Headaches and how Massage can help
This article discusses what is happening in some common headache types and how massage can help. Primary headaches are a condition themselves, while secondary are a result of something else; but mixed types are possible. Headaches are classified into seven groups, including; viral illness, neurovascular (migraine and cluster headache); cervical (referred from the neck/head), tension/muscle contraction headache; intracranial (tumour, haemorrhage, hematoma, meningitis), exercise-related or other (drugs, post-traumatic). If you are having a new or unaccustomed headache, with a fever, extreme neck stiffness, weight loss, a sudden severe headache, are being woken at night or early morning by the headache, patterns have changed or a headache continues to increase over a few days medical assessment is wise to rule out pathologic causes.
With secondary headaches excluded, we are left with neurovascular, tension and cervical causes, which we can help or minimise. In a cervical headache; a disorder of the neck is recognised as pain in the head, triggered by trauma, joint dysfunction, sustained postures or repetitive motions. The nerves receiving information from upper cervical joints 1-3 meet with those from the occiput (base of skull/back of the head) and trigeminal (supplying the face) at the same spinal cord neurons meaning these anatomical structures can refer into the head. So if receptors in joint, muscle, or nerves start to give feedback via these pathways that the brain perceives as threatening the pain may be expressed in the forehead, eye, temple, ear or neck, building by the end of the day with sustained input. The exact mechanisms of a tension-type headache are not known but these same pain pathways most likely play a role, and in chronic cases the brain can become more sensitive over time, taking less to trigger a pain response. Increased tenderness in the muscles of the neck, jaw, head and face, especially the base of the skull is consistently found in tension headache. In contrast, migraine is a neuronal disorder where the cerebral cortex (the cell bodies at the outer layer of the brain) is most important and blood/brain metabolic coupling drives blood vessel changes. This may involve an “overreaction” to sensory stimuli, excess accumulation of noxious substances, triggering a cascade of events that activate trigeminal nerve endings and pain processing areas. A slowly spreading wave of excitability starts at the base of the brain moving forwards, with a reduction in blood flow, then inhibition. The headache phase begins with the release of plasma proteins by the trigeminal nerve, dilating cerebral blood vessels and activating pain receptors, inciting a neurogenic inflammatory cascade. Medications for acute management of migraine have improved although drugs and new treatments are constantly evolving. Medications used preventatively include antidepressants, beta blockers, anti-inflammatory and anti-convulsants. Frequent use of some medications may contribute to increasing headache or resistance to medication, and complex migraine types need expert direction according to symptoms and severity. In tension and cervical headache, manual therapy is particularly useful to reduce the irritation of structures that feed into these areas, quieting the inputs and activating descending pain inhibitory pathways. Reducing trigger point activity, muscle tension and joint dysfunction can be specifically indicated for cervical headache and directly impact pain. In migraineurs, facilitating relaxation, along with reducing painful inputs can lower stimuli that trigger an attack. Aerobic exercise also has a great benefit for migraine, along with knowing and controlling triggers such as lack of sleep, fasting, stress, certain foods, caffeine and alcohol.