Massage and hands-on bodywork like myofascial release help headaches. We demonstrate this instinctively when we rub our temples to relieve our own headaches.
We also know this scientifically, from the numerous studies indicating that receiving regular massage or bodywork can reduce the severity and frequency of many kinds of headaches.
There are many kinds of headaches—from common tension headaches to migraines, sinus headaches, cluster headaches and more. Not only are there numerous varieties of headaches; head pain is often a symptom of other conditions, such as illness, dehydration or allergies.
Drawing on material I have developed, I will share fundamental goals and principles for working with headaches, which can be incorporated into your existing work right away.
Types of Headache
With so many causes and types of headache, how do we know which tools to use and which approach to take? Being able to identify your clients’ headache type will help you be more effective in your work, no matter what your therapeutic modality or approach. This knowledge can also help you avoid worsening a headache, since what works with some types of headaches can make others worse.
Despite the confusing profusion of headache types, a simple distinction can be drawn between primary headaches, where the headache itself is the main symptom; and secondary headaches, that is, headache as a symptom arising from another condition, such as missing a meal, dehydration, sinus issues, an injury or a medical issue. Hands-on work can be helpful in relieving and preventing both types of headache.
Although lasting relief for secondary headaches usually involves improving the underlying condition itself—for example, a dehydration headache will improve only once the body is rehydrated—we can often provide welcome relief from pain, even when it is caused by another condition. For many primary headaches, we can often get right to the roots of the headache pain itself.
Three Types of Primary Headaches
Primary headaches have three general types: Tension and strain-based headaches; migraines and related headaches; and comingled headaches, which have a combination of both tension and migraine-type elements.
Tension headaches tend to affect both sides of the head; as opposed to migraines, which are usually unilateral. Tension headaches don’t usually change in response to increased physical activity, while many types of migraines are worsened by activity—with cluster headaches, related to migraines, being a notable exception, as they sometimes improve with exercise.
Most importantly, migraines are almost always accompanied by some kind of sensory phenomena, such as extreme sound sensitivity, nausea, or visual disturbances such as blind spots, aura or double vision, to an extent not seen in tension headaches.
Although not necessarily the most severe kind of headache, tension headaches, or musculoskeletal headaches, are by far the most common, affecting about 80 percent of all people at some point in their lives. While many massage therapists probably think of tight muscles when they hear the word tension, the fascial wrappings that surround the muscles—as well as the bones, nerves, and all other structures of the head and neck—are about 10 times more sensitive to pain than muscle tissue itself.
These outer layers of the head can be responsible for a great deal of headache pain. The superficial fascial layers (Figure 2) in particular are densely innervated with pain-sensing nociceptors and free nerve endings.
These outer layers are directly connected to the superficial fasciae of the neck, check, back, and the rest of the body. The fascia on the top of the head is in a unique position to transmit mechanical stress from the left, right, front, and back of the body, meaning that pain here can reflect issues elsewhere in the body. And of course, eye strain, face, neck or jaw tension, as well as stress or mental exertion can all be reflected as strain in t superficial layers of the head and scalp.
The fascia of the scalp has several layers here. The deepest is the pericranium (called the periosteum elsewhere in the body) and is adhered directly to the cranial bones themselves. Over the pericranium is the galea aponeurotica, which has several sub-layers itself, and which contains the occipitalis and frontalis muscle fibers.
Since the galea layer is connected laterally with the temporalis fascia over the jaw’s large temporalis muscles, this layer is particularly sensitive to strain from jaw tension. The most superficial of the scalp’s many layers is the subcutaneous fibro-adipose layer, which lies between the galea aponeurotica and the skin.
With prolonged strain, fascia becomes harder, thicker and stiffer. In an influential 2013 study, “Ultrasonography in Myofascial Neck Pain: Randomized Clinical Trial for Diagnosis and Follow-Up,” published in Surgical and Radiologic Anatomy; 36, no. 3 (2013): 243–53.), Italian anatomists Antonio and Carla Stecco showed that thicker or harder fascia tends to be more painful, and that this thickness and hardness can be reduced by hands-on myofascial techniques, resulting in less pain.
Working with the suboccipital region at the base of the neck can reduce many tension headaches. It is here that the greater and lesser occipital nerves, which innervate the back of the head, wind their way through the fascial wrappings of the small muscles at the base of the skull.
Nerves follow the fascial planes between muscles, so working the membranes and tissues around and between the muscles becomes even more important than working the muscles themselves. Some migraines can be worsened by work at the base of the neck, however; so understanding which type of headache you are addressing is important. Use caution when working the base of the neck if the signs of migraines, listed above, are also present.
