

    Special Tests/Contraindications

    During Migraine, massage may be contraindicated depending on symptoms.   Do not cause vasodilation (no heat or deep work)  Avoid music, bright lights and fragrance

    Treatment Plan – Increase Relaxation, decrease pain.  Prone may be poorly tolerated.  Cold hydrotherapy to head and neck.  Hand and foot massage may be tolerated.  Manual lymph drainage. Release sub-occipitals.  Triggerpoint therapy.  

    Between attacks decrease sympathetic nervous system firing, hot hydrotherapy, essential oils (peppermint and lavender)

  2. Tension Headaches:  

    Definition –  Muscle contraction type headache

    Causes – Myofascial triggerpoints, myofascial pain syndromes, facilitation, trauma, acute muscle overload, postural imbalances (forward head posture), referred pain and emotional stress, TMJD (temporal manibular joint dysfunction.)

    Signs/Symptoms – Bilateral, diffuse and constant, dull or vise- like.  Location is often in the referral pattern of the specific muscles. Chronic daily headache may have associated neck and shoulder pain, tenderness and stiffness.  If SCM is involved, may experience nausea, vertigo and tinnitus.

    Special Tests/Contraindications – Differential diagnosis.  Rule out other types of headaches that can be more serious.  No deep work or vigorous techniques that could create kick-back.

    Treatment plan – Massage is best for tension headache.  Reduce sympathetic nervous system firing, reduce pain, hypertonicity, triggerpoints and joint dysfunction.  Increase Range of Motion, Tissue health.

    Pre-tx with heat to affected muscles

    During tx – use diaphragmatic breathing

    Prone or supine may not be tolerated well – use sidelying.

    Work Pectoral muscles and posterior neck.

    Reduce triggerpoints in upper trapezius, splenius capitis, splenius cervicis, Occiptialis, Frontalis, Suboccipitals, SCM, Temporalis, traction

    (see anatomy)

  3. Sinus

    Definition – Acute or chronic inflammation of the paranasal sinuses

    Causes – Infection, increase in pressure, Predisposing factors like deviated septum, allergies, upper molar abscess

    Signs/Symptoms – Pain, tenderness over the affected sinus, fullness, pressure, difficulty breathing

    Special Tests/Contraindications – Acute infection no manual lymph drainage.  Avoid prone positioning as it may increase drainage and pressure.

    Treatment Plan – Increase breathing, decrease pain. Manual lymph drainage to neck and face, massage to facial muscles and neck, static pressure on sinuses, eucalyptus steam.

  4. Trigeminal Neuralgia
  5. Cluster

    Definition – Group of headaches often once a day for several weeks: more men than women.

    Causes- Unknown;  tobacco use is more prevalent than with other types of headaches

    Signs/Symptoms –  Unilateral; 1-6 per day; 30 minutes – 3 hours.  Onset 1-3 hours after person goes to sleep.  Nasal congestion, swelling, drooping of eyelid and pupil constriction.

    Special Tests/Contraindications – Differential diagnosis   


  1. Migraines: mostly unknown (by medical community), cranial circulation problem, misalignment of neck vertebrae, food or chemical sensitivities (environmental), hormonal changes (female, thyroid), blood sugar imbalances
  2. Tension: muscle spasm, TMJ problems, neck alignment
  3. Sinus: allergies (can be food, pollen, etc.), bacterial or viral, neck misalignments
  4. Trigeminal Neuralgia – 5th Cranial Nerve irritation


  1. Migraines:  bilateral or unilateral pain, pain mild to severe lasting for hours or days, nausea, vomiting, distorted or blurred vision, sensitive to light and sound, cold extremities
  2. Tension: pain, referred pain, muscle spasm and tension, triggerpoints, duration 1 hour to 1 day, TMJ, frontal, temporal and occipital regions often affected
  3. Sinus: pressure around eyes, nose, cheeks or back of head, congestion, excess mucous,
  4. Trigeminal Neuralgia -triggerpoints in face, lips, tongue, jaw, more common in older people (50+)

Treatment Goals:

    • be aware of clients tolerance: may need dark room, soft touch depending on stage and type of headache
    • decompress neck, facial bones, occipital area
    • massage may sometimes cause headache to become worse
    • most kinds of headaches can be relieved by working the back of the neck, occipital area, SCM, upper back, trapezius, levator scapula.
    • treat triggerpoints on top of head, back of head, neck
    • ice to back of neck, forehead; heat to feet/hands.
    • traction to neck

Other helpful therapies: Chiropractic, Acupuncture, Cranio-sacral, Naturopathy to detoxify and eliminate foods/chemicals

Possible Triggers Include:

    • Birth Control Pills
    • cheese
    • chocolate
    • dairy products
    • bananas
    • alcohol
    • sensitivities to wheat
    • caffeine

Touch Research Institute :

Migraine HeadachesMassage therapy decreased the occurrence of headaches, sleep disturbances and distress symptoms and increased serotonin levels in adults with migraine headaches.

Hernandez-Reif, M., Field, T., Dieter, J., Swerdlow. & Diego, M., (1998). Migraine headaches were reduced by massage therapy.

R E S E A R C H Massage Magazine report :Massage Reduces Headache Frequency

Massage Therapy for Tension Headaches Pilot Study Concludes Massage Therapy Foundation News

Somatic Research By Shirley Vanderbilt Massage and Bodywork Magazine

The Dual Concept Massage Approach to Headaches The Institute for Integrative Healthcare Studies

Fewer Migraines with Massage Therapy Bastyr University

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