Massage Therapy and Frequency of Chronic Tension Headaches
The effect of massage therapy on chronic non-migraine headache was investigated.
Chronic tension headache sufferers received structured massage therapy treatment directed toward neck and shoulder muscles. Headache frequency, duration, and intensity were recorded and compared with baseline measures.
Compared with baseline values, headache frequency was significantly reduced within the first week of the massage protocol. The reduction of headache frequency continued for the remainder of the study (P = .009). The duration of headaches tended to decrease during the massage treatment period (P = .058). Headache intensity was unaffected by massage (P = .19).
The muscle-specific massage therapy technique used in this study has the potential to be a functional, nonpharmacological intervention for reducing the incidence of chronic tension headache.
Research in massage therapy has found promising results for reducing pain associated with chronic conditions including migraine headache (1), lower back pain (2,3,) fibromyalgia (4), and juvenile rheumatoid arthritis (5). The benefits of massage therapy may therefore extend to other chronic pain conditions such as tension headache.
In the few studies of nonpharmacological interventions addressing chronic tension headache found in a literature search, the treatment described included physical therapy (6), transcutaneous electrical nerve stimulation (7), acupuncture (8), and homeopathy (9). These techniques resulted in varying levels of success in reducing pain associated with chronic headache, although the literature is scant. Only 1 scientific research study has been conducted on the effects of massage therapy on chronic tension headache (10). In that study, the authors noted a decrease in neck pain after subjects received 10 one-hour upper body massages over a 2-week period. Although the treatment was effective, the massage regimen employed may not be realistic for most patients; furthermore, the therapeutic massage procedures were not clearly described. Interestingly, the effects of massage may persist, as neck pain was still reduced at a 6-month follow-up.
The etiology of tension-type headache is unclear (11), but there is evidence to suggest that some forms may originate from sustained isometric contraction of muscles associated with the head and neck (12–14). This type of extended muscle contraction may result in local nutrient deficiencies due to ischemia (15), which can generate trigger points within muscles. The tightly contracted region of a muscle trigger point can remain contracted for an extended period of time even without sympathetic activation (16). Collectively, these effects may result in a tension headache. The activation of myofascial trigger points has also been implicated as a cause of headache (17). Trigger-point treatment via electrical stimulation has been effectively used to increase pain threshold in patients with tension headache (18). Manual treatment of trigger points has also been suggested for reducing trigger-point pain (19). Massage therapy techniques, which act in part to increase blood flow to tissue, may also reduce the activity of a trigger point. Thus, it is possible that headaches originating from this etiology may be reduced with massage therapy.
The objective of this study was to determine whether a regimented massage therapy program could have beneficial effects on the frequency, intensity, and duration of pain associated with chronic tension headache. A 4-week measurement period prior to treatment was used to establish individual subjects’ baseline measures. Following the baseline period, a 4-week treatment program was initiated that included therapeutic massage and trigger-point treatment of the following 6 muscles: upper trapezius, sternocleidomastoid, suboccipital, splenius capitis, levator scapulae, and temporalis. In addition to massage, each session included stretching and muscle energy techniques as outlined in the “Methods” section.