Headache is one of the most common complaints that clients present to their massage therapists.

According to the National Headache Foundation, in the United States, an estimated 45 million people have chronic headaches, and more than 29 million suffer from debilitating migraines.

Hands-on therapies can be highly effective for headache relief and prevention. For practitioners, headaches provide a rich ground for learning about the mind-body connection to chronic pain, and how people can embody change. When you help people recover from chronic headaches, you have the opportunity to positively affect the quality and course of their lives.

Relieving and Preventing Headache

Healing headaches is my passion. In 1970 I created a hands-on method of headache relief. In 1992, when I became a certified massage therapist, I translated this method into step-by-step instructions for my clients. I then designed a mind-body, self-care program for headache management. I’ve since taught this technique, the Mundo Method, in my private practice, at medical centers, universities and corporations.

Like the founder of Hair Club for Men, I’m also a member. I know what it feels like to have a blazing migraine, and I will suffer if I don’t practice what I preach.

I relieve headaches and migraines by feeling sensations on the head that correlate to or hold pain, manipulating them to move in the same direction with subtle touch and focused concentration, then recycling them out of the head. I teach clients how to prevent headaches within a somatically oriented framework.

Somatics and Headache

Somatics, derived from the Greek word soma, means living body, and honors the whole person: body, mind, emotions and spirit. In headache coaching and bodywork, we consider a person’s current lifestyle and past experience. Everything counts. What’s too much, not enough, or just right for each client, in each situation, with each headache episode? That’s what I call a challenge.

As body-centered practitioners we do not diagnose, but 99.9 percent of my clients have been diagnosed by their physician and will tell you this, or write it on their intake form.

In this article I will introduce the main types of headaches and some of their characteristics, and will describe and demonstrate some solutions for headache prevention and relief that you can try with your clients. If you know the type of headache your client has, you can be more effective, because each type requires different treatment.

Headaches, Inside and Out

The four primary headache types are tension-type, migraine, coexisting migraine and tension-type headache, and cluster. Primary means the headache is not caused by something else, such as injury, surgery or disease. Each primary headache type has unique and characteristic sensations, which usually correspond to the client’s pain and can be felt by the practitioner.

1. Tension-type (tension) headaches result from bodily-held tension, and may be episodic or chronic. People complain of a dull, aching head pain, like a tight band, and tension in the upper back, shoulders, neck, head or face. When palpated, these areas feel very rigid and stuck, like nothing is moving.

2. Migraines are vascular headaches (related to blood-vessel dilation or swelling), and can be severely debilitating and disorienting. They are often accompanied by a host of other symptoms, such as nausea and vomiting; visual, sound and smell disturbances; and mood, sleep, appetite and digestive changes. (If you’ve never had a migraine, then try to remember your worst hangover and you’ll have an idea of what it feels like.)

Migraine sufferers seek comfort by lying down in a quiet, darkened room, avoiding even the slightest movement or disturbance that could exacerbate the pounding in their heads. The characteristic internal pulsing and pounding of a migraine can actually be felt when you palpate the head; it feels like mini-explosions under your hands, occurring at the temples, forehead, eyes or on the sides of the head.

These headaches are far more common among women than they are among men.

3. Coexisting migraine and tension-type headaches (formerly called mixed headaches) are a combination of tension and migraine symptoms, and account for most of the headaches I see in my practice.

In addition to migraine symptoms, clients with this dual headache complain of a unilateral tight, stuck or stabbing feeling at the back of the neck, shoulders or the base of the skull. During palpation these areas and the front of the head feel hard and immobile, and seem to be holding down, or containing, the pulsations of the migraine.

4. Cluster headaches are so named because episodes occur daily for several weeks, and then disappear for six months to a year.

They are characterized by a stabbing sensation in one eye, which becomes bloodshot and sheds tears, and same-side stuffy or runny nose.

Instead of needing to lie down and be still, people with cluster headaches become agitated and pace the floor. Cluster headaches affect mostly males, usually smokers.

Other headaches: While there are numerous other kinds of headaches identified, they usually either fall into one of the primary categories or are secondary headaches, attributable to another cause, and need to be diagnosed by a physician. Examples include sinus, hormonal, rebound and dangerous headaches.

Dangerous headache can be described as the worst ever and unlike any other kind of headache. It can have a sudden onset and be accompanied by other aches and pains, fever, chills, dizziness, nausea or other symptoms. If a client presents with these symptoms, advise him to immediately contact his primary health care provider.

