Everything You Need to Know About Massage Therapy for Headaches

Headaches are among the most common pain complaints, affecting approximately 40% of adults worldwide . While medications provide temporary relief for some, many people would prefer not to rely on medication and have more agency over their headaches.

Massage therapy is a popular intervention especially for those that recognize a correlation between the tension in the muscles in their neck and shoulders, and the intensity and frequency of their headaches.

As an evidence-informed massage therapist, I’ve helped clients manage tension headaches, cervicogenic headaches, and even post-concussion pain(after clearance from a doctor). Unfortunately not all headaches respond to massage, and often a combination of modalities is needed to manage them. Some require medical intervention, while others may improve with simple lifestyle adjustments.

Types of Headaches & How to Tell Them Apart

Not all headaches are the same. Understanding the different types of headaches can help to identify which areas are tender, what movements are restricted, and what the best course of action is for managing the headaches. Diagnosing your headache type is NOT within my scope of practice. If you are unsure of your headache type it is best to consult with a physical therapist or neurologist. They will take you through written, verbal, and movement based assessments and ultimately determine what types of headache you're experiencing.

Primary vs Secondary Headaches

When a headache in and of itself is a pathology it falls under the primary headache category(ie. Migraines and Tension-Type Headache). When a headache is a result of some underlying health condition or external factor it falls under the secondary headache category(ie. Sinus Headache and Cervicogenic Headache).

When Massage Can Help

Massage is generally helpful for managing symptoms of headaches that have some contribution from muscle tension, limited range of motion, and stress. While some people get relief in their sinuses, this is not a reliable expectation to have from massage. Cluster headaches and recent trauma to the head and neck generally contraindicate massage until the client has been medically cleared for massage by a doctor(preferably a physical therapist or neurologist). Generally speaking, if you feel that "muscle knots", pulling sensations, and certain movements contribute to the intensity and duration of your headaches massage can be a good adjunct treatment to manage symptoms.

How Massage Helps

The primary benefit of massage is reducing hypertonicity(read tightness) in the muscles. Massage doesn’t just relax muscles—it directly influences the pain-alarm system(nociception) in helpful ways. The sensory input from various massage techniques allows for the nervous system to alter the intensity and frequency of pain signals over time. This can be a double-edged sword, and sometimes the pressure and technique used can increase the amount of pain experienced by the client or cause a reliance on massage. This is why it's important to communicate with your massage therapist and avoid overly excessive pressure and range of motion. Massage can be a great opportunity to identify painful or sensitive areas that you may not be aware of. Massage can help to increase accessible range of motion for a short period of time, which can be leveraged to increase range of motion over the long term with carefully managed exercise. Most people experience a deep relaxation during massage sessions. This is facilitated by a downregulation in stress hormones and an influx of oxytocin and serotonin. Massage has a secondary circulatory benefit, meaning that blood flow to the areas massaged will be increased a marginal amount during the session.

In the context of headaches, specific massage to the muscles in the jaw, upper back, chest, anterior neck, posterior neck, arms, and shoulder blades can allow for temporary relief from headaches and increased range of motion. Though it's not uncommon for some client's headaches to completely go away after massage it should not be an expectation. Often the amount of tension in the muscles that is felt in resting postures is reduced, and clients are able to see how much stress impacts their experience of pain and tightness.

My Personal Experience With Headaches

I never had frequent headaches until I was in a car accident in May 2021. A drunk driver rear-ended my car driving extremely fast as I had just started to accelerate through a green light. Following this incident, I would have about 16 months of unrelenting headaches every single day. MRIs of my neck showed stenosis in my cervical vertebra and I presented with some whiplash symptoms. My pain was intensified with the turning of my head to the right and a constant pulling sensation at the base of my skull. After imaging was done and my headaches were Identified as cervicogenic, I received treatments from a chiropractor on a weekly basis and followed his suggested exercises. At first, I would only receive my typical 4-6 weeks frequency massage, but I noticed how much better I felt with a weekly or biweekly frequency after a few months and continued with that for about 3 months. Unfortunately in the case of the chiropractor and massage therapists I saw it was not always the case that I left with relief. At times they would insist on painful massage, or spending time on areas that were not a direct source of pain. After some trial and error, I was able to advocate for myself and receive manual therapy that truly made a difference in my pain. I also had a brief but helpful 6 weeks with a virtual physical therapist that helped me transition into strength training on my own. While I learned a lot of great stretches and specific exercises, I didn't find them to be all that important for my recovery. As long as I was maintaining a reasonable activity level and not over working myself my headaches eventually subsided.

Posture & Exercise: The Hidden Triggers

Posture is tricky because there are no bad postures. But holding any posture for long periods of time can absolutely contribute to pain. It's also very common for certain movements and postures to intensify pain and headaches. This is an individual process that you will have to discern for yourself over time, but there are some common patterns I see in people with headaches. Usually people notice discomfort with rounded shoulders and a forward head. They may also struggle with turn their head from left to right or bringing there ear to their shoulder. When headaches and pain related to them are really intense it's not a bad idea to spend some time doing specific exercises and stretching in that area. I personally found that simply meeting the physical activity guidelines was far more important.

When Massage Won’t Help (Red Flags)

If you're experiencing frequent and intense headaches it's a good idea to mention it to your primary care provider Seek a doctor if headaches:

• Are sudden and severe ("worst headache of your life").

• Include fever, confusion, or vision changes.

• Worsen with lying down or straining.

Self-Massage Techniques (Safe & Effective)

Suboccipital Release (with tennis ball):

1. Lie on back, place ball at skull base.

2. Gently nod "yes" for 30 sec.

Precautions:

• Stop if pain increases or radiates.

Non-Massage Habits That Can Influence Headaches

• Hydration: can be a factor and intensity and duration of headaches.

• Sleep: Prioritize 7–9 hours. Lack of sleep can contribute to intensity and duration of pain.

• Caffeine or other Stimulants: Can contribute headaches and excess muscle tension in some people

• Stress: reducing the stress you're under can have a significant impact on any pain you're experiencing including headaches.

Final Thoughts

Massage can be a powerful tool for tension and cervicogenic headaches—but it’s not magic. If you’ve tried stretches, hydration, and stress management with no relief, let’s work together.

📅 Book a session today, and let’s create a personalized headache-relief plan for you.