shiatsu for the effective treatment of migraine - amta · pdf fileshiatsu for the effective...

Shiatsu for the Effective Treatment of Migraine

with Leisa Bellmore, Shiatsu Therapist

• Migraine affects ~20% of population • 2/3 of migraineurs are women ages 15-55 • In at least 50% migraine goes undiagnosed and untreated

Image:www.123rf.com; Image ID: 237928 ©Fred Goldstein

• Specifics of Migraine • Pathology of Migraine • Triggers • Self-Care • Research on CAM & Migraine • Shiatsu Therapy • Shiatsu for Acute Migraine Treatment • Shiatsu for Preventive Treatment

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• Complex neurological condition

• Chronic with no cure

• Involves moderate - severe headache with nausea & other symptoms

• Lasts hours - days

Four Phases of Migraine

• Prodrome • Aura • Headache (or Pain Phase) • Postdrome (or Resolution Phase)

Image: www.flickr.com/photos/jahdakinebrah/250796603

• Experienced by ~60%

• Precedes headache by hours-days

• Main symptoms: difficulty concentrating, fatigue, stiff muscles

• Other possible symptoms: excessive yawning, osmophobia, irritability, visceral symptoms

Prodrome


• Lasts 20-60 minutes

• Main symptoms: visual disturbances such as bright lights or spots

• Other possible symptoms: motor disturbances, parasthesias, osmophobia, sensitivity to touch

Aura

• Experienced by 100%

• Lasts 4 - 72 hours

• Main symptoms: pulsing, unilateral head pain, nausea, photophobia

• Other possible symptoms: vomiting, osmophobia, phonophobia, pallor, blurred vision, nasal congestion, diarrhea, cold extremities, sweating

Headache or Pain Phase


• Lasts hours-days

• Main symptoms: exhaustion, difficulty concentrating, mood changes

• Other possible symptoms: gastro-intestinal changes, polyuria, weakness

Postdrome

Migraine theories

• For many years migraine was thought to be a vascular disorder

• Other theories were briefly thought to be the cause: Serotonin Theory, Depolarization Theory, Neurovascular Theory

• Researchers now agree that migraine is a neurogenic disorder

Image: www.flickr.com/photos/double-m2/5551033595

• Many researchers feel the root of migraine is a malfunction in the brain stem and activation of it initiates migraine

• Some believe cortical spreading depression triggers trigeminal nerve system, causing the pain of migraine

• Neural events result in dilation of blood vessels, aggravating pain and causing further nerve activation

• Others believe the pain of migraine stems from hypersensitivity of nerve fibres near blood vessels

Pathophysiology of migraine

Cortical Spreading Depression

• Cause of aura

• A wave of hyper-excitability of nerve cells followed by a wave of neuronal inhibition

• Timing of nerve cell activity coincides with symptoms of aura

• Migraine is genetic – several genes are linked to it

• Involves sensory sensitivity: increased activity in somatosensory, visual & auditory networks

• Somatosensory cortex is thicker in migraineurs

• Gray matter is thicker in area known for pain processing

Pathophysiology of migraine

Not all severe headaches are migraine! .

The following should be investigated:

• Those that change in character over time

• Those accompanied by neurological sx. (weakness, loss of sensation, diplopia, ataxia)

• Those with stiff neck & fever • Those that develop after head

injury or trauma

• Those that 1st occur after age 55 • Those with no clear family

history of migraine

Image: www.flickr.com/photos/lephasme/3937933083

Triggers

• Food & Drink • Environmental • Behavioural • Chemical • Health

• Thought that trigger threshold must be reached

• Can occur without triggers

Image: L. Bellmore

Psychological impact of migraine • Depression is 3 times more

likely in migraineurs • Depression causes increased

perception of pain • Frustration, hopelessness,

helplessness • Lack of control over

condition, health care & life • Social isolation • Loss of self-identity Image: www.flickr.com/photos/rust/3754185255

Importance of Self-Care

• Physical and psychological benefits

• Increases feelings of control

• Creates positive attitude • Client responsible for

improvements • Mind-body connection • Recognition of self-worth

Image: www.123rf.com/photo_8212359

Self-care for migraines

• Hydrate!

