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2019AmericanMassageTherapyAssociationNationalConvention

ShiatsuTherapyfortheEffectiveTreatmentofMigraine

withLeisaBellmore,ShiatsuTherapist

Migraineisadebilitatingchronicneurologicalconditionwithnocure.Itinvolvesmoderatetosevereheadachealongwithnauseaandothersymptomsandlastsfromseveralhourstoseveraldays.Statistics&Symptoms:• WHOreportcitesmigraineasoneofthefourmostdisablingchronicconditions• In2011WHOestimatedaworldwideprevalenceofcurrentmigraineof13%andalifetimeprevalenceof18%

• HighestprevalenceinNorthAmericafollowedbyCentral&SouthAmerica,Europe,AsiaandAfrica

• Approximately3000ofeverymillionpeopleworldwidehaveamigraineonanygivenday

• 2/3ofcasesarewomenages15-55;overall75%arewomen• 70-80%ofmigraineurshaveafamilyhistoryofmigraine• Migraineisundiagnosedanduntreatedinatleast50%ofpatients• Lessthan50%ofmigraineursconsultaphysicianabouttheircondition• 34%ofmigraineursexperiencedifficultiesordiscriminationatworkduetotheircondition

• Depressionisthreetimesmorecommoninmigraineursthaninhealthypeople• Astudyin2010showedthatonly21%ofmigraineurscouldpredicttheirnextattackwithin3days

• Chronicmigraine>15headachedays/month,Episodicmigraine<15days/month• 38%ofmigraineursget1-12migraineseachyear,38%get1-3amonth,37%get1perweekand11%get2-6aweek

• Onestudyshowed85%ofpeoplewithmigraine/severeheadacheusesomekindofCAMtreatment;60%feltthosetreatmentsprovidesomerelief

• Migraineistheendresultofacomplexneurologicalprocess• Anaverageof4hoursofundergraduatemedicaltraining&10hoursofspecialisttrainingarededicatedtoheadachedisorders;manyundergradcourseshavenone

• Therearemultiplesymptoms:severe,pulsing,unilateralpaininhead;nausea;vomiting;fatigue;difficultyconcentrating;photophobia(increasedsensitivitytolight);phonophobia(increasedsensitivitytosound);visualdisturbances;motordisturbances

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Pathophysiology• Consideredformanyyearstobeavasculardisorder;itwasthoughtthatmigrainepainwascausedbybloodvesselsthatdilatedandthenconstrictedtoosuddenly

• Researchoverpastseveraldecadeshasshownmigraineisaneurogenicprocesswithsecondarychangesincerebralperfusion(thepressuregradientthatcausescerebralbloodflow)

• Corticalspreadingdepression(CSD)causesaura:awaveofhyper-excitabilityofnervecellssweepsthroughthecortex,especiallyareasthatcontrolvision

• Thehyper-excitablephaseisfollowedbyawaveofneuronalinhibition• Theperiodsofintenseanddepressednervecellactivitycoincidewiththetimingofthesymptomsofaura

• Someresearchersbelievethatcorticalspreadingdepressionstimulatesthetrigeminalnervesystem,thuscausingthepainofmigraine

• Researchershadbelievedthatmigrainepainstemmedfromextracranialtissues,duramaterandbloodvessels,howeveraveryrecentstudyshowedthatextra-cranialarteriesdidnotexpandduringmigraineattacksandintracranialarterieswherethepainwasfeltonlyexpandedslightly

• Manynowbelievethatthepainofmigraineoccursbecausethenervefibresaroundthebloodvesselsbecomehypersensitive

• Apotential‘migrainecentre’inthebrainstemhasbeenproposed;Manyclaimtherootofmigraineisamalfunctioningofthebrainstemasthreeofitsnucleiareextremelyactiveduringandaftermigraine

• Thebrainstem’sactivationmaybetheinitiatingfactorinmigraine• Thebrainstem'scontrolovermanyaspectsofexperiencecouldexplainthevariedsymptomsofmigraine

• Someresearchers,however,believetheactivitychangesinthebrainstemaretheresultofmigraine,notthecause;theyfeelCSDisthecauseofpain,andcanoriginateinanypartofthebrain

• Themechanismfor‘turningoff’migraineandendingtheprocessisasyetunclearOtherFacts• Thebrainsofmigraineursaremoreactivethannon-migraineurs• Thereisincreasedactivityinthesomatosensory,visualandauditorynetworksandinsomatotopicrepresentationsoftheface

