Are Tension-Type Headaches Treated by Massage Therapists?

Tension-Type Headaches: what can you expect?

 

According to the International Association of the Study of Pain (IASP), Tension type headaches (TTH) are:

“headache attacks with mild to moderate pain intensity and is often described as having a pressing or tightening (non-pulsating) quality that is not aggravated by routine physical activity, such as walking or climbing stairs. The pain lasts for at least several hours to days and is predominantly felt bilaterally.”

 TTH originates from a combination of tissue sensitivities in the head and neck as well as how the nervous system interprets the signals from those tissues.  Development from episodic to chronic TTH is thought to be accompanied by increasing Central Nervous System sensitivity to the tissue signals like a car alarm that is triggered by a loud truck. Diagnosis of TTH is based on a “featureless” headache and normally results in a neurological examination. Most commonly found are tender spots around the head and neck. Additional diagnostic workup by your doctor is important if you have additional symptoms other than headache.  Chronic TTH is often associated with medication overuse.

Tension-type headache is the most common form of headache. It can be categorized into three subtypes according to the International Classification of Headache Disorders based on headache frequency:

(1) infrequent episodic TTH (<12 headache days/year), (2) frequent episodic TTH (12-180 days/year), and (3) chronic TTH (>180 days/year)

(2) frequent episodic TTH (12-180 days/year)

(3) chronic TTH (>180 days/year).

 Stress seems to play a big role in Tension Headaches. Managing that stress can be beneficial in reducing frequency and duration of these headaches.

According to the International Association of the Study ofPain:

 The lifetime prevalence of episodic TTH is almost 80%, and that of chronic TTH is 3%. Women are slightly more affected than men. The age of onset peaks between 35 and 40 years, and prevalence declines with age in both sexes

o   Headaches are the most prevalent neurological disorders and among the most frequent symptoms seen in general practice.

o   50% of the general population have headaches during any given year, and more than 90% report a lifetime history of headache.

o   The average lifetime prevalence of migraine is 18%, and the estimated average prevalence in the past year is 13%.

o    The prevalence of migraine in children and adolescents is 7.7%.

o   Tension-type headache is more common than migraine, with a lifetime prevalence of about 52%. However, only frequent or chronic tension-type headaches are disabling.

o   3% of the general population have chronic headache, i.e., a headache ≥15 days per month. They are the most severely disabled.

Clinically, this is the most easily and effective type of headache for an RMT to treat. In our experience, after an initial assessment and treatment, future treatments usually should be around 30 minutes 1-3x a week with a follow up in 1-2 weeks depending on severity and chronicity. After your first visit the normal course is of at least a 50-80% resolution of head pain around 30 minutes after the massage treatment. This relief should last from 3 days to 2 weeks and will increase with future treatment.

Make sure to ask for some home care such as exercises and or movements which will depend on the tissues and structures that are sensitized then work together with your Massage Therapist to create a plan of action that is effective and obtainable.

