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Hi all, I have a regular client who just told me that after each of her last 2 massages, she ended up with an incapacitating migraine headache.  She is overweight and I would say the work I did was moderately deep, so I'm wondering if her headaches were the result of an onslaught of metabolic waste being dumped into her system faster than normal.  Any insights would be appreciated.  She is (understandably) a little wary about coming in for her next massage... thanks!

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Hi Debra . . I think you have encountered a contraindication, probably nothing to do with a metabolic waste issue. Back to the GP or an experienced osteopath . . so many possibles that need to be eliminated before you go there again, if ever! Your client will appreciate your concern and an appropriate referral. Cheers Peter
Hi Peter, thanks for your response. I'm unclear what you mean about encountering a contraindication - do you mean her headaches may be the result of some underlying illness and massage is triggering it? I fear that she may not want to come back if every time she gets off my table she gets a pounding headache!
Debra,
Does your client have frequent migraines? Also, did you work too long on her neck-especially the upper cervical area. It's also possible that some other stressor is causing her migraines. Suggest that for the next session, you would spend less time on her neck and more on other areas.
Cheers,
Jody H.
Hi Jody. Yes, I do tend to spend a lot of time on the neck with most clients, but less so on this one, as she does not seem to carry a lot of tension there. What I feel more with her is somewhat puzzling to me - I just keep calling it "congestion," which feels like soft fatty deposits, mostly around her joints. She does get migraines, and we're both hoping it's a coincidence that her last two came hours after getting a massage. But question for you - why would working on the neck CAUSE a headache? If I'm relieving muscle tension, shouldn't that induce feelings of release and relief instead?? Thanks for taking the time to respond!
I have to agree with Peter on this one. To be safe, I would tell my client to make an appointment with their doctor in order to rule out any other unknown "issues". Personally, I have told a number of clients not to come back to me until they have seen their DR and I am given a release from said DR. CYA method for you, but it also shows your true concern for your clients health.
Thanks Marissa. I will be recommending she talk to her doctor, for sure. I also just came back from getting my own massage (self care is a beautiful thing!) and asked my LMT and her colleague for their input. They both cited the possibility of cervical releases as the culprit (and something she'd have to work through over time) and/or dehydration, which is a real possibility. Though I always stress hydration, I have no clear idea of what her level of intake is. I will also ask her about that. And then I will cross my fingers when she leaves here the next time!
Hi Debra,

Having experienced lots of massage during school, I went 2x to a professional MT during my training. We were urged to do so and so I did. Both times I had a headache and even a little nausea one of the times. And yet I was getting massages through my school colleagues regularly. What I came to the conclusion for me was that her touch was too quick paced for me. I noticed both times it felt that her hands were always quickly moving around my body versus the long slower strokes. I'm not saying that's the case for your client, but thought I'd share an experience.

L
Thanks for sharing your experience, Lisa. I, too, have experienced nausea after a massage, but for me it was after really deep work, rather than due to the pace. At a deep tissue class recently, a friend of mine actually went home during the lunch break because she thought she had come down with the flu. Turns out it was the result of the deep work. I have a firm hand but wouldn't consider my work particularly deep. But maybe it's too deep for her, and maybe at this time. Another colleague today told me she had suffered from migraines and, after a total check up with blood work, it turned out she had a vitamin D deficiency. From the stories I'm hearing, it appears that there may be more than one answer and it is too hard (and not appropriate) for us, as therapists, to figure it out; a recommendation to visit the doctor is probably wise. I still plan to ask my client how much water she's drinking...
Hi Debra . . yes, you have understood my view perfectly. Sorry for the delayed response. There seems to be a hint of an underlying inflammatory disease (joint nodes). I would be most reluctant to continue with this patient; my fear is that she would not have further investigation. For example, what if there is a "fair, fat and forty" gallbladder crisis going on reacting to parietal work. . . what if the 'improved' circulation through the neck is exacerbating an intracranial aneurism? Alarm bells, I'd say . . . For what its worth, the neck is the last area that I'll attend to. Its only after the pelvic structure and fascia are happily talking to the thorax and shoulders that the neck is treated. Further, the practice of attending to the neck in isolation is a second-rate deal for the trusting patient. Scanning the body for key structural anomalies (and contraindications) takes only a few minutes, and potentially results in a less risky experience with the well-intentioned therapist. I encourage careful listening to the client's initial description of the ailment . . usually there is a clue to be found. Don't you just love the daily challenges that come to your door? Warm regards, Peter