• Thiscorrespondstotheenhancedsensorysensitivityofmigraineurs• Thesomatosensorycortexinmigraineursis~21%thickerthannon-migraineurs• Femalemigraineursshowthickergraymatterintheposteriorinsula,involvedinpainperceptionandtheprecuneus,whichwasrecentlylinkedtomigraines

• Recentlyageneticdefectwasfoundthatislinkedtomigraine,howeveritseemsapersonbecomessusceptiblebyinheritingmutationsinanumberofgenes

Notallsevereheadachesareduetomigraine.Theycanbeawarningsignofamoreseriouscondition.Thefollowingshouldraiseconcernandshouldbeinvestigated:

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• Changeincharacteroftheheadacheovertime• Headachesassociatedwithotherneurologicalsignsorsymptoms(eg,diplopia,lossofsensation,weakness,ataxia)

• Headachesofunusuallyabruptonset(migrainesnormallyhaveagradualonset)• Headachesthatarepersistent(particularlymorethan72hours)• Headachesthatfirstoccuraftertheageof55years• Headachesthatdevelopafterheadinjuryormajortrauma• Persistentheadachesononesideofthehead(one-sidedthrobbingheadachesmimickingmigraines:arteriovenousmalformationshouldbeexcludedw/imaging}

• Headachesthatareassociatedwithstiffneckorfever• HeadacheswithoutaclearfamilyhistoryofmigraineheadachePhasesofMigraineTherearefourdistinctmigrainephases;notallpeoplewillexperienceallphases;itmayvaryfromoneattacktoanother.1stphase-Prodrome:~60%experienceit;precedesheadachephasebyhourstodays;symptomscanincludefatigue,yawning,irritability,alteredmood,stiffmuscles,visceralsymptomsandosmophobia(sensitivitytosmells)

2ndphase-Aura:~30%experiencevisualsymptoms;lasts20-60minutes;symptomscanincludevisualormotordisturbances,osmophobia,paresthesias(pins&needles),sensitivitytotouch;whenauraisexperiencedbutnotfollowedbymigraineitiscalledamigraineequivalent,acephalicmigraineoropticalmigraine

3rdphase–Headache(orPain):100%experienceit;lasts4-72hours;symptomscanincludethrobbing,unilateralpainaggravatedbyphysicalactivity,nausea,vomiting,photophobia,phonophobia,pallor,blurredvision,nasalcongestion,sweating,diarrhea,coldextremities

4thphase–Postdrome(orResolution):~70%experienceit;symptomscanincludefatigue,difficultyconcentrating,moodchangesincludingeuphoria,weakness,gastrointestinalsymptomsCommonTriggers• Thereisawiderangeoftriggers;formanyitisacombinationof2or3factors• Researchersbelieveathresholdfortriggersmustbereachedtocausemigraine• Identifyingtriggerscanhelptomanagemigraines• Migrainescanoccurwithnotriggeratall• Manytriggersarebeyondourcontrol• ResearchershavenoknowledgeofwhycertainthingsactastriggersFollowingisalistofsomeofthemorecommontriggers:

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Food&DrinkRedwine;coffee;agedcheeses;processedmeats;mono-sodiumglutamate(MSG);preservatives;anythingcontainingsulphitesornitrates;gluten;occasionallybananasandnuts(usuallyalmonds);chocolateisrarelyatriggerChemicalsPerfume/cologneoranyscentedbeautyproduct;cleaningproducts;airfresheners/roomdeodorizers;adhesives;paint,varnish,strippers,etc.EnvironmentalFactorsHeat(indoorandoutdoor);highhumidity;changingweathersystems(stormfronts,etc.);suddenchangesinbarometricpressure;seasonalchanges;highaltitude;brightlighting(especiallyflorescent)HealthStress;musculartension;eyestrain;dehydration;hunger;allergies;hormonalchanges(womencanbemorepronetomigrainesjustbefore,duringorjustaftermenstruation;migrainescandevelopordisappearduringpregnancyorcandisappearaftermenopause);lackofsleep;fatigueBehaviouralSkippingameal;changeinsleepingpatterns(sleepinginonweekendsifonenormallywakesearlyduringtheweek);exerciseoroverexertionPsychologicalImpactofChronicConditions• Manylivingwithchroniccondiditonsexperiencefrustration,helplessnessandfeelalackofcontrolovertheirsituation