Causes of Migraine
Migraines affect about 16 percent of all people, and about two to three times more women than men, according to the large-scale American Migraine Prevalence and Prevention Study. Our understanding of migraines is undergoing rapid and profound change.
For the last few hundred years, migraine pain was thought to be caused by uncontrolled vasodilation and increased blood flow to the brain. Although brain tissue itself is insensate and does not feel pain, this flooding of the brain with blood was thought to stretch and compress the blood vessels and surrounding meninges, both of which are highly sensitive.
However, with the advent of brain scans which allowed researchers to watch the brain’s blood flow in real time, it was discovered that vasodilation happens only in a minority of migraine sufferers, and only at the beginning of a migraine episode, so is not the primary cause of migraine pain.
Although still not fully understood, migraine pain is now generally thought to be more neurological than vascular. Wave-like storms of pulsating electrical activity called cortical spreading depression spread through the brain, and these are thought to directly stimulate the experience of pain and cause the sensory epiphenomena that accompany migraines, such as visual disturbances, extreme sound or odor sensitivity, and nausea.
The structure of the brain itself may be different in migraine sufferers as well. A 2007 study at Harvard Medical School showed that the brain’s sensory processing area corresponding to the trigeminal nerve, which supplies the head and face, was thicker than normal in people who have migraines.
It isn’t clear whether this is a cause or an effect of migraine pain; however, the authors of the study theorize that the sensory cortex’s differences may help explain why some migraine sufferers also experience back pain, jaw pain, skin sensitivity, and other sensory problems along with their headaches.
Although migraines seem to involve the brain and neurological activity more than fascia or other tissues, myofascial approaches—as well as other kinds of hands-on bodywork—can often help migraine sufferers. At least two formal studies show a reduction in both severity and frequency of migraines in those receiving regular bodywork.
This could be because comingled headaches, also known as mixed headaches or transformed migraines, where both tension and migraine elements are present, are very common, and tension headaches can trigger migraines.
Issues with the mouth’s hard palate, such as crowding or bite issues, have been known to trigger migraines, as many of those who have had orthodontics or braces can attest to. Conversely, migraine pain can often be relieved by direct work with the hard palate.
In some locations, massage therapists are prohibited from working inside the mouth, or they are required to have a specific intraoral certification. In any case, be sure to have proper training and explicit, informed consent before working inside a client’s mouth.
Finally, we can often help migraines by working with the brain itself. The root of the trigeminal nerve, which is implicated in both migraines and cluster headaches, is nested into a recess in the petrous portion of the temporal bone. This is the same bony structure that houses the ear canal, so direct and sensitive traction on the fascia of the ear canal can conceivably reach the trigeminal nerve root at the base of the brain.
Skillfully combining this ear traction with active movements of the eyes can be very effective in reducing migraine pain. This might be because movements of the eyes pull on the strong, fibrous optic nerves. The connective tissue of these thick, strong nerves links the eyes to the brain, and is part of the stabilizing structure of the eyeball itself.
4 Steps to Address Cranial Fascia
Improving the elasticity and differentiation of the cranial fascia is relatively straightforward. One method is to use your fingertips to move the various layers against each other, and against the skull.
1. This is not like scrubbing the surface of the scalp; instead, focus on shearing, sliding and freeing the fascial layers.
2. Use firm, deep transverse pressure to sense, assess and release fascial adhesions, pulls and thickenings. (Imagine loosening a too-tight bathing cap.)
3. Use a confident but sensitive touch.
4. Spend at least several minutes with this technique, addressing the various layers over the whole head. Add active movements of the eyebrows, face and eyes after releasing the outer layers. This last action engages the nervous system, which leads to more effective results.
When to Refer
Hands-on work can often help relieve or prevent headaches. Nevertheless, it is best to keep in mind that severe, recurring, or very sudden and strong headaches are cause for physician referral, as such headaches can be a sign of a potentially serious underlying medical condition.
Learn to distinguish between tension and migraine headaches. My approach to tension headaches is to increase fascial differentiation and elasticity, particularly the superficial fascia, the temporalis fascia and the galea aponeurotica. Migraines, on the other hand, have been observed to respond to work with the hard palate, and with the nerves themselves, via the eyes and ears.
Whatever type of headache your client presents with, she will be grateful for the relief your work provides.
About the Author:
Til Luchau is a faculty member of Advanced-Trainings.com, which offers distance learning and in-person seminars throughout the U.S. and abroad. He is a Certified Advanced Rolfer™ and originator of the Advanced Myofascial Techniques approach.