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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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While I agree with much of the advice so far given and would definitely err on the side of caution, I was surprised to see no one (until henry) making the connection between SCM triggerpoints and headache pain.

There is a huge correlation between SCM triggerpoints and migraine style headache pain. After all other contraindications are ruled out I would go for a release of Traps and the SCMs (though not in isolation of the rest of the spine/body) and Trigger point work for the SCMs in particular. You may have been relaxing the neck just enough (without releasing its triggerpoints) to elicit a reflexive guarding response in these two muscle groups which are often the last left holding on to a destabilized cervical region.

Fair warning, which should be shared with the client and consent received before applying such work, is that SCM triggerpoint work can sometimes bring on/exacerbate headache symptoms before they get better. A great place to start is with myofascial release for the Traps and SCMs with special attention payed to the sternoclavicular joint.

feel free to write me if you would like clarification/more detail.
Review your treatment....any C/T work ?
Does this individual have restricted movement in cervicals that you worked on/with?
Did the last 2 treatments differ radically from previous treatments? If so, how?
Ask yourself the question.....was it actually a migraine?
What was the reason for 'deep work'? and where did you work deeply.....
and of course always hydration, hydration, hydration.....
Henry Hardnock said:
depends on where and how deep you are working. if you are working deep in the sub ocipital area be aware of the vertebral artery that run thru the transverse processes. Also all of the nerves that exit between the anterior and middle scalenes. you could also be causing a latent trigger point to be come active and then causing referral pain. the upper trap and SCM both could contain trigger points that cause similar referral pain as a migrain headache.
she could also have spurs that may be irritating the spinal cord or even stenosis that could cause sever headaches.
just a thought. but my brother is evidence of the spurs causing migrain type headaches.


Debra Bloom said:
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 see her tomorrow. Hopefully much will be revealed then! I'll update when I know more. Thank you for your response.


Allan J Jones said:
Review your treatment....any C/T work ?
Does this individual have restricted movement in cervicals that you worked on/with?
Did the last 2 treatments differ radically from previous treatments? If so, how?
Ask yourself the question.....was it actually a migraine?
What was the reason for 'deep work'? and where did you work deeply.....
and of course always hydration, hydration, hydration.....
Osteophytic spurs are a contraindication to HVLA.......nothing more. In general these spurs are more of a precaution for the vertebral artery rather than the spinal cord.
We should all examine our treatments first when unexpected events occur.Nerves exiting btw ant & mid scalenes are part of the neurovascular bundle for the upper extremity. .
First thing for me is to understand exactly what is meant by 'neck'.


Henry Hardnock said:
depends on where and how deep you are working. if you are working deep in the sub ocipital area be aware of the vertebral artery that run thru the transverse processes. Also all of the nerves that exit between the anterior and middle scalenes. you could also be causing a latent trigger point to be come active and then causing referral pain. the upper trap and SCM both could contain trigger points that cause similar referral pain as a migrain headache.
she could also have spurs that may be irritating the spinal cord or even stenosis that could cause sever headaches.
just a thought. but my brother is evidence of the spurs causing migrain type headaches.


Debra Bloom said:
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!
Alan,

can you explain the meaning of HVLA?

thanks
Hi Aaron...HVLA = high velocity, low amplitude. Thats the terminology used for manipulation, adjustment, crack, bonesetting etc in most modern scientific study of the phenomenon, which in essence is just a rapid expansion of the joint capsule, with a corresponding 'pop' as nitrogen changes from liquid to gas.

Cheers

AJ
Aaron Allen said:
Alan,

can you explain the meaning of HVLA?

thanks
Hi Debra... have you encouraged your client to drink plenty of water after the massage?? She may be dehydrated and alone side of the metabolic waste after the massage... If she says she doesn't like water, have her flavor her water with any kind of fruit. I've been doing that with my clients who say they don't like water... now they drink it all the time!! Good luck...
Hi Abbie,

I just saw this client this morning (the first time since this discussion began) and I got her to tell me EXACTLY how much water she'd been drinking... she was always vague about it before. And yes, I always push hydration. So today she revealed that she probably drinks less than she knows she should because she doesn't like getting up in the middle of the night to go to the bathroom! We talked about tapering off water intake later in the day and the fact that her body would probably adjust to a fuller bladder over time. She knows I've been investigating this issue for her, which has already prompted her to increase her intake, and she says she has not had a headache lately. She promised to call tomorrow to let me know how the rest of today went. My suspicion is that the root of the problem all along was dehydration. I will update when I hear back! Thanks for checking in. -Debra

Abbie Darrough said:
Hi Debra... have you encouraged your client to drink plenty of water after the massage?? She may be dehydrated and alone side of the metabolic waste after the massage... If she says she doesn't like water, have her flavor her water with any kind of fruit. I've been doing that with my clients who say they don't like water... now they drink it all the time!! Good luck...
Good news! It is amazing how little water people drink and the whole 'I don't like water' argument is like saying 'I don't like air, so I don't breathe so much.' I tell people to get a BPA free Nalgene bottle, which fills a good litre full of water, and to sip throughout the day. Eventually, the will find themselves filling it up THREE times a day! Three litres is what we ALL need to drink!

Debra Bloom said:
Hi Abbie,

I just saw this client this morning (the first time since this discussion began) and I got her to tell me EXACTLY how much water she'd been drinking... she was always vague about it before. And yes, I always push hydration. So today she revealed that she probably drinks less than she knows she should because she doesn't like getting up in the middle of the night to go to the bathroom! We talked about tapering off water intake later in the day and the fact that her body would probably adjust to a fuller bladder over time. She knows I've been investigating this issue for her, which has already prompted her to increase her intake, and she says she has not had a headache lately. She promised to call tomorrow to let me know how the rest of today went. My suspicion is that the root of the problem all along was dehydration. I will update when I hear back! Thanks for checking in. -Debra

Abbie Darrough said:
Hi Debra... have you encouraged your client to drink plenty of water after the massage?? She may be dehydrated and alone side of the metabolic waste after the massage... If she says she doesn't like water, have her flavor her water with any kind of fruit. I've been doing that with my clients who say they don't like water... now they drink it all the time!! Good luck...

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