My mother suffered from migraines, and I did too, beginning in adulthood, so I know firsthand what my clients feel. I also know what helps or hurts them.
A migraine is a disorienting and disruptive neurological disorder that almost defies description. Besides experiencing pain on one or both sides—which often begins with a stuck-feeling knot at the back of your neck or skull—you feel like your head is going to explode. Even the slightest movement exacerbates the pulsing, pounding, throbbing, aching or stabbing sensations you feel.
Beyond your head, your symptoms reverberate throughout your entire body.
During an episode, and sometimes before and after one, migraine sufferers can become so sensitive to light, touch, sounds and scents that whatever was normal mere moments before suddenly becomes amplified.
A range of symptoms, such as nausea, vomiting, sweating, chills, diarrhea, visual disturbances and mood changes overcomes them.
Chances are, some of your clients are among the 37 million people in the U.S. who get migraines, two-thirds of whom are women. A few of them might have turned to you seeking help for migraines, but it’s likely they’ve had to cancel during an episode because they felt too sick to move. They might have tried massage as a mean of help for migraine pain previously, but ended up feeling worse and don’t want to chance it.
I’m a professional and a personal member of the migraine club. Forty-six years ago, I developed the Mundo Method, a touch-and-concentration protocol that stops a migraine on the spot. I’ve taught it as part of my mind-body self-care relief and prevention program for 25 years.
Migraines Imitate Life
Although our contemporary stressors and caffeinated culture play their roles, migraines are not thoroughly modern. Remedies date back to ancient Egypt, Greece and Rome. With growing precision, due to recent imaging technologies, researchers have studied migraines for decades, and yet their exact neurobiological mechanisms remain a mystery.
The underlying causes, or triggers, however, are fairly identifiable using good detective work. In my experience, most people embody a combination of factors, often a veritable perfect storm that add ups to create cycles of pain.
From diet, lifestyle, environment and physical factors to medications and hormones, how we live can help or hurt us. This isn’t about blaming the victim; it’s about helping people live in ways that support their well-being.
Family history and cultural background are also part of the equation: How people were raised and learned to feel about, view and treat their bodies and themselves in sickness and in health can also factor into their headaches.
Do they push through pain and ignore it?
Do they feel ashamed, weak, or guilty when they get sick?
Do they take a pill to keep going, instead of resting or slowing down?
Do they only have bodily awareness when sick or in pain?
Help For Migraine
We are not just our foods, posture and lifestyle. As complex, dynamic beings, mind, body, emotions and spirit factor into our health. This somatic, or body-as-self, approach, might explain why triggers can affect each migraine sufferer so uniquely.
A somatic approach to migraine empowers clients to take charge of their own health, so they can prevent the buildup of tightness that perpetuates pain. They learn to build awareness of, and feel, the body in gravity and be present in each moment.
This is an overview of my methods of help for migraine:
- I often work with the clothed client seated in a chair.
- I give self-care instructions and coaching during the session.
- I describe the body and techniques in terms of qualities and sensations instead of anatomy.
- I use low-movement holds, squeezes and pressure, along with myofascial and energy work, to ease out and soften tight tissue and balance and recycle pulsing sensations.
Although your client might not make it to your office during a full-blown headache or migraine, she might come in for massage for migraine relief when experiencing lingering after effects or when she feels a headache or migraine impending. Typically, she feels stressed, with raised shoulders, shallow breathing and a collapsed chest—and expresses fear that the pain could escalate.
Working with the client in a straight-back chair can address all of the above-noted conditions. I help my client sit and align vertically, breathe, find her feet on the ground and her seat in the chair, and center and settle into gravity. That is about half the work—because experiencing relaxation while vertical, which is our waking world, is a valuable practice.
My client remains seated for any additional steps, such as gentle upper-body work and hands-on headache therapy. When the client is seated, both of my hands can work on the head unimpeded, and the head has no other points of contact as it would with table work.
It’s a head-forward world, which creates perfect conditions for tightness, tension and pain in the shoulders, neck and head. During seated work, speaking softly, calmly and confidently, I give gentle coaching and prompts to direct my client’s awareness to posture, alignment, breathing, centering and letting go of thoughts.
Working with these principles in a bodywork session can reduce muscle and fascia tightness in the moment, and these principles are also effective as daily practices.
Being seated, with awareness, in a supportive, relaxed position is a living lesson in learning how to be present to feeling a difference and what it produces for clients, which makes it more likely they can recreate mind-body self-care. That is the heart of prevention.
When I taught classes for HMO wellness programs, I developed a language of touch as a way to describe some pretty far-out tissue and energy phenomena to the patients, and it stuck. Although I use a few anatomical terms and markers, such as trapezius, sternocleidomastoid and levator scapulae, I mostly work with the felt qualities and sensations of tissue, tightness, tension, pain, holding and release.