Debra Bloom said:
Hi Peter, thanks for your response. I'm unclear what you mean about encountering a contraindication - do you mean her headaches may be the result of some underlying illness and massage is triggering it? I fear that she may not want to come back if every time she gets off my table she gets a pounding headache!
Hi Peter (and Luciana). Thanks for the replies. I have spoken with this client about my concerns and she admitted that she had not been drinking very much water, so I am hoping the culprit is *simple* dehydration. Interesting you mention gall bladder as a possible problem - she had hers removed 2 years ago. And for clarity's sake, I just want to say that I start with her face and neck but it is always a total body massage; never is the neck done "a la carte!" I also didn't mention that I do energy work and end each session with a chakra balance, which starts from the feet (grounding) and moves up through the body to the crown of head. Now that she has brought up the issue of headaches, I will start the chakra balance at the head and move down the body, energetically "pulling" any excess energy out through the feet. I did tell her that I thought she should see her physician and she has an appt. coming up. I will still see her for a massage next week, though. Let me ask you - where were you taught to "scan the body for key structural anomalies and contraindications?" I know a little about posture, but had no in-depth training in massage school for what sounds like the fairly thorough exam you are conducting. I would like to know more! - Thanks, Debra
Hi Debra . . the reference to sequences of treatment was aimed mainly at chiros and osteopaths who are not au fait with the influence of fascial connections through the entire body. My view is that the lumbar area is a major centre of effort. Its influence is global . . for example, a pubic symphysis misalignment is always reflected in cervical lesions.
I work with chakras too, and their respective colours. Scanning for structural lesions comes from years of relentless enquiry, culminating so far in the discovery of a discrete ligament that sits inside the iliac crest. Its function is to mediate transpelvic fascial tension and has an indirect role in muscle sequencing. I would be happy to correspond further by email. In the meantime, my wild guess is that your client has a problem in the left SIJ, jammed joints around T6 to T9, and a flexed closed lesion at left C7(showing as a protrusion on the right. As far as contraindications go, I believe that they are usually taught in every massage course. I imagine that most masseurs use the same techniques, palpating fibrous areas, detecting anomalous heat variation, finding triggerpoints and calcifications etc . .
Regarding structural stuff, I am looking for an opportunity to spend some time post-congress with manipulators purely to pass on some insights about pelvic integrity and its influence on movement. Its new territory and builds on work by Myers, Lee, and others in that area. At the LBP congress in LA I'll be detailing a perceived fascial link between pelvic obliquity and ductal carcinoma. This stuff is not everybody's cup of tea, but it certainly gives me the energy to keep digging. Hope you don't mind my rabbiting on . . the passion continues! Cheers P

Debra Bloom said:
Hi Peter (and Luciana). Thanks for the replies. I have spoken with this client about my concerns and she admitted that she had not been drinking very much water, so I am hoping the culprit is *simple* dehydration. Interesting you mention gall bladder as a possible problem - she had hers removed 2 years ago. And for clarity's sake, I just want to say that I start with her face and neck but it is always a total body massage; never is the neck done "a la carte!" I also didn't mention that I do energy work and end each session with a chakra balance, which starts from the feet (grounding) and moves up through the body to the crown of head. Now that she has brought up the issue of headaches, I will start the chakra balance at the head and move down the body, energetically "pulling" any excess energy out through the feet. I did tell her that I thought she should see her physician and she has an appt. coming up. I will still see her for a massage next week, though. Let me ask you - where were you taught to "scan the body for key structural anomalies and contraindications?" I know a little about posture, but had no in-depth training in massage school for what sounds like the fairly thorough exam you are conducting. I would like to know more! - Thanks, Debra
Hi Debra,

I just recently signed up for this site and this post caught my eye. There is a lot of good feedback here and I was actually surprised no one mentioned hydration. To me it makes sense that would be part of the problem considering that cellular hydration is one of the effects upon manipulation, so if there is little water within the system to accomplish this, I would think some unpleasant reaction, like a migrane, would occur.

Another thought on Peter's coments relating to the pelvis in connection with the cervical spine is to refer her to a good cranial sacral therapist. And of course advise pher to drink 3 liters of water a day!

Amanda

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