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myofascial techniques

BY TIL LUCHAU

In the Advanced Myofascial Techniques training, our hands-on goal when working with migraines is to metaphorically “decompress” the bones of the
cranium, which can provide both immediate pain relief and a reduction in headache frequency. Image courtesy of 3DCranio. Used with permission.

108 massage & bodywork november/december 2010
Working With Headaches, Part 3
Techniques for Migraines

Hands-on work can help

migraines. Multiple studies

substantiate this,1 as does

the anecdotal evidence we’ve

witnessed in our private

practices and in the stories

we hear from our Advanced

Myofascial Techniques

seminar participants.

Even though the causes and
mechanisms of migraine and cluster
Palate technique. Feel through the maxilla
headaches are only partially understood
from both inside and outside the mouth.
(as discussed in Part 2 of this series,
Massage & Bodywork, September/
October 2010, page 108), we’ve found
we’re often able to relieve active and released, our primary hands-on goal
acute migraines and, in many cases, can for working with vascular headaches
reduce their frequency when chronic. becomes reducing cranial compression.
In Part 1 (Massage & Bodywork, This empirical approach
July/August 2010, page 110) of this originates in my personal experience
series, we looked at how tension and as an occasional migraine sufferer.
other musculoskeletal headaches are During one of my own migraines,
dramatically relieve many migraines
different from migraines. For more my clear sense was that relief from
if performed during an episode.
common musculoskeletal headaches, the crushing pain lay not in working
Prevention is harder to quantify, but
our main hands-on goal is to release on the outside of my head, but by
many clients (though not all) have
any myofascial tension contributing to getting inside my cranium itself and
reported reduced headache frequency
the head pain. This is also a useful way opening it outward from within.
and severity when regularly performing
to start when working with migraines, I can’t say if “reducing cranial
these techniques on themselves.
especially since many migraines are compression” is solely a subjective
comingled with myofascial restrictions metaphor, or if the techniques
Palate Technique
(and can even be triggered by a tension described here actually diminish
If our aim when working with
headache). In the case of migraines, cranial compression in an objectively
migraines is to decompress the cranium
there is an additional step we can take. verifiable way. However, in both my
from the inside out, what better place to
Once fascial restrictions have been personal and clinical experience, these
get inside the head than the palate? Not
methods reliably and sometimes quite

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Join Til Luchau and the Advance-Trainings.com faculty, with special guest Art
Riggs, in Costa Rica, February 26–March 5, 2011, for an Advanced Myofascial Retreat.
Call 877-499-8811 or visit www.advanced-trainings.com for more information.

In the embryo, development of the maxilla and palatine bones closes Conversely, a pronounced palatine raphe (an anterior/posterior
the plate. A cleft palate results when this closure is incomplete. ridge along the palate’s intermaxillary and interpalatine midline
Image from Gray’s Anatomy of the Human Body, 1918. sutures) may be a result of cranial crowding or narrowing of the
palate. Image courtesy of Primal Pictures. Used with permission.