I use common words—and some humorous, made-up ones—to describe the subtle experience of working with the head and body.
The idea of working with migraine is to still it. Because it has a pulsation of its own, you don’t want to create another beat; that would make it worse. Instead, I use hands-on energy work, mental focus and sensation markers to quiet the pain on the head and release it. Instead of petrissage or effleurage, I use holds, squeezes and pressure to ease out, open, melt and balance upper-body tightness that is often part of one’s migraine experience.
Touch Work and Migraine
My clients typically have been diagnosed by their neurologists and often are taking medications for pain relief or prevention, or both. Touch work can be so effective, yet, sadly, is often left out of treatment plans. It’s as if a headache has no relation to shoulders, neck, head and face, and how thoughts, worries, fears and frustrations contribute to bodily tension.
That’s where a massage therapist’s educated touch and coaching can help; however, it’s wise to proceed subtly and work slower and less deeply than you ordinarily would or feel you should. Even in the absence of an episode, people with migraine are often more sensitive to touch, especially if they’ve been holding upper body tension over time. Their bodies will react in pain if too much in-depth or fast-paced work is done in one session. Slow means like molasses, where you feel the melt.
Stack the Body in 5 Steps
Unconscious head-forward posture developed from using computers and phones, as well as reading and driving, takes a huge toll on the shoulders, neck, upper back and lower skull. People’s torsos end up C-shaped—both vertically and horizontally. Their posture is slouched and shoulders are curled in, which keeps their upper-body muscles and fascia in a state of contraction.
The alignment produced by stacking the body releases tension, opens the chest, promotes fuller breathing, and saves the therapist’s thumbs and wrists. Using gravity and posture helps you do the work with much less effort.
1. Center in gravity. Always start with the feet hip-distance apart and trace a line from feet up to the hip joint, so hips, knees and feet are aligned and the client’s weight can drop down and be held in gravity. You may use props, such as a pillow below the waist to support the sacrum.
2. Stack the body. Standing to the side of the client, lightly tap the client’s ear, side of the shoulder and side of the hip with your finger, saying, “Vertically align your ears, shoulders and hips.” Lightly trace a line between these three areas to give a sense of their alignment.
3. Breathe lower. If the client is chest-breathing, where the chest moves with each breath, or is breathing shallowly with little movement, have the client place one hand below her belly button and drop her breath behind her hand, so it gently moves out on inhale and toward the spine on exhale.
This usually takes gentle coaxing, prompts and reminders, because most people hold their breath in one way or another.
4. Soften around the jaw. Ask the client to rest her tongue on the roof of her mouth and let her teeth slightly part. This helps relax the face, jaw, eyes, chin and neck.
5. Close eyes and let go of all thoughts. This helps internal focus. Observe as the client does this, and repeat the suggestion if the breathing rises or stops, or the body tightens.
Ease Out Tight Tissue
When performing seated techniques, I soften the shoulders, neck, head, forehead, and around the eyes and jaw. I use light-touch holds, squeezes, little circles and gentle pressure to ease out fascia and work from general to specific in order to warm, soften and melt tight areas and points.
Shoulders: Grab the upper ridge of the trapezius on each side, squeeze, and gently pull up toward the ceiling. Keep holding as you feel the tissue warm and soften. Release and work outward toward the arm and then back toward the neck.
Upper back: Rest fingers on the trapezius, do little circles and pressure on the levator scapulae. Don’t force the tissue, keep feeling it ease; then go slightly deeper into the next layer.
Back of neck: Use your front hand to support the client’s forehead. Squeeze the back of the neck with traction and ease straight back. Go slowly; feel the tissue soften. Keep holding; slowly release the hold.
Face: Using all of your fingers, press lightly and hold points while exerting slight downward pressure on the forehead, cheekbones, jaw joint, jawline and chin.
Overall: If migraine is present, apply the Mundo Method.
Check in: Have the client keep her eyes closed. Ask for a report about what feels different. Give an assessment of what you saw and what you felt shift. Ask the client to slowly open her eyes.
According to the World Health Organization, 50 to 75 percent of adults aged 18 to 65 have experienced a headache in the last year, and among those people, more than 30 percent have experienced migraine. And according to the Migraine Research Foundation, migraine is the sixth most disabling illness in the world.
Your skilled touch can help many people find relief from this particular type of pain—and by promoting yourself as a headache-and-migraine-relief expert, after obtaining appropriate training and gaining necessary experience, you could develop a healthy niche practice at the same time.
About the Author
Jan Mundo, C.M.T., C.M.S.C., is certified as a Master Somatic Coach, Body-Centered Therapist and massage therapist. She is also a Registered Somatic Movement Educator. Specializing in headaches, stress and self-transformation, she practices in Manhattan, New York, and via webcam. Her book, The Headache Healer’s Handbook, is forthcoming from New World Library.