• Strong coffee

• Self-shiatsu

• Acupressure

• Stretching for neck

• Cold compresses

• Hot soak for hands

Image: www.123rf.com/photo_8241711

Helps with identification of triggers and determining what works and what doesn’t • Date, time & duration of migraine • Phases & symptoms • Characteristics & level of pain • Triggers & other factors • Interventions & effectiveness

Migraine Diary

Research on Migraine & CAM

• ~ 50% migraineurs use CAM compared to 34% of non-migraineurs

• >50% of migraineurs who use CAM do not discuss it with their primary health care provider (Wells et al, 2011)

Research on Migraine & CAM

Massage – 2 small RCTs (Chaibi et al, 2011):

• 28% decrease in frequency, 71% decrease in pain severity

Acupuncture (Linde et al, 2009):

• Additional benefits to usual care

• At least as effective as prophylactic drugs without side effects

Chiropractic (Chaibi et al, 2011):

• Several studies show decrease in frequency & duration www.flickr.com/photos/hannekemulder/5488611506

Nutritional Supplements

Magnesium (600mg trimagnesium dicitrate)

• 41.6% decrease in frequency

• Adverse effects: diarrhea

Riboflavin (B2; 400 mg)

• 59% saw ≥50% decrease in frequency

• Adverse effects: (rare) diarrhea, polyuria

Coenzyme Q10 (150mg)

• 61% saw 50% decrease in headache days (Sun Edelstein & Mauskop, ,2009) Image: Lisa Brewster/flickr

Herbal Supplements Feverfew (Pittler et al, 2000)

• Mixed results; insufficient evidence; interactions common

• Adverse effects: G-I disturbances, mouth ulcers, “Post-feverfew syndrome”

Butterbur (Sun Edelstein & Mauskop,2009)

• Decreased frequency significantly

• RCT with children/adolescents: 77% had 50% decrease in frequency

Image: www.123rf.com/photo_10500918elenathewise

Shiatsu Therapy

• Japanese but based on TCM & anatomy

• Shi=finger, atsu=pressure

• Sustained, comfortable pressure to specific points

Image: A. MacKay © L. Bellmore

Eastern perspective: • Points follow meridians • Pressure can release blockages,

increase energy flow & help restore balance

Western perspective: • Points based on TCM & anatomy • Pressure can release muscular

tension, increase circulation, relieve pain, help the body to function well

Shiatsu Theory

Application

• Holistic treatment; full-body but can be more focused

• Client remains fully-clothed; no oils or lotions used

• Sequence of points is usually repeated several times

• It should never be painful; gentle pressure is effective

Image: A. MacKay, © L. Bellmore

Application

• Use the pads of thumbs or fingers

• Gradually increase pressure, hold 4- 5 seconds, slowly release

• Thumbs are extended • Arms are straight • Use body weight to apply

pressure

Image: J.D. Mowat © L. Bellmore

Uses:

For stress management, preventive care and to treat chronic and acute conditions

• Soft tissue and joint injuries

• Chronic pain

• Respiratory conditions

• Neurological conditions

• Digestive disorders

• Mental health issues

• Contagious illnesses, infectious skin ailments

• Serious medical conditions, i.e.: inflammation of internal organs, internal bleeding, etc.

• Do not work on or near open wounds, cuts, scrapes

• Gentle pressure on injured areas or where there is pain

• Abdominal points not used during pregnancy or on those with hypertension

Contraindications:

Acute Treatment


Acute treatment

• Client is supine

• Therapist is seated at head of table

• Work on face, head, neck and shoulders

• Use gentle but firm pressure

Pressure over eyes, forehead & temple

• Using fingers apply gentle but firm pressure over eyes

• Slowly increase, hold for ~60 seconds, slowly release

• Gentle but firm pressure to forehead with palm

• Gentle but firm pressure to temples with palms

Frontal Region (forehead)

• 3 points on midline of forehead, inferior-superior

• 1st above brow, 3rd below hairline

• 3 rows of 4 points from midline toward temple

• Left side, then right; work inferior to superior

• Points are on: corrugator supercilii, orbicularis oculi, frontalis

Infra & Supra-orbital (above & below eyes)

• 4 points below eye along inferior orbital ridge

• 4 above eye along just inf. to supraorbital margin

• Left then right, medial-lateral

• Infra points: levator lab. sup. al. nasi, orbicularis oculi, lev. lab. sup., zygomatic min.

• Supra points: corrugator supercilli, orbicularis oculi, frontalis, lev. palpebrae

Temple Region

• 3 points along each temple

• Work anterior to posterior • Left side first, then right • Points are on: orbicularis

oculi (some cases for pt. 1), ant. auricular m. (some cases for pt.3), temporalis

