With Deep Gratitude,

The Tension is Palpable

December 18, 2016


Whether you suffer from the annoyance of your typical headache every so often or know someone who has migraines once a week, it can be understood that headaches are some of the most ambiguously specific ailments one may (or may not) encounter in life.


If that statement left you with a headache, Welcome to the Club!


But really, what is a headache?   Many sources indicate that a headache is simply a pain in your head caused by a number of factors (1), however if you are interested in the specifics of headaches you could be studying for years, as there are over 150 diagnostic headache categories. (2) From a pathological standpoint, there are two categories of headaches: primary and secondary. Primary headaches are not related to any serious condition and generally occur with the stresses of life. Secondary headaches are symptoms of other potentially serious problems.


Within these categories there are the subcategories of tension-type headaches, migraine headaches, cluster headaches, and rebound headaches. The most important factor in differentiating these categories and subcategories is their source.


What brought on the headache?  

How long does it last?   

What did you eat?   

What noise was around?  

Have you been sleeping well?   

Do you have a fever?


Tension-type headaches are the most common form in adults and adolescents. (2) Because the average adult head weighs over 15 lbs, it is the job of the muscle in the neck to keep it from toppling over.   The cervical vertebrae have very tiny muscles connecting the skull to the transverse process of C1. These muscles work together to provide tension on anterior, posterior, and lateral aspects of the neck. This moderate tension balances the head in place on top of the neck and also allows for movement based on different muscles contractions.


When the level of tension exceeds the necessary amount for standard function, an imbalance occurs. This imbalance can be caused by a number of external or internal stimuli. Even a postural insufficiency in your feet could refer pain to your head. When the arches of the feet collapse, the knees compensate which put the hips out of alignment requiring further compensation. This then puts the spinal vertebrae out of alignment, which also calls for more compensation. From there the shoulders adjust, then the neck and then the head.


While in some cases these compensations can be helpful and even necessary, they can also create that imbalanced tension resulting in a Tension-type headache originating at the feet. (2) Tension-type headaches can also stem from eyestrain, subluxation of a vertebrae, trigger points, and can be episodic or chronic.


So what do we do about all of this tension and stress?


There are a number of treatments for Tension-type headaches including NSAIDS (non-steroid anti-inflammatory drugs), Serotonin agonists, Botox injections, Analgesics, and even anti-seizure medications. From the Holistic Massage Therapist’s perspective it is our job to assist in providing moderate to substantial relief before clients go to these drugs.


Tension-type headaches specifically indicate massage, which can help tackle the musculoskeletal and stress-related holding patterns that factor into inefficient movement and pain. From a Clinical Massage approach, observations confirm that many of these headaches originate in trigger points in the neck muscles.   By resolving these trigger points, these tension-type headaches can be reduced in frequency and intensity, if not completely eliminated.


Muscles that can be worked through include: Frontalis, Occipitalis, Temporalis, Masseter, Sternocleidomastoid, Scaleni, Trapezius, the Erector Spinae group, and even the Multifidi and Rotators. Manual Therapy techniques include: Cross-fiber Stroking, Stripping, Compression, Pincer Compression and even some Petrissage. (3)


When working through these areas it is important to remember that headaches still have contraindications. Any headache that is also accompanied with fever, confusion, numbness, or any other nerve based signs may be a medical emergency and contraindicate massage. Like any other pain, it is important to be cognizant of all the factors and contribute to the headache. (1)


Finally, while massage and drugs can provide relief both long-term and temporary, it is important for a person to reflect on the root of what caused this stressful outburst.  Maybe the best cure is slowing down, thus providing healing for mental, physical, and emotional health.

Article by Janie Crick, LMT



  1. Werner, Ruth. A Massage Therapist’s Guide to Pathology. 5th Lippincott Williams & Wilkins. 2013.

  2. http://www.webmd.com/migraines-headaches/guide/migraines-headaches-basics. 3 July 2015.

  3. Clay, James H. & Pounds, David M. Basic Clinical Massage Therapy: Integrating Anatomy and Treatment. 2ndLippincott Williams & Wilkins. 2008

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