Migraines and massage therapy; a comprehensive guide.
According to the International Headache Society, 30 million Americans; about 20%; suffer from 1 of or a combination of, the 18 known types of migraines. Most sufferers under the age of 15 are boys, while the vast majority (over 60%) develop in women between the ages of 15-50.
While 70-80% of migraines sufferers report a familial component; its also important to note the ages in which migraines are present. For younger men, the production of vast amounts of testosterone are developing and *could be* the reason they are more affected as teens and young people.
We already know that women's hormones (estrogen and progesterone) and their dance with serotonin levels do result in a migraine known as 'menstrual migraines'. 60% of women report these types of migraines before, during, and after their menses. Doctors are still understanding this dance of hormones and how they result in painful and often debilitating migraines.
But what is a migraine? I already mentioned there were 18 different types of migraines and while they are still being actively studied as they rely mostly on patient feedback, there is a lot we do know about how they happen and why. Also how to prevent them; which is where massage therapy can help. Or not. keep reading.
Any of the 18 types of migraines must follow a certain formula to be considered a migraine. This is at least 5 episodes, lasting between 4 and 72 hours, exhibiting the following 4 phases;
Prodrome; this is the subtle birth of a migraine where the person may feel digestive irregularities, depression/drowsiness, food cravings (specifically junk foods), and jitteriness or hyperactivity. Irritability may also show up. Some sufferers skip this step altogether and go straight into the next phase which is;
Aura; this is the visual, sensory, or dysphasic (speech interruption) phase that can last between 20-30 minutes before the next phase. Often sufferers will experience temporary blindness, blind spots, or wavy lines. Sensory feedback may be tingling or numbness on the limbs or face, they may have trouble answering basic questions or speaking clearly. What is happening is the body is recognizing a neurological disturbance, and alerting you to it.
the Attack phase is when the person is in full migraine, throbbing and pulsating pain that gets worse with exertion or activity. This is the 'put me in a dark room and turn off all sounds' phase. What is happening is that the trigeminal nerve has released chemicals and caused the blood vessels on the brains surface to swell. *its important to note that previous research believed that the blood vessels dilate. Further research has indicated this is not the case* Ill cover why the trigeminal nerve released its chemicals when we talk about triggers, below.
the final stage of a migraine is the Postdrome phase; or the 'headache hangover' phase. This is when the person is over their attack phase and is tired, weak, dizzy, and they probably have issues concentrating.
Usually after years of these sort of migraine episodes, the person will experience evolving kinds of migraines or headaches due to a few different factors. When a person has been in migraine pain for months or even years, this is obviously uncomfortable. Living in pain for that long can be debilitating. If they do not seek out preventative measures, such as stress reduction, massage therapy, mental health support, etc., they may end up relying on the usage of pain killers or anti-inflammatories to prevent or abort the onset of a migraine. While there is no judgment for choosing to cope this way, its very important to understand that using analgesic pain killers more than 10-15 days per month can adversely affect a persons migraines and actually open a window to a new style of headache called;
Medication Overuse Headache syndrome
This style of headache develops over time and after a series of migraines. This is a daily, tension like headache and it often is made worse with caffeine or a high fat/ high sugar diet.
For the sake of what I do and the purpose of this blog, that's where I'll stop and go into what massage and bodywork can, and can't do for migraine sufferers. And why that trigeminal nerve(along with your entire nervous system) may trigger a release of chemicals that result in a migraine.
Change in daily routine
Hormonal changes (for women, a severe drop in estrogen (menopause) and hormone replacement therapies, also; birth control
Specific foods and skipping meals (main contenders are red wine, beer, aspartame, caffeine, salty/processed foods, MSG, chocolate)
Sensory stimuli (bright fluorescent lights, sun glare, strong or unpleasant odors, computer/tv/movie, loud noises)
Stress, both good (new job) and bad stress (can't pay rent)
Underlying depression (situational, lack of vitamin D, disease)
When working with a migraine sufferer the most important thing for a massage therapist to do is be educated on migraines, where they come from, how they can be triggered, and when to stop a session. As the client, it is vital that you openly communicate the medications you take both for acute migraine attacks and any preventative medications you take daily. Its also important that you communicate your triggers with us so that we set up our room (lighting, music, colors, outside sounds) to reduce the onset of an attack. During the session, communication is also very important. If you start to feel tingling, numbness or pain develop, its important you tell us to stop and possibly reschedule the session for a time you are not in the acute phase of a migraine.
Its also really important for your therapist to understand the nervous system and how to manipulate and soothe it so that it can have less reaction to the above triggers. Long term massage therapy is incredibly helpful in regulating the nervous system so that a large reaction can be slower, giving you more time to either prepare or abort an episode altogether.
For clients taking analgesic pain relivers such as over the counter Advil or Tylenol, as well as harder pain meds like Opiates(Vicodin, Oxycodone, Dilaudid, etc.) or corticosteroids (like Dexamethazone); it is imperative that the massage therapist tailor their session to account for the client to not be able to give proper pain feedback as their central nervous system is not accurately relaying pain signals. Too much pressure is contraindicated. Most likely any style of massage at the head, neck and upper shoulders may also be completely off limits. The biggest thing to remember when working with clients that use pain medication daily, is that the release of muscular tension can trigger a migraine attack.
For these clients, its best to see them during a dormant period of their migraines and provide stress relief, supportive massage therapy to give an overall sense of calm, relaxation, and reduce overall perceived pain.
Studies have shown that for clients with regular migraines, on migraine medication, and not using pain medications daily; massage is incredibly effective at relaxing the muscles of the head, neck and scalp, relieving overall inflammation and tension, providing a healthy environment where the client can be heard, understood and therefore strengthen their mental wellness and ability to cope, etc.
Massage as a preventive therapy can greatly influence the long term suffering of migraine patients. When unsure, always get a referral from the patients doctor, ask questions and do your homework.
There is a chance to be migraine free with the proper awareness, prevention, and abortive procedures. You don't have to suffer in dark rooms alone your whole life. Come out and see the light (without the pain, of course!)
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