Temporal Region – Median Line

• 6 points along median line of frontal & parietal bones

• Work anterior to posterior

• 1st point just posterior to hairline

• 6th point at crown of head

• Points are on: galea aponeurotica, superficial fascia

Temporal Region

• 6 rows of 4 points on each side of midline

• Work posterior to anterior, left side then right

• Start at midline and work laterally

• End with points of midline • Points are on: galea

aponeurotica, superficial fascia

Lateral Cervical

• 4 points on sides of neck

• 1st point just below mastoid process

• 4th point at base of neck

• Points are on: scalenes, levator scapulae, splenius capitis, SCM, platysma

Sub-Occipital Region

• 3 points just inferior to occipital bone

• 1st point inferior, posterior to mastoid process

• 3rd on either side of spine • Points are on: scalenes,

semispinalis cap. splenius cap., levator scap., SCM, trapezius

Occipital Region

• 3 points along base of skull

• 1st point just posterior to mastoid process

• 3rd point on either side of foramen magnum

• Points are on: trapezius, galea aponeurotica, superficial fascia

Posterior Cervical

• 4 points either side of spine

• 1st point just below occipital bone

• 4th point at base of neck • Points are on: erector

spinae group, levator scap., splenius cap. & cerv., trapezius

Supra-scapular Region

• 3 points along top of shoulder

• 1st beside base of neck

• 2nd over brachial plexus

• 3rd point just medial to acromion process

• Points are on: trapezius, supraspinatus

Preventive Treatment


Preventive treatment

• Begin with client in sideline

• Do lat. cervical, sub-occipital, occipital, medulla oblongata, post. cervical, supra-scapular and interscapular

• With client supine do points on face and head


Lateral Cervical

• 4 points on sides of neck

• 1st point just below mastoid process

• 4th point at base of neck

• Points are on: scalenes, levator scapulae, splenius capitis, SCM, platysma

Sub-Occipital Region

• 3 points just inferior to occipital bone

• 1st point inferior, posterior to mastoid process

• 3rd on either side of spine • Points are on: scalenes,

semispinalis cap. splenius cap., levator scap., SCM, trapezius

Occipital Region

• 3 points along base of skull

• 1st point just posterior to mastoid process

• 3rd point on either side of foramen magnum

• Points are on: trapezius, galea aponeurotica, superficial fascia

Medulla Oblongata

• 1 point at foramen magnum (hollow inf. to median line of occipital bone)

• Use very gentle pressure, increase, hold ~10 seconds

• Point is on: rectus capitis post. minor & major, lev. scap., ligamentum nuchae, semi-spinalis cap., trapezius

Posterior Cervical

• 4 points either side of spine

• 1st point just below occipital bone

• 4th point at base of neck • Points are on: erector

spinae group, levator scap., splenius cap. & cerv., trapezius

Supra-scapular Region

• 3 points along top of shoulder

• 1st beside base of neck

• 2nd over brachial plexus

• 3rd point just medial to acromion process

• Points are on: trapezius, supraspinatus

Inter-scapular Region

• 5 points on either side of spine

• 1st point parallel to superior angle of scapula

• 5th point parallel to inferior angle of scapula

• Points are on: ext, intercostal, lev. costarum, rotatores, erec. spinae, splenius cerv., serratus pos. sup., rhomboid min. & maj., trapezius

Frontal Region (forehead)

• 3 points on midline of forehead, inferior-superior

• 1st above brow, 3rd below hairline

• 3 rows of 4 points from midline toward temple

• Left side, then right; work inferior to superior

• Points are on: corrugator supercilii, orbicularis oculi, frontalis

Infra & Supra-orbital (above & below eyes)

• 4 points below eye along inferior orbital ridge

• 4 above eye along just inf. to supraorbital margin

• Left then right, medial-lateral

• Infra points: levator lab. sup. al. nasi, orbicularis oculi, lev. lab. sup., zygomatic min.

• Supra points: corrugator supercilli, orbicularis oculi, frontalis, lev. palpebrae

Temple Region

• 3 points along each temple

• Work anterior to posterior • Left side first, then right • Points are on: orbicularis

oculi (some cases for pt. 1), ant. auricular m. (some cases for pt.3), temporalis

Temporal Region – Median Line

• 6 points along median line of frontal & parietal bones

• Work anterior to posterior

• 1st point just posterior to hairline

• 6th point at crown of head

• Points are on: galea aponeurotica, superficial fascia

Temporal Region

• 6 rows of 4 points on each side of midline

• Work posterior to anterior, left side then right

• Start at midline and work laterally

• End with points of midline • Points are on: galea

aponeurotica, superficial fascia

Neck Stretch: Forward Flexion

• Slide right hand under head so hand rests on left shoulder

• Place left hand on right shoulder

• Straighten arm so head is stretched forward

Neck Stretch: Lateral Flexion

• Place right hand at base of skull

• Place left hand on left shoulder

• Push shoulder down while moving head gently toward right shoulder

Neck Stretch: Traction

• Place fingers at either

side of spine just below base of neck

• Run fingers up neck till just below occipital bone, stretching neck

Migraine Resources

• Migraine Research Foundation: www.migrainereserachfoundation.org

• Migraine Action: www.migraine.org.uk

• National Headache Foundation: www.headaches.org

• Migraine Resource Network: www.migraineresourcenetwork.com

Leisa Bellmore, Shiatsu Therapist [email protected]………………. [email protected]

Leisa Bellmore, Shiatsu Therapist on Facebook

Thank you!

shiatsu for the effective treatment of migraine - amta · pdf fileshiatsu for the effective...

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