Theraphy and Patient Charting

Millions of Americans suffer from migraines—painful, long-lasting headaches that can cause nausea and extreme sensitivity to light. Massage has shown some success in treating this condition, but recent research may help make massage even more effective.

A subgroup of migraine sufferers

Among migraine sufferers there is a subgroup for whom pain is associated with neck pain. This subgroup can easily be identified by an excessive pain response when palpating the suboccipital muscles at C1 and C2. (This is the convergence of the greater occipital nerve and the trigeminal nerve called the trigeminocervical complex.)

People in this subgroup will show decreased mobility of C1 and C2 and poorer function of the deep anterior flexors of the neck. The increased tightness of the neck is associated with more severe attacks, higher frequency of headache pain, and continuous headaches.

Recovery goals

To best serve clients with this type of migraine, create a treatment plan that focuses on the following recovery goals:

• Mobilize the upper cervical vertebrae.
• Relax the suboccipital muscles.
• Reduce pain in the upper cervicals.
• Relax and stretch the anterior neck muscles (longus capitis and longus coli).
• Increase cervical flexion.

Treatment techniques

You can help your clients reach their recovery goals by using the following techniques:

• Manual traction at the occiput.
• Gentle resistive extension of the head by looking overhead.
• Mobilizing upper cervicals by maintaining a long neck and traction at the occiput and using eye movements up and down to guide flexion and extension.
• Mobilizing lateral flexion by rocking the head side to side with fingers pushing upper cervicals while keeping neck long.
• Pin and stretch deep anterior flexors by palpating longus captious and coli from the side and behind the thyroid cartilage with one hand and rocking the head forward and backward with the other hand.
• Draining the neck with long, light drainage strokes.

Continuing care at home

Persuading your client to practice self-care in addition to massage treatment can go a long way to preventing migraine. The "bobble head" exercise can be effective: Use eye movements to mobilize the head at C1 and C2 and wobble the head around once loose. (If your client has balance problems this can be done with eyes closed while lying down.)

Come back often for more treatment tips

Return to my blog for more up-to-date information about advances in massage therapy treatments. And make sure you're using the electronic health record that's built for health care—Hands Heal EHR.

Be well,
Diana