• Depressionis3timesmorelikelyinmigraineurs• Depressionincreasesperceptionofpain• Socialisolationiscommoninchronicconditions,especiallyonesinvolvingpain• Lossofself-identityisaseriousconsequenceofchronicconditionsImportanceofSelf-Care• Physicalbenefits:decreasedfrequency,durationandseverityofmigraine,increasedenergylevels,improvedsleep,increasedfunction

• Psychologicalbenefitsareequallyimportant:decreasedfeelingsofhopelessnessorhelplessness,decreasedfrustration,increasedoptimism,decreasedstress

• Thosewithchronicconditionscanhavefeelingofbeingdetachedfromtheirbody–self-carecanincreasetheconnectiontoone’sbody

• Evenminorimprovementsintheirconditionmaybenoticed• Researchshowsself-careleadstoincreasedfeelingsofmasteryandcontrol–theseinturnleadtoimprovedhealthoutcomes

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• Increasedfeelingofcontrolcanleadtoamorepositiveattitudewhichcaninturnhaveapositiveimpactonourhealth

• Withapositiveattitudepainandothersymptomsmaynotseemassevere• Withregularself-care,clientwillseebenefitsandhavetheknowledgethattheyarehavingapositiveimpactontheircondition

Self-CareforMigraine• Hydrate:researchhasshownmigraineursmaybemoresensitivetodehydration;increasingwaterintakeby4glassesperdaydecreasesheadachedaysby50%

• Strongcoffeeininitialstagesofmigrainecanhelp• Coldcompressestoforeheadandneck• Hotwatersoakforhandsandwrists• Regularstretchingofneckandshoulders• Self-shiatsu,acupressure• Peppermint/gingerteafornausea;lightsnacktopreventnauseafromworsening• Freshaircanhelptoeasemigraine• Getproperrestandeatwell• StressmanagementtechniquesifstressisatriggerMigraineDiary• Triggerscanbeidentifiedthroughtheuseofamigrainediary• Clientscanchartmigrainesandidentifyanypatternsofoccurrence• Listdates/timesofmigraine;duration;phases;symptoms;severity• Listpossibletriggersorothercontributingfactors• Documenttherapeuticinterventions(biomedical,CAM,self-care)todeterminetheireffectiveness

• Ifclientisunawareoftriggersaneliminationprocessmayhelpidentifythem• FormanytheirtriggersareamongthemorecommononesBiomedicalTreatment• Prescriptionmedication–triptansandopioidsarecommonlyused• Opioids:highlyaddictive,oftenhavesideeffects;overusecausesreboundheadaches• Botoxinjectionsaresometimesusedtotreatmigraine• Veryrecentresearchhasshownthattranscranialdirectcurrentstimulation(tDCS)canreducethefrequencyandseverityofmigraine

• Thissendsamildelectricalcurrentdeepintothebrainfromelectrodesattachedtothescalpandtargetsareasinvolvedinperceivingandregulatingpain

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CAMforMigraine• Lackofevidence-basedresearchonCAM;lackofmigraineresearchingeneral• ~50%ofadultswhosufferfrommigrainesorsevereheadachesuseaformofCAM• Morethan50%ofmigraineurswhouseCAMdonottelltheirhealthcareprovider• Shiatsu:shiatsumoreeffectivethanshiatsuwithamytriptalineoramytriptalinealoneindecreasingheadachefrequencyandseverity(Villanietal,2017)

• Shiatsu:Severalcasestudieshavenotedbenefitsformigraine• Shiatsu:decreasesshortandlong-termstress,anxietyandtension,whichcanbetriggers,andincreasesabilitytocope(Long,2007)

• Acupuncture:Additionalbenefitstousualcare;atleastaseffectiveasprophylacticdrugswithoutthesideeffects(Lindeetal,2009)

• Massage:2smallRCTsshoweda28%decreaseinfrequency,71%decreaseinpainseverity(Chaibietal,2011)

• Chiropractic:studiesshowdecreaseinfrequencyandduration(Chaibietal,2011)• Magnesium(600mgtrimagnesiumdicitrate):41%decreaseinfrequency;numberofdayswithmigraineanddrugusedecreased;adverseeffectsinsome(diarrhea);contra-indicatedinthosewithkidneyfailure(Peikertetal,1996)

• Riboflavin(vitaminB2,400mg):decreaseinfrequencyofatleast50%in59%ofparticipantsanddecreaseinuseofabortivedrugs;adverseeffectsrare(polyuria,diarrhea)(Boehnkeetal,2004)

