MANUAL THERAPY Malissa Martin, EdD, ATC, CSCS, Report Editor Acupressure for Tension Headache

Sandra Hendrich, PT, DPT; Leamor Kahanov, EdD, LAT, ATC; and Lindsey E. Eberman, PhD, LAT, ATC • Indiana State University

Tension headache (TH) or “stress head- milder severity and longer duration and is ache” is the most common type of headache generally described as a feeling of tightness occurring among adults, occurring twice as or a band-like pressure felt around the back often in women as in men, and a leading of the neck or the head or in the forehead health complaint.1,2,3 Exercise-related head- region.1-4 The pain associated with TH is usu- aches are one of the ally dull in nature and generally occurs on most common medical both sides of the head. Tight muscles in the Key PPointsoints problems affecting ath- neck, shoulders, upper back, and temporal Addressing three key acupressure points letes, with up to 50% regions, often accompanied by stress, may (temporal, base of the skull, first dorsal reporting headache as be an indication that myofacial trigger points 1-4 interossi) may reduce or eliminate tension a regular consequence (MTPs) are a cause of TH. headache symptoms. of athletic participa- Treatment may include psychological tion.4 A majority (72%) counseling, manual therapy, physiologic Accupressure points (i.e., Joining of the of these athletes report intervention, and pharmaceutical treat- Valleys, LI4; Gates of Consciousness, that neither trauma or ment.1,3 An association between MTPs and GB20; and the temporal region) may be concussion is the cause, TH has been identified, with treatment ame- specific to tension headaches but may also and therefore, such liorating or eliminating symptoms.2,3 MTPs be hypersensitive muscles delineated by a headaches can be cat- in the upper trapezius, sternocleidomastoid taut band of tissues. egorized as tension or (SCM), and temporalis muscles have been migraine.1-4 Tension and associated with greater intensity and dura- Acupressure should be held on identified migraine headaches are tion of chronic TH, but not frequency.8 MTPs points for one to two minutes or less the most common types in the right temporalis muscles were associ- depending on the patient’s pain relief. that athletes will expe- ated with longer headache duration, whereas rience, and the clini- MTPs in the left temporalis muscles were cian needs to address both the cause and associated with greater headache intensity.8 symptom(s).4 Latent MTPs may influence TH frequency.8 Pain that is referred from MTPs may relate Evaluation and Treatment Options to patient perception of headache8-21 and thus, they also need to be addressed by treat- Any patient who reports a headache should ment.8 Acupressure can help to alleviate TH receive a full neurologic examination to symptoms.5,8,22 ascertain the etiology of the headache.4-11 For nontraumatic headaches, attention Acupressure should be focused on the cervical spine as Proper administration of acupressure requires a potential source of the pain.4-11 TH can be skill that is developed over time. The novice distinguished from migraine headache by practitioner who is learning how to administer © 2011 Human Kinetics - ATT 16(3), pp. 37–40 international journal of Athletic Therapy & training may 2011  37 acupressure techniques may provide symptom relief to the unborn child). This acupressure point is called by simply massaging just one or two of three acupres- “Joining of the Valleys” (LI4).23 The easiest way to locate sure points: (a) Joining of the Valleys (LI4), (b) Gates of and massage this point is to squeeze the soft tissue in Consciousness (GB20), and (c) the temporal region.23 the web space, close to where the bones join in the MTPs can also be identified in the bellies of muscles hand (Figure 1). Patients may experience a sharp pain on the basis of four diagnostic criteria: (a) the exis- or a feeling of discomfort when this area is massaged. tence of a palpable taut band, (b) the identification Press and hold the tissue, massage in small circles, or of a hypersensitive tender spot in the taut band, (c) apply a pulsating pressure. All are effective treatment a local twitch response elicited by manual snapping techniques, but each patient will respond differently of the taut band, and (d) reproduction of the referred to a given technique. Massage the area for one to two pain pattern of the TH in response to compression.5,6 minutes23 or until the patient relates that the headache A key acupressure point that is used to treat many is lessening. Have the patient shut his or her eyes and types of head or neck pain is located in the web space slow down breathing while the acupressure massage between the thumb and the first finger over the first is administered. Massage both hands. dorsal interossei muscle (note that this point should A second set of acupressure points for the treat- not be treated in a pregnant patient, because it may ment of TH is located at the base of the skull between produce uterine contractions that could be harmful the origins of the SCM and trapezius muscles. These points are called the “Gates of Consciousness” (GB 20).23 Massage of these points is particularly helpful for the treatment of tension headache pain that is located at the base of the head, in the neck, or behind the eyes. To find these points, place your thumbs in the depres- sion between the origins of SCM and trapezius muscles (Figure 2).23 Your thumbs should slip into a small groove or indentation. Direct pressure upward toward the backs of the eyes, press and hold, or massage in very small circles. The patient may begin to breathe easier while these points are massaged, because they are also used for the treatment of sinus congestion. Treatment of these acupressure points can be per- formed with the patient in a seated, supine, or prone position. Patients may also administer self-treatments Figure 1 Joining of the Valleys acupressure point. at these acupressure points.

(a) (b)

Figure 2 “Gates of Consciousness” acupressure at the base of the occiput, treated by the practitioner in prone (a) or by the patient (b).

38  may 2011 international journal of Athletic Therapy & training