only is the hard palate the “keystone” Feel for unusual bony resilience pressure and wait for a small, yet
of the cranium’s interlocking bony (soft or hard areas, not to be mistaken perceptible, yielding. The pacing
structure, compression of the palate by for the nodules of the small glands on of your pressure is slow and steady.
braces or orthodontics seems to have the posterior palate). Check in with Imagine pushing a boat away from a
at least an anecdotal relationship with your client (verbally and nonverbally) dock: at first, there is no movement, but
migraines and comingled headaches.2 for feedback about any places that as you lean and wait, the boat yields and
When working the palate, all change the quality of the head pain. begins to drift. At the risk of mixing
customary considerations about If your client is having a headache, metaphors, another way to describe
intraoral work apply, of course. Be sure there will usually be areas where what we’re feeling for might be the
to explain the purpose for working pressure will relieve or change the tactile “give” of a nearly ripe avocado.
inside the mouth to your client and pain. Wait in these places with steady A pronounced palatine raphe (an
get explicit permission before you do pressure, encouraging your client to anterior/posterior ridge along the
so. Practice sanitary procedures with relax, breathe, and release. Although palate’s midline sutures, Image 4)
glove disposal and hand washing, ask it can take several minutes in each can sometimes be a result of cranial
about latex sensitivity, and be familiar spot, you can often diminish the crowding or narrowing of the palate.
with any local or state scope-of-practice headache’s intensity and sometimes Using gentle but firm outward pressure,
stipulations (some states require relieve it completely by being patient encourage widening and lateral
specific training or endorsement to be and methodical here—painstaking release of the roof of the mouth.
qualified to work within the mouth, and might be the right word. A cleft palpate could be thought
a small minority prohibit it outright). We aren’t trying to release the of as the opposite—a palate with
To work the palate, use your gloved soft tissue or myofascia on the palate; too much decompression. In fetal
index finger inside the mouth, together we’re waiting for a change in bony development (Image 3), the bones of
with the thumb of the other hand mobility. Although subtle, this tangible a cleft palate never met and closed
outside, feeling the maxilla and palate yielding of bony resilience indicates along the centerline. Anecdotally, some
between your two hands (Images 1 and suture release and an increase of people whose cleft palates have been
2). Use firm, static pressure to feel the osseous adaptability. Although your repaired surgically report an increase
shape and mobility or fixity of the bones touch is receptive, this isn’t the light in migraines, almost as if the closing of
that make up the palate. Don’t slide touch of craniosacral work. Although the palate was accomplished too tightly.
around with your inner finger; instead, skilled craniosacral work can be Why does mobilizing the bones
press, feel for a response, wait, and then extraordinarily helpful for migraines, of the palate so often reduce migraine
release and move to the next spot. in this technique we use firm, tangible pain? Perhaps it is through an effect

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myofascial techniques

on the trigeminal nerve, which
branches into the greater palatine and
nasopalatine nerves above and below
the palate (Image 5). Or perhaps the
direct pressure is transmitted through
the vertical vomer into the sphenoid
bone and the cranial base, where
the pituitary and hypothalamus sit
(both of which may play a role in the
neuro-electrical “brainstorm” of a
migraine). Since much of the venous
drainage of the cranial vault occurs
through foramina in this area, we may
help decrease intracranial pressure by
opening the vascular “drains” of the
vault. Whatever the reason it works,
I am confident that you and your
migraine clients will come to value this
technique. Instruct your clients on how
to perform it on themselves at the first
sign of migraine.

External Acoustic
Meatus Technique
Since our intention with migraines
is to decompress the relationship
between the cranial bones, the ears are
convenient handles for applying traction
directly to the temporal bones. The
Our metaphorical goal of decompressing the cranial bones may give relief to migraines by
external part of the ear (or auricle) has
relieving pressure on the trigeminal nerve, shown here with the brainstem. One of the trigeminal’s
firm fascial attachments to the surface
branches, the greater palatine nerve (green), may be the reason that work on the hard palate
of the temporal bone, and the ear canal
can often relieve migraine pain. Image courtesy of Primal Pictures. Used with permission.
(or acoustic meatus) passes deep into
the temporal’s petrous portion (Image
6). The medial end of this petrous part
your client about how much traction via their connective tissue linkages
cradles the trigeminal nerve where
is comfortable; pull steadily, and wait to the internal acoustic meatus and
it emerges from the brainstem (the
for at least a few breaths. Try traction tentorium). Repeat this simple but
trigeminal nerve is likely involved in
in slightly different directions and profound release in a slightly different
both migraines and cluster headaches).
stay in close verbal communication direction. Alternatively, you can grasp
Aligned with the meatus and adjacent
about which variations most affect the tragus (the small external projection
to it within the petrous portion of
the headache’s pain. Sometimes the anterior to the opening of the ear canal)
the temporal bone are the carotid
smallest adjustments to angle, grip, or the earlobes to feel into different
canal and the internal carotid artery.
and pull make a large difference parts of the ear canal. As with palate
These supply blood to the cerebral
to your client’s experience. work, be patient and thorough, staying
hemispheres, eyes, and forehead—areas
Once you’ve found an angle that in constant verbal communication
where migraineurs and cluster headache
feels relevant to your client, simply with your client to get the angle
sufferers are often most affected.
hold the traction, imagining or feeling and amount of traction just right.
Holding both ears’ conchae (the
how the ear canals might actually Freeing the temporal bones in
inner cartilaginous bowl around the
connect with one another at a place this way can relieve both migraines
opening of the ear) as in Image 7,
a little anterior of the center of the and musculoskeletal headaches.
apply sensitive but firm posterolateral
head (which in one sense, they do, Musculoskeletal headaches
traction. Use the ear canal to feel or
imagine deep into the cranium. Ask