• Co-enzymeQ10(150mg):50%decreaseinheadachedaysin61%ofparticipants• Feverfew:insufficientevidenceforrecommendation;interactionsandadverseeffectscommon(Pittleretal,2000)

• Butterbur:decreasedfrequencysignificantly;50%decreaseinfrequencyin77%ofadolescentparticipants(SunEdelstein&Mauskop,2009)

MigraineandOrientalMedicine• FromanOrientalmedicineperspectiveimbalancesinLiver&GallBladdermeridiansareconnectedtomigraine;damp/phlegmpathologiesmaybeinvolved

• StagnantLiverKiorKidneydeficiencyarethoughttocontributetomigraine• TherootofmigraineinOMisconsideredtobebloodkioryindeficiencyorheat• CirculatingstagnantKiintheneckandheadcanhelptorelievesymptoms• WorkingontheLivermeridianintheleg,particularlyLiver3,canfurtherhelp• TherearecountlessunderlyingcausesofheadachesfromanOMperspective,dependingonlocationofpain,timing,severity,othersymptoms,correlatedevents

ShiatsuTherapyTheory• ShiatsuisaJapanesemanualtherapyw/rootsinTraditionalChineseMedicine(TCM)• ThewordshiatsumeansfingerpressureinJapanese• Involvestheapplicationofsustainedpressuretospecificpointsonthebody

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• Asastandalonedisciplineithasbeeninexistenceforabout100years• Therearemanydifferenttypesofshiatsu:Masunaga,Zen,Namikoshi,etc.• WithMasunaga&ZenshiatsutheoryisbasedprimarilyonTCM• NamikoshishiastutakesamoreWesternapproach,consideringanatomyandphysiology

• Easternperspective:pointsfollowmeridianswhichrunthroughthebody• Qi,or‘vitallifeenergy’flowsthroughmeridiansandpressuretopointsalongthemcanpreventblockages,increaseenergyandhelprestorebalanceinthebody

• Westernperspective:pointsfollowmusclelines,nervepathways,bloodvessels• Pressurecanreleasemusculartension,relievepain,increasecirculation,boosttheimmunesystemandhelpmuscles,nervesandorganstofunctionattheirbest

• Regardlessofthestyle,somepointsusedarethesameasistheendresult• Shiatsucombinesassessmentandtreatment,differingfromotherTCMmodalities• ThetypeofpressureusedincreasescirculationsignificantlyandrelievespainApplication• Shiatsuisaholistic,full-bodytreatment,thoughthetherapistcanconcentrateonthespecificneedsofthepatient

• Thepressureshouldalwaysbeadjustedtosuitthecomfortlevelandhealthconditionoftherecipient;itshouldneverbepainful;evenverygentlepressureiseffective

• Itcanbedoneonanyone,regardlessofageorhealth;usegentlepressureonchildren,theveryelderlyorthoseinpoorhealth;usegentlepressureoninjuredorpainfulareas

• Therapistsusuallyworkfromproximaltodistal,lighttodeep(increasingpressurewitheachrepetitionofasequenceofpoints)

• Pressureisappliedwiththumbs,sometimeswithfingersorpalm(someuseelbows)• Usingthepadsofthethumbs,graduallyincreasepressure,holdforaboutfiveseconds,graduallyrelease

• Asequenceofshiatsupointsisusuallyrepeatedseveraltimes;thisincreasescirculationandenhancesrelaxation

• Thetherapistwillalsoincludestretchesinthetreatmentifappropriate• Shiatsuistraditionallydoneonafutonmatonthefloor;itismorecommonnowtousemassagetablesormassagechairs

• Thetherapistshouldapplypressurewiththethumbsextended;armsshouldbestraightbutelbowsnotlocked

• Whenstandingthetherapistsfeetshouldbeapart,kneesslightlybent• Useyourbodyweighttoapplypressure–leaninwhileapplyingpressureandleanbackwhilereleasing;Exhalewhileapplyingpressure,inhalewhilereleasing

Uses:• Usedforrelaxation,stressmanagement,aspreventivetreatmentandtotreatspecificchronicandacuteconditions

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Canhelpwith:• Muscle/jointinjuries,repetitivestraininjuries,overusesyndromes• Chronicconditionssuchasinsomnia,rheumatoidandosteoarthritis,ChronicPainSyndrome,Fibromyalgia,headaches,tinnitus,TMJ

