chronic headaches

To complement the Research Reports in the July 2015 issue of MASSAGE Magazine. Summary: In a recent study, subjects suffering from chronic headaches who received Thai traditional massage over a period of three weeks showed both decreased headache intensity and an increase in pressure pain threshold, versus a control group whose pressure pain threshold remained unaffected.

Among patients with chronic headaches, the application of Thai traditional massage (TTM) resulted in a significant increase in pressure pain threshold (PPT) and a significant decrease in headache intensity, according to recent research.

The study, “Effects of Thai traditional massage on pressure pain threshold and headache intensity in patients with chronic tension-type and migraine headaches,” involved 72 people, ranging in age from 20 to 50, all of whom had been diagnosed with chronic tension-type or migraine headaches. In order to be included in the study, subjects had to have a headache diagnosis for at least three months prior to the study; headaches present for 15 days per month at a rate of at least two headaches per week; and a headache intensity score of at least four on a visual analog scale.


Massage for headaches

Study participants were randomly assigned to either the TTM group or a sham ultrasound control group. Subjects in the control group received nine 30-minute sessions of sham ultrasound throughout the three-week intervention period. These sham sessions employed a detuned ultrasound device with circular kneading to the upper neck or upper back while the participants were in supine and side-lying positions.

Subjects in the TTM group received nine 30-minute sessions of Thai massage throughout the three-week intervention period. The routine consisted of 25 minutes of massage and five minutes of stretching. The massage focused on the temporalis, suboccipitals, posterior neck extensor group, upper trapezius and levator scapulae, with subjects in supine and side-lying positions.

“The line of massage was that followed by Sen sib, that is, the meridian line according to the TTM theory, along the lines of In-ta, Ping ka-la and Gan-la-ta-ree,” stated the study’s authors. “For the thumb pressing used in TTM, the massage therapist applied gentle and gradually increasing pressure along the meridian lines.”

Thumb pressure was applied until the subject began to feel some discomfort—the subpain threshold—and then that pressure was held for five to 10 seconds on each of the TTM massage points. This routine was repeated three to five times for each meridian line, and the sessions closed with passive stretching.


Some positive results

The main outcome measure for this study was the PPT of each participant. PPT was defined as the minimal amount of pressure required from the initial sense of pressure to the first sense of pain when pressure was applied to each subject’s most painful trigger points in the posterior neck and upper back muscles.

The secondary outcome measures for this study were the intensity, frequency and duration of headaches; suboccipital and neck range of motion; and scores on the Headache Disability Index. Each outcome measure was assessed before and after the three-week intervention period, and again three and nine weeks later.

Results of the research revealed a significant increase in PPT among subjects in the TTM group immediately after the intervention, as well as three and nine weeks later, compared to the sham ultrasound group, which showed no change in PPT. For both groups, there was a significant decrease in headache intensity at each post-intervention assessment.

“In conclusion, these results indicate that TTM can improve both PPT and headache intensity during both the short-term of treatment and during the relatively long-term of post-treatment,” stated the authors. “TTM could be promoted as an alternative treatment for patients with [chronic tension-type headaches] and migraines.”


Authors: Uraiwan Chatchawan, Wichai Eungpinichpong, Suparat Sooktho, Somsak Tiamkao and Junichiro Yamauchi.

Sources: Back, Neck and Other Joint Pain Research Group, Khon Kaen University, Khon Kaen, Thailand; Department of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan; and Future Institute for Sport Sciences, Tokyo, Japan. Originally published in June 2014 in the Journal of Alternative and Complementary Medicine, 20(6), 486-492.