Healing Begins at Home

Unfortunately, in this busy world people often become aware of their bodies only when they have aches and pains. But when they finally bring their attention to the body, they want to escape because it’s painful. My approach is, “You must be present to win.”

I teach my clients how to be more aware of their thoughts, posture, mood, breath, state of tension or relaxation, and the combined effect of these on their headaches.

For example, during an episode, migraine sufferers are extremely sensitive. To help these clients, I must embody the change that I want to produce. If I’m rushed, tense or defensive, the client feels that through my touch, my words, my voice and my energy.

My work begins from the inside out, with my own centering practices in meditation, breathing, awareness, somatic-movement exercises and qigong. In order to coach a client to wellness, you must be it to see it. In this way, you can touch people long before ever laying hands on them physically.

The Journey from Pain to Empowerment

Whether a session is centered on headache relief or self-care training, I guide clients in the direction of empowerment and hope. This begins during our first phone interview, as I listen deeply to language, tone of voice and mood, and ask questions in a way that fosters thinking to help connect the dots between lifestyle, history and headaches.

As a practitioner, when you work with headaches, you’re not only handling physical pain; you are dealing with the person who has it, her ways of coping with her life and health, and how she feels about all of it.

In session, I look for clues in how a client sits, stands, walks, drives and uses her body at home and work.

For example, is her posture collapsed, making it hard to take a full breath? Are her shoulders tight and lifted toward her ears? Does her upper torso lean backward, making her head come forward to form a c-curve? Does she sit up so straight that her head and neck appear stretched up and away from her body?

All these factors can contribute to tension headaches and coexisting migraine and tension headaches, and thus provide clues for unwinding them.

I work with clients in a straight-backed chair, and the first thing I do is help them sit in a way that supports their bodies in gravity. Working with postural subtleties extends my effectiveness, because simply aligning head, shoulders, hips and feet vertically changes the dynamic of the upper body and its state of tension and relaxation. This makes everyone’s job easier, and effects change while educating the client.

Clients often report feeling like they’re leaning forward or backward when sitting upright, because they’re not used to it, nor are they accustomed to using their backs, necks and abdominal muscles in an aligned position.

Quiet Mind, Quiet Hands

While working with alignment, I guide the client through belly breathing, using gentle reminders to keep letting go of all thoughts. By quieting my mind and applying gentle touch, I build trust with the client; this is especially important when working with migraine sufferers.

I use the skin as a latching-on point to palpate tissue, fascia, muscle and bone quality, rather than working with anatomical form and function. Even when holding a point, practitioners need to be aware that any extra pulsation or movement can amplify migraine pain.

Tension headaches are the most responsive to massage, because they often release with softening of the shoulders and neck before you even get to the head. The goal is to loosen the tissue and get it moving, but I like to soften, instead of forcing, the tissue.

We’ve each had clients who ask us to “get in there as deep as you can.” I “get in” really deep, but the client can’t tell, because I ease my way in. I start with shoulder squeezes and holds along the shoulder ridge, feeling the area soften and warm. I work slowly, moving forward only as tissue lets me in, which is different for each person on any particular day, and for each point or area of the body. Then I increase pressure to find the floor of the next layer of tissue, using holds and pressure, instead of movement-oriented strokes. When I reach the bottom depth of resistance, and the area or point feels pliable and alive, that point is released — and so is the pain!

Helping a Client with Migraine

If a client comes to a session in the midst of a migraine, that person isn’t feeling well at all, and it’s usually a big effort to make it into my office.

When treating a migraine, the object is to still the headache rather than get it moving. It’s already pulsing and pounding, and you want to stop it using barely any movement. My voice is soft yet confident and compassionate; my studio is dimly lit and scent-free. I have to administer headache first aid, so I keep instruction to a minimum and save headache prevention training for another day.

The postural alignment and breathing lessons are delivered in a kind of shorthand, using touch and few words to help the client drop into relaxation effortlessly.

Depending on the situation, I ask the client to describe the pain or locate it myself. Using very light touch with firm contact, I “listen” for pulsating mini-explosions that feel stronger than a pulse, and quell them one point at a time. When all pulsing points are stopped, the migraine lifts and equilibrium is restored.

Hope for Headache Sufferers

Headache healing takes place over time, with baby steps and giant leaps, sometimes two steps up, one step back. Using body-centered coaching, somatic bodywork, exercises, handouts and other support tools, clients are able to build an active lifestyle that supports their heath and sustains them in a life minus headaches.

The first step often begins with a practitioner’s skilled hands and the ability to relieve a client’s headache on the spot.

About the Author

Jan Mundo, CMT, CMSC, 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, was published by New World Library in 2018.