Massage Therapy

Headaches - Migraines vs Tension

by Michael Gerrior, BA, RMT

Chances are, many of us have at one point in our lives, had experience with headaches. Either we have had them ourselves or we have known someone who has had them. For most people, headaches come and go without any major concerns, but for others they can be debilitating or impede on normal functioning. Most cases fall somewhere in between. Many people are afflicted with headache pains, minimal to severe, caused by several factors and/or triggers. The most commonly known types of headaches include migraines and tension headaches, both of which can be treated with massage therapy. For information on the 13 categories of headaches acknowledged by the International Headache Society, please see Silberstein et al, 1998.

The term "migraine" is sometimes overused to refer to when any painful headache starts, but migraine headaches are not as common as they appear to be. Migraines are often misunderstood, especially in the absence of diagnosis by a physician. When there is no pathology detected and the patient has come to a manual therapist for assistance, it is the responsibility of that therapist to treat the headache as the condition rather than the symptom: because at that point, that is what they want to make disappear.

As a Registered Massage Therapist, I encounter many patients who have checked off "Migraines" on their health history forms. However, only about 25% of people suffer from the true neurological disorder known as the migraine headache. Migraines are characterized by a 72-hour period in which a specific identifiable trigger [see list] causes a response in nerves and blood vessels, which in turn causes an initial painful headache; most often unilaterally (i.e., one-sided). Then, the autonomic nervous system reacts as well. The autonomic nervous system is a system of reflexes that link your brain to your organs, glands, and the muscles that surround these structures. This part of the nervous system can function normally without you taking notice, such as when you are breathing normally. When the autonomic system kicks in during a migraine attack, symptoms such as nausea, vomiting, sweating & photophobia (i.e., sensitivity to light) start to occur. These will last up to 72 hours after the headache has stopped. The migraine sufferer will most likely require a dark room without sound so they can rest until the symptoms and pain have decreased enough to function again. After that time, the sufferer will likely be exhausted and may enter into a depression as well. In some cases, the 72-hours will abruptly end with a bout of vomiting or an extreme emotional release (such as crying or anger). Sometimes, a migraine sufferer will be pre-warned with what is known as an aura, which is a visual disturbance (e.g., seeing falling stars, seeing one bright star; or when reading, having letters or words seem to disappear when going across a page). Although migraines can also be without aura, visual disturbances are still common. This is how the migraine sufferer will know that a headache is eminent. With a migraine attack, there are definite beginning and endpoints. There are many assumed causes for migraines, including food sensitivities and stress, which could be addressed by a physician (including a naturopathic doctor). For a list of common triggers, see below.

Other types of headaches can also be seen, especially in those who are taking medications on a regular basis. These medication-induced headaches occur most often in the early morning when blood levels of the drug are lower. Once the drug is ingested and introduced to the circulatory system again, relief occurs for the patient. These headaches are characterized by a daily and constant dull headache on both sides of the head. Also, the intensity of pain can fluctuate from periods of high to low. Contrary to migraine symptoms, nausea and photophobia are not common. Sometimes memory impairment and medication-specific symptoms are also seen. Birth control is an example of a medication that commonly causes headaches. Hydration is always considered with headaches of these sort. Drinking adequate amounts of water on a daily basis helps to avoid dehydration and, consequently, reduce headache pain. All of these health concerns can be addressed by a general physician, including a naturopathic doctor.

The other most common type of headache pain, the tension headache, can be easily confused with having a migraine. Often times, because of the severity and disruption to one’s life, many patients mislabel their tension headaches as "migraines". Tension headaches involve muscle contraction and due to their variability, they can manifest in very different ways. A tension headache is usually described as a vise-like pain. Although with varying degrees of intensity, the pain is most often felt on both sides of the head. It may have several degrees of severity and it will elicit different autonomic responses depending on the structures involved.

There are several back, neck, and shoulder muscles that will create tension headache pain. It is even possible for jaw, scalp, and facial muscles to create headache pain. This type of pain is due to a phenomenon called trigger points. When we feel "knots" or "balls of tension" in our muscles, these are trigger points. The knots we feel are a development of contracted muscle fibers concentrated in certain areas of muscle tissue. Essentially, when a muscle fiber has been used repetitively over a long period of time (e.g., carrying a backpack full of textbooks or a handbag on the same shoulder for all those years of university) or sometimes even if used repetitively over a short period (e.g., that work out you had the other day that made your arms sore, but a "good" sore), the muscle fibers get "angry" and develop bundles within the fibers. At this point, the trigger point develops a predictable pain pattern associated with where it is. This is called referral pain. This pain occurs when a trigger point is pressed or manipulated and will create a pain sensation near or along the muscle fiber. For example, the muscles of the side of the neck can refer pain up to the temples and jaw. It is not a normal state for a muscle to contain trigger points, therefore, with treatment to the specific structures affected (e.g., trigger point release, massage therapy, myofascial release, craniosacral therapy, etc.), it is possible to minimize and/or eliminate trigger points. Nevertheless, it is inevitable for soft tissue in the human body to develop trigger points; we stand, we sit, we develop postural imbalances from moving certain ways. With the increased reliance on computers, we see various types of postural changes for those of us who use them on a regular basis. Head forward posture, an increased or exaggerated curve of the upper back and neck can contribute to headaches. If you think of the body as webbing or a mesh, one affected area creates a domino effect and pulls on other structures, warping and twisting along the way. Therefore, what affects the hips for example, in turn will eventually affect the neck or travel downward to affect the feet.

It is very beneficial for sufferers of tension headaches to have their soft tissue treated for relief. As a massage therapist, I see many patients come in with various headache issues. Usually if a patient experiences headaches, he or she can point to where they feel the pain. From there, we can pinpoint where we need to go with the treatment and hopefully decrease referral pain and headache. By releasing trigger points, adhesions, and the tension in the neck and shoulders, we are decreasing the pain of the headache. In addition to massage therapy, other beneficial forms of treatment for headache pain include: chiropractic, acupuncture, stretching techniques (e.g., including yoga), hydrotherapy, and lifestyle changes (including diet, regular exercise) and, generally, naturopathic medicine.

Headache pain is manageable. However, like many things, it requires some patience and the correct information. With a better understanding of migraines versus tension headache symptoms and the various treatment options available for each, patients should be able to more accurately describe their pain and seek the appropriate relief.

Examples of Common Triggers for Migraine Headaches:

- stress [emotional and/or physical]
- food additives [MSG, aspartame, etc.]
- foods [chocolate, red wine, cheese, citrus, etc.]
- hunger
- medications [oral contraceptives, etc.]
- weather changes [barometric pressure change]
- visual stimuli [bright lights, reflected sunlight, computer screens]
- auditory stimuli
- olfactory stimuli [perfume, cologne, lotions]
- sleeping patterns [too long, too little]
- hormonal shifts [ovulation, pregnancy, menstruation, breast-feeding]
- allergies [foods]
aggravating factors include: movement, trigger points [referring pain to neck and head] and postural dysfunction.
** The number of triggers can increase with age. Sensitivity to a trigger may take years to develop.

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