Not Just A Headache
By Sharon Livingstone
My client is a tradie in his mid-30s. During the 8 years I’ve been working with him, our focus changes depending on his crossfit and fitness dedication, his stress levels and the amount of time he’s been spending on the tools – tradie talk for physically doing their trade.
I’d only seen him the week before and wouldn’t normally see him any more often than once every 6-8 weeks. He’d had a fair bit of back pain the previous week and I figured that the pain was still there but when I saw his face, I immediately knew it wasn’t his back that bothered him.
Many, many years ago, I worked in a place with a typing pool – we hand wrote letters and they typed them up – and my desk was located beside the typing pool. The head typist was Val, a grey-haired, rotund woman with arthritic knees and an infectious laugh. More than once, Val would walk past my desk, stop, narrow her eyes at me and ask, “Migraine?”. Then she’d pop off the enormous rings adorning many of her fingers and pummel her fists into my shoulders for a few minutes. Afterwards, I’d catch her watching me and if she wasn’t satisfied, she’d walk out and tell me to go home. It was always a mystery to me how she knew my brain was trying to escape my skull through my right eyeball.
I guess the ghost of Val is haunting me because I now have the gift of being able to see migraines on people’s faces, and so it was with my tradie client.
He wasn’t interested in pre-treatment discussion. He explained his migraine thus:
“My head is exploding. It’s been building all day.”
He kicked off his steel capped boots and closed the treatment room door in my face.
Neither of us spoke until 10 minutes to go, when he reminded me of the first time he came for massage. He’d experienced a thunderclap headache (investigated, no known cause) that was unlike the migraines he’d had since a teen.
His face had transformed after his session and he paused at the front door, turned back and said, “Thank you for tonight.”
But what had I done? If I’d left him in the treatment room for an hour with the lights dimmed, would his migraine have eased? If I’d spent the hour prattling on about how great massage is while I provided massage treatment, would his migraine have eased?
Does massage have a direct impact on the migraine symptoms or are we only helping with the side effects of the migraine?
Not Just a Headache
Migraine and Headache Australia provides a basic overview of the types of headaches. Migraine is but one type of headache.
An estimated 4.9 million Australians (71% women) suffer from migraines at an economic cost of $35.7 billion.1
What is a Migraine?
Migraine and Headache Australia describes migraine as “a neurological disorder that can be very distressing and disabling. Typically it is a one-sided throbbing or pulsating headache that is at least moderately intense and can be aggravated by physical activity. It is very often associated with nausea and vomiting, as well as increased sensitivity to light, sound and even some types of smell.”
The Migraine Trust adds that “symptoms will vary from person to person and individuals may have different symptoms during different attacks. … attacks may differ in length and frequency. Migraine attacks usually last from 4 to 72 hours and most people are free from symptoms between attacks.”
My migraines usually started with vision disturbance – squiggly lines in my vision or blank spots like looking at someone’s face but not being able to see their nose or their left ear, making it impossible to look at a computer screen – and came with nausea, intense throbbing pain, lethargy, cognitive impairment and difficulty speaking. I still have issues with bright lights and noise.
Read more about the classifications of migraines (and other headaches) here.
What Causes Migraines?
The cause of migraines is not yet known and there is no cure. There is a strong genetic link for many people with migraines. My mother got migraines and so did her mother – although she called it a “bilious head”. While my sister got migraines throughout her teens, they stopped in her early 20s. My migraines started at 17 and persisted until my mid-30s. None of our other siblings have ever had migraines.
Migraineurs (people who get migraines) will generally know the trigger for their migraines, either via the use of a headache diary or because it’s bleeding obvious – eat chocolate, get migraine soon after. In my case, it was instant coffee, which I discovered using a diary but ironically, I was doing an assignment as part of my massage training and not investigating the cause(s) of my migraines. Honestly, my massage career has had multiple benefits.
Treatment for Migraines
The Migraine Trust lists current treatments for migraine here. Spoiler: Massage is not listed.
Migraine Australia lists treatment for symptoms, and management of migraine here. Spoiler: Massage is not listed.
Migraine and Headache Australia lists treatment for managing migraines here, even going into a full list of alternative and natural therapies as potential treatments for migraine but doesn’t mention massage either.
You may now be asking, if these peak bodies aren’t listing massage to manage symptoms, does massage actually help ease the symptoms of migraine?
Does Massage Help?
A systematic review published in 2011 (here) found 2 studies – one in the US, the other in NZ – that supported massage as having benefit for migraineurs. The US study found that “Massage therapy had a statistically significant effect on pain intensity as compared with controls” and the NZ study found “The migraine frequency was significantly reduced in the massage group as compared with the control group, while the intensity of attacks was unchanged. … while sleep quality was significantly improved in the massage group (p < 0.01), but not in the control group”. While encouraging, both studies had limitations.
In a randomised control trial published in 2006 (here), state anxiety, heart rates, and salivary cortisol, as well as perceived stress and coping efficacy were assessed. The results are listed as: “Compared to control participants, massage participants exhibited greater improvements in migraine frequency and sleep quality during the intervention weeks and the 3 follow-up weeks. Trends for beneficial effects of massage therapy on perceived stress and coping efficacy were observed. During sessions, massage induced decreases in state anxiety, heart rate, and cortisol.”
Related article: Does Massage Reduce Cortisol
Massage does not appear to prevent migraines but may have some efficacy for reducing symptoms and frequency of migraines. The increase in sleep quality post-massage may also be important.
The benefit of massage to migraineurs appears to be an improvement in quality of life.
My migraineur tradie reports that his migraines are often triggered by increased stress. According to the American Migraine Foundation, stress is a trigger for 70% of migraineurs.2 Perhaps I helped ease some of the stress symptoms he had, such as muscle tension. I also can’t discount the impact of a dimly lit room and a quiet environment as beneficial to his migraine severity.
Massage therapy is not a panacea, no matter how much we massage therapists would like it to be. However, we can find our place in a bigger picture. Massage doesn’t take away a migraine but how can massage be used when our client presents with an active migraine? How can massage be helpful to migraineurs between migraines? What questions should we be asking migraineurs to determine how massage might improve their quality of life?
Fortunately for my tradie client, he recognises the benefit of massage in managing his stress and reducing the severity of his migraines. He returned the following week for more treatment to help decrease the physical symptoms of his stress. Neither of us want me to see the pain of a migraine across his face for a very long time.
Vale Val Black (1937-2019), you marvellous human and unpaid massage therapist.
About the Author
Sharon Livingstone is a massage therapist based in Sydney. Sharon gave up coffee for 10 years after discovering it triggered her migraines. She saw the light eventually and is now a devoted coffee drinker but never touches that instant crap.