Contributed by Jolie Haun PhD, EdS, LMT; Beth Barberree BA, RMT; Derek Austin, PT, DPT, MS, BCTMB, CSCS

Chronic headaches can be debilitating. Though it seems intuitive that massage therapy may be an effective treatment for chronic headaches, little research has been conducted to validate the use of massage therapy for managing chronic headaches. In this month's research review provided by the Massage Therapy Foundation, we take a closer look at one research team's attempt to examine massage therapy as a nonpharmacological approach to treating chronic headaches. Quinn and colleagues conducted a pilot study with individuals 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."

Though the cause of chronic headaches is unclear, evidence cited by Quinn and colleagues suggests that these headaches may originate from sustained contraction of head and neck muscles, resulting in local nutrient deficiencies due to ischemia. Ischemia can generate trigger points within muscles, which can remain contracted for an extended period of time and collectively result in a tension headache. Because the activation of myofascial trigger points has been implicated as a cause of headaches, the authors focused on the role of trigger points in treatment of chronic headaches with the hypothesis that reducing trigger point pain may result in decreased headache pain. Quinn and colleagues suggest massage treatments that aim to increase blood flow to tissue may reduce the activity of a trigger point. Thus, it is possible that headaches that have this origin may be reduced with massage therapy.

The Study Design

Ten chronic tension headache sufferers participated in an 8-week study beginning with baseline headache measures recorded for the first 4 weeks that allowed each participant to serve as his or her own control. In the remaining 4 weeks, the participants received 30-minute massage therapy sessions twice a week. Each participant was asked to complete a nightly logbook in which they recorded their number of headaches, intensity of most severe headache, and duration of longest headache for each day. Headache intensity was measured using a visual analog scale (0–100mm; 0 = no pain; 100 = most pain).

The Treatments

The treatments were directed toward neck and shoulder muscles, specifically the "upper trapezius, sternocleidomastoid, suboccipital, splenius capitis, levator scapulae, and temporalis." The massage protocol consisted of six distinct phases within the 30-minute time frame: preparatory tissue warm-up; myofascial release; axial cervical traction; trigger point therapy procedure; facilitated stretching techniques; and session closure. The full article provides complete detail of each of these phases of the treatment protocol.

The Results

Due to incomplete data, data was analyzed for four of the original ten participants. Within-subject analyses (i.e. participants are their own control) indicated headache frequency was significantly reduced within the first week of the massage protocol, which held for the remainder of the study. Though not statistically significant, duration of headaches decreased during the massage treatment period (p = .058). Headache intensity was unaffected by massage treatments.

Anecdotally, on four occasions when a participant began the massage session with a headache, the headache was alleviated by the end of the 30-minute treatment. This suggests that massage administered during a headache episode might result in immediate beneficial effects and that patients should be instructed in appropriate self-massage techniques.

Overall, Quinn and colleagues suggest, "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." Notably, they suggest the protocol was successful in reducing pain associated with chronic tension headache, but they cannot state the massage portion directed at relieving trigger point activity was the causative agent rather than the stretching or relaxation techniques.

Implications for Research and Practice

The most impressive aspect of this study is the highly standardized massage treatment protocol. The authors recognize that the protocol complicates the question of which component of the treatment was most effective. While this research does not clarify what is the most effective massage technique for headaches, the overall protocol was shown to be effective at treating chronic headache symptoms. The authors suggest that treatment protocols validated for their efficacy can be later examined to determine which aspects of massage have a clinically significant therapeutic contribution.

Though this pilot study is unique in its examination of chronic headaches with a highly standardized protocol, its usefulness is greatly limited by its extremely small sample size. With only four subjects used for analysis, there is almost no power – proof of validity – in the findings. Though this may sound discouraging at first, it is important to realize that small studies such as this one provide foundational knowledge to determine if a large scale study is warranted. In the case of this pilot study, data indicate that the use of massage therapy as a nonpharmacological treatment for chronic headaches is worthy of further exploration.

Practitioners now have a data to support the recommendation of massage therapy for the treatment of clients with chronic headache pain. Furthermore, maybe the greatest contribution of this publication is the detailed protocol. Massage and bodywork practitioners may find the detailed protocol used in this study useful for delivering a standardized treatment in their own practice. This study, and others like it, continue to support the ever-expanding scope of conditions for which massage therapy can be delivered as an effective nonpharmacological adjunctive treatment to alleviate pain and suffering.

Are you interested in learning more about the uses of massage therapy to alleviate pain and promote wellness? To learn more about the effects of massage therapy, you can review the Massage Therapy Foundation review article archives, read accepted MTF Research Grant abstracts, or search PubMed for massage therapy studies.

Resource:

• The full article is available for free on PubMed Central: Quinn C, Chandler C, Moraska A. Massage Therapy and Frequency of Chronic Tension Headaches. Am J Public Health. 2002 October; 92(10): 1657–1661. PMCID: PMC1447303.