• Asthma,allergies,sinusitis• Neurologicalconditions:migraines,Parkinson'sDisease,Alzheimer'sDisease,neuralgia

• Digestiveconditions:IBS,Chron'sDisease,diarrhea,constipation• Paresthesias,paralysis(especiallyusefulforthosewhohavehadstrokes)• Stress,anxiety,depression,lackofenergy• Researchhasdemonstratedshiatsuisofbenefitfor:pain;shortandlong-termstress;anxietyandtension;depression;structuralproblems;sleeplatencyandmaintenance;fibromyalgia;schizophrenia;autism

Contraindications• Contagiousillnesses;infectiousskinailments;veryhighfever• Immediatelyaftersurgery;oncesafetoapplyshiatsuareaofincisionshouldbeavoideduntilfullyhealed

• Appendicitis,cirrhosisoftheliver,duodenalulcers,intestinalobstruction,pancreatitis,pepticulcers,peritonitis,pleurisy,pyelitis,twistingofthebowels

• Abdominalpointsshouldbeavoidedonsomeonewhohaskidneystones,bladderorgallbladderstones,orifpersonhasinflammationofbladder,uterus,ovaries,fallopiantubes

• Abdominalpointsshouldbeavoidedduringpregnancyandwithanyonewhohasuncontrolledhypertension(gentlepressureonabdomenw/managedhypertension)

• Abdominalpointsshouldbeavoidedafteraheavymeal• Shiatsushouldbeavoidediftherehasbeenanybleedinginthelungs,brain,stomachShiatsuPointsforAcuteMigraineTreatmentTechnique:• Workwiththeclientinthesupinepositionwiththeirheadsupportedbyapillow• Onamassagetableorshiatsumatthepractitionerisseatedabovetheirhead• Graduallyincreasethepressure,hold~fiveseconds,graduallydecreasepressure• Pressureshouldalwaysbewithintheclients'comfortlevel;itdoesnothavetobestrongtobeeffective;keepinmindthattheclientisalreadyinpain

• Thisprotocolcanbeusedtodiminishmigrainepainbeforeproceedingwithyourregulartreatmentorusingmoredistalpoints

• ForPreventiveTreatment:workpointsonneck,shouldersandupperbackinproneposition;workpointsonheadandfaceinsupineposition

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PalmPressuretoForehead,Temple&Eyes• Uselefthandtosteadyhead• Applypalmpressuretoforeheadwithright;hold10-15seconds,slowlyrelease• Usebothpalmstoapplypressuretotemples;hold10-15seconds,slowlyrelease• Withfingersheldtogetherapplypressuretoeyes• Slowlyincrease,hold10-15seconds,slowlyreleaseFrontalRegionè • Threepointsalongmid-lineofforehead• Workinferiortosuperior;Repeatthreetimes• 1stjustabovebrowline,3rdjustbelowhairline• 3rowsof4pointsfrommid-linetowardtemple• Leftside,thenright,workinginferiortosuperior• Pointsareon:corrugatorsupercilii,orbicularisoculi,frontalis

Infra&Supra-OrbitalRegionsè • 4pointsbeloweye,workmedialtolateral• 4pointsaboveeye,workmedialtolateral• Workleftside,thenright• Repeatthreetimes• Infrapoints:levatorlabisup.alaequenasi,orbicularisoculi,lev.lab.sup.,zygomaticmin.

• Suprapoints:corrugatorsupercilli,orbicularisoculi,frontalis,levatorpalpebrae

TempleRegionè • 3pointsalongeachtemple• Workmedialtolateral,leftside,thenright• Pointsareon:orbicularisoculi(somecasesforpt.1),ant.auricularm.(somecasesforpt.3),temporalis

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ParietalRegion–Midlineè • Beginwithsixpointsalongthemid-lineofhead• Workanteriortoposterior• 1stpointjustbackfromhairline• 6thpointatcrownofhead• Pointsareon:galeaaponeurotica,superficialfascia

ParietalRegionè • Sixrowsoffourpointsoneachsideofmid-line• Workposteriortoanterior• Beginwithleft,thenright• Startatmid-lineandworklaterally• Finishwithsixpointsalongmid-line• Pointsareon:galeaaponeurotica,superficialfasciaLateralCervicalè • Fourpointsonthesidesoftheneck• Worksuperiortoinferior• 1stpointjustbelowmastoidprocess• 4thpointatbaseofneck• Point1isonsternocleidomastoid,spleniuscapitus,levatorscapulae,scalenusposterior;Point2:SCM,levatorscapulae,scalenusmedius;Point3&4:platysma,scalenusanterior(pt.4),brachialplexus,scalenusmedius