Simple Changes Can Help Shoulder Pain

By Marcy Wright Reoch, BSc, RMT

Since the beginning of 2014, I have seen more shoulder-related patients than I can count. Some patients present with pain between their shoulder blades, and others with pain over the Deltoid muscle (the side or front aspect of the shoulder). Sometimes, the pain can travel down the arm. Whatever the aggravating case, the shoulder complex always seems to be in a compromised position.
The shoulder joint is made up of four joints that together are called the shoulder complex. These joints are the sternum (chest bone) and clavicle (collar bone), clavicle and scapula (shoulder blade), scapula on the ribs, and the humerus (upper arm) in the scapula.  Don’t get bogged down in the anatomy, and remember to try to keep your shoulder comfortable and open. Try keeping your chest open during everyday life, whether sitting at a desk, driving in your car, working out at the gym, or playing with your children. Think of what a confident person’s posture looks like. By practicing to open through our chest, we discourage the rounding through our shoulders and collapsing our chest. We are pulling our scapulae together and down our back by keeping our chest open. We are depressing our clavicles. Hence, they are horizontal when looking in the mirror instead of being diagonal, and we are positioning the head of the humerus (upper arm bone) in its neutral resting point in our armpit.
When we practice poor postural habits, the alignment of our shoulder girdle is inefficient and unsupported and allows risk for injury. Muscles might be working too hard, and pain, inflammation, weakness, headache, and other symptoms may arise. By practicing good postural habits through our shoulders, chest and upper back, we allow the soft tissue to rest comfortably when we are at rest. Then, when we choose to move, the musculature is in its most efficient, supported, and most vital position through the range of motion.
Standing up tall and engaging through your abdomen is a great way to set your shoulders into a good position. Now, squeeze the muscles between your scapula (shoulder blades), pulling your scapula closer together and then pulling them down your back. Once you have done this, acknowledge where your head is. Most people's heads will be too far forward and must be pulled back into proper alignment. So, think of a string pulling the top of your head upwards. This will elongate your neck and retract your chin from jutting forward.
It is important once you have an understanding of good shoulder positioning, to check in with yourself throughout the day. If you sit at a desk, you can put a red sticky dot on the monitor that will remind you to re-evaluate your posture every time you look at the dot. If you are driving in your car, place the seat upright. The biofeedback from the seat on your shoulder blades and the back of your head will help you recognize poor posture and allow you to correct it. When at the gym, it is important to always align your shoulders before entering a new set of your workout. This will help prevent injury by supporting the joint and allowing the muscles to work as efficiently in order to gain strength and endurance as quickly as possible.

Click here for : Body Awareness - Shoulder Positioning Video

How does stress make pain worse?

Do you ever have neck or back pain after a stressful day? Maybe a headache?
Why do you get tight muscles when something stresses you out?

Nerve receptors are involved in pain generation. Their job is to send a signal to the brain that they have been stimulated. The brain knows that a signal from these receptors in the body is usually a sign of danger and will usually then decide that the body is in pain, specifically in that area. In his talks, David Butler often mentions adrenaline-sensitive peripheral nerves and the amazing ion channel turnover. Specifically, this means that these nerve receptors can become extra sensitive to the chemical adrenaline, also called epinephrine. With this sensitivity, less stimulation is needed to send a danger signal to the brain. Think of a car alarm set to go off when someone breaks the window. When the alarm is hypersensitive, it may go off if a loud truck drives by. No damage happened to the car, but the alarm still went off. When we are stressed out, our bodies produce more adrenaline. This can be a good thing because it helps us to prepare for action. Unfortunately, if a nerve is damaged, stretched, or pressed on for too long, it will create "baskets" of adrenaline-sensitive fibres. As David says here:
"If a person has a highly adrenoreactive area of peripheral nerve and if they are in a state of persistent elevated stress then repeated firing into the CNS will occur. And if the person is stressed, central inhibitory controls will probably be lifted anyway, and a persistent neuropathic pain state may ensue."

What this means is that if someone has a nerve that is sensitive to adrenaline and is always stressed out, the danger signal to the brain will be almost constant. If that is the case, the Drug Cabinet in the brain will be lifted away, and persistent pain will likely develop. Not fun.

Fortunately, you have some control over this. The first line of defence is to reduce your stress level, thus reducing your adrenaline. Also, knowing that your pain is not from a damaged muscle but stress chemicals, your brain will be less likely to think of the signal as pain. Third, if you get out and move your body in a way that reduces any specific nerve perturbations you will have less chance of a future sensitivity. Most good Manual Therapists (RMT, Chiro, PT, etc) will know how to help you do this.

Most forms of massage therapy have good evidence behind their ability to reduce stress. Two of the modalities Michael implements, DNM and Simple Contact, work on a model that directly addresses pain and adrenal-sensitive nerves.
If you have any questions about this, feel free to contact us at well+able. We would love to help you out. It would also be beneficial to watch the previous stress video, the Drug Cabinet video, and the What is Pain video.