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You can see these techniques in Massage & Bodywork’s digital edition, which features a video
clip from Advanced-Trainings.com’s Advanced Myofascial Techniques DVD and seminar
series. The link is available at massageandbodywork.com and abmp.com.

The ears are effective handles for applying With the External Acoustic Meatus Technique, use firm but gentle posterolateral
traction to the temporal bone (superimposed traction with the external ear to feel deep into the fascial and osseous connections
in blue). The temporal’s petrous portion within the cranium. Active movement of the eyes and jaw can augment and broaden
(medial, darker violet) houses the acoustic the release. Image courtesy of Primal Pictures. Used with permission.
meatus and the internal carotid artery, which
supplies the cerebral hemispheres, eyes, and
forehead. Its medial end cradles the trigeminal
our expectations about completely play an extremely useful role in
nerve (yellow). Source images courtesy of
“curing” migraines. Migraines are managing the pain of migraines and in
Primal Pictures. Used with permission.
complicated and seem to have multiple preventing the stress and myofascial
causes. Although I have had very good strain that can trigger them.
luck at relieving acute migraine pain in
my practice (perhaps 90 percent), the Til Luchau is a member of the Advanced-
respond especially well when you
percentage of clients who have reported Trainings.com faculty, which offer distance
add active movement of the eyes
an overall improvement in frequency learning and in-person seminars throughout
and jaw to extend the release into
or severity is somewhat lower than that the United States and abroad. He is also a
these structures (Image 7).
(perhaps two-thirds have reported less Certified Advanced Rolfer and teaches for
frequent migraines, although I suspect the Rolf Institute. Contact him via info@
Do Good Work
this percentage could have been higher advanced-trainings.com and Advanced-
It is always a good idea to have your
if we’d been able to do more frequent Trainings.com’s Facebook page.
client check with his or her physician
work together). Regularity seems to
when there are recurring, severe,
be an important key: the two studies NOTES
or persistent headaches, even if you 1. Two studies that show beneficial effects of hands-on
cited in note 1 below, both employed
are able to relieve the pain with the work with migraine sufferers are: Maria Hernandez-Reif
regular, repeated sessions, and both
methods described here. In almost all et al., “Migraine Headaches are Reduced by Massage
found that this helped reduce migraine Therapy,” International Journal of Neuroscience
cases, headaches are uncomfortable but
frequency, as well as provided other (October 1998) 96: 1–11; and Sheleigh P. Lawler and
benign; however, they can be a sign of
benefits such as improved sleep, etc. Linda D. Cameron, “A Randomized, Controlled Trial
other problems and a medical doctor of Massage Therapy as a Treatment for Migraine,”
Whether or not we permanently
should rule these out, just to be safe. Annals of Behavioral Medicine 32 (2006): 50–9.
“cure” our clients’ vascular headaches,
Although hands-on work can 2. Kirsten Hannan, “Orthodontic Braces and Migraine
or simply provide them with welcome
provide welcome relief for migraine Headache: Prevalence of Migraine Headache in Females
symptomatic relief, I’m confident
and cluster headache sufferers, it is Aged 12–18 Years With and Without Orthodontic
you’ll find that hands-on work can Braces,” International Journal of Osteopathic
wise to be optimistically balanced in
Medicine 8, no. 4 (December 2005): 146–151.

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