OccipitalRegionè • Threepointsalongbaseofskull• 1stpointjustbehindmastoidprocess• 3rdoneithersideofforamenmagnum(hollowatcentreofbaseofoccipitalbone

• Worklateraltomedial• Pointsareon:trapezius,galeaaponeurotica,superficialfascia

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Sub-OccipitalRegionè • Threepointsjustbelowoccipitalbone• 1stpointjustbelowandbehindmastoidprocess• 3rdpointoneithersideofspine• Worklateraltomedial• Points1&2areonsternocleidomastoid,spleniuscapitis,levatorscapulae(2),longissiumuscapitiis(1),posteriorbellyofdigastric(1),obliquscapitisinferior(1);Point3:trapezius,levatorscapulae,semispinaliscapitis,spinaliscapitis,rectuscapitisposteriormajor,intertransversarii

PosteriorCervicalè • Fourpointsoneachsideofthespine• Worksuperiortoinferior• 1stpointjustbelowoccipitalbone• 4thpointatbaseofneck• Points1&2areontrapezius,spleniuscap.,lev.scap.,iliocostaliscervicus,longissimuscap.,semispinaliscap.(1),semispinaliscervicis(2),obliquscap.inferior(1),multifidus(2),intertransversarii;Points3&4:spleniuscervicis,longissimuscervicis,semispinaliscervicis,multifidus,intertransversarii

Supra-ScapularRegionè • Threepointsalongtopofshoulder• Workmedialtolateral• 1stpointjustbesidebaseofneck• 3rdpointjustbeforetheacromion• Sustainedpressureonmiddlepoint:hold10-15seconds(overbrachialplexus)

• Pointsareon:trapezius,supraspinatusInter-scapularRegion(forpreventivetreatment)è • Fivepointsoneachsideofthespine• Worksuperiortoinferior• 1stpointparallelwithsuperiorangleofscapula• 5thpointparallelwithinferiorangleofscapula• Pointsareon:trapezius,rhomboidsminor(1),rhomboidsmajor,serratusposterior(1-3),spleniuscervicis(3-4),spleniuscapitis(1-3),thorocolumbarfascia(4-5),longissimusthoracis,spinalisthoracis(3-5),semispinalisthoracis,semispinaliscapitis,semispinaliscervicis(1-3),multifidus

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StretchestoReleaseNeck&ShoulderTensionForwardFlexionforNeckè • Supportclient'sheadwithlefthand• Sliprighthandunderclient'sheadplacinghandonleftshouldersothatheadrestsincrookofarm

• Placelefthandonrightshoulder• Gentlystretchheadforwardbystraighteningrightarmwhilesupportingsideofheadwithleftarm,risingupsomewhatwhileyoudoso

• Holdfor10-15secondsthenlowerhead• SupportheadwithlefthandwhileremovingarmLateralFlexionforNeckè • Supportheadw/righthand,placingleftonleftshoulder• Gentlypushshoulderdownwhilegentlymovingheadtowardrightshoulder

• Holdfor10-15secondsthenrelease• RepeatwithrightsideTractionforNeckè • SlipbothhandsunderclientsnecksoyourfingersrestoneithersideofspinenearC7

• Usingupwardpressureslidefingersalongsideofspineallthewayupnecktosub-occipitalarea

• Repeat,holdingfingersbelowocciputfor5-10secondsResources• MigraineResearchFoundation–valuableresourceofinfoonallaspectsofmigraineforthosewithmigraineandhealthprofessionals:migraineresearchfoundation.org

• MigraineAction–resourceforthosewithmigraineandhealthprofessionals;includesfactsheets,downloadsandeducationalevents:www.migraine.org.uk

• AssociationofMigraineDisorders–resourceincludingresearcharticlesforthepublicandhealthprofessionals:www.migrainedisorders.org

• MigraineResourceNetwork–educationalinitiativeforhealthprofessionalswithcon.ed.,casestudies,assessmenttools:www.migraineresourcenetwork.com

LeisaBellmore,ShiatsuTherapist416.844.1487www.leisabellmore.com

leisa@leisabellmore.comleisa.bellmore@uhn.caLeisaBellmore,ShiatsuTherapistonFacebook,LinkedIn&ResearchGate

©2018LeisaBellmorePleasedonotreproducewithoutpermission.