PT Classroom - Acupressure for the Treatment of Headaches ׀ by Denise Chang, MD & Chai Rasavong, MPT, MBA

Headaches are a common condition which are experienced by many and may be treated by physical therapists in the physical therapy clinic. The National Headache Foundation estimates that more than 45 million Americans suffer from headaches (1). Conducting a detailed evaluation along with obtaining a thorough history can not only assist with establishing an accurate diagnosis but aid in determining a proper plan of care for the patient as well (2).

The International Classification of Headache Disorders classifies “primary headaches into four categories: 1.0, migraine; 2.0, tension-type headache; 3.0, cluster headache and other trigeminal autonomic cephalalgias; and 4.0, other primary headaches. There are nine categories of secondary headache, which are headache attributed to 5.0, head and neck trauma; 6.0, cranial or cervical vascular disorders; 7.0, nonvascular intracranial disorders; 8.0, substance or its withdrawn; 9.0, infection; 10.0, disorder of homeostasis; 11.0, disorders of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or cranial structures; 12.0, psychiatric disorders; and 13, cranial neuralgias and central causes of facial pain. Finally, there is a fourteenth category that includes headache not classifiable elsewhere (3)”.

In the physical therapy clinic patients seen with headaches usually present with migraine or tension-type headaches. Physical therapists can employ a range of treatment options varying from postural training, functional training, modalities, stretching and various manual therapy techniques to assist with treating these patients with headaches. One form of an alterative treatment option which we have found useful for treating headaches in the clinic is acupressure. This treatment option is somewhat similar to another technique called trigger point release which is already utilized by many therapists in the clinics for treatment of headaches and other conditions.

Acupressure is a traditional Chinese medicine technique derived from acupuncture which utilizes fingers to press key points on the surface of the skin that are especially sensitive to bioelectrical impulses in the body (4). It is believed that when these points are pressed, endorphins are released which have the ability to block pain and promote the flow of blood and oxygen to an affected area (4). This in turn will also cause the muscles to relax and stimulate the body’s self-curative abilities (5).

Two preliminary studies (6,7) reported benefits from using finger pressure on specific acupuncture points (acupressure) to relieve tension-type headache pain in some patients. However, no controlled research on this approach has been done (8).

In a study which supported acupressure but not necessarily its use for treating headaches, Kober et al. found that acupressure is an effective and simple-to-learn treatment of pain in emergency trauma care and leads to an improvement of the quality of care in emergency transport (9).

In light of the positive results which we have obtained in the clinic, one can see that a review of the published research which is available for acupressure for the treatment of headaches is exceptionally encouraging but to some extent still limited. As we wait for better quality research to be conducted and published, we hope that practitioners continue to be open-minded and believe that the provision of this alternative treatment option should not be withdrawn.
 

	Gall Bladder 20 (GB20) - Wind Pool       How to locate the point: Wind Pool is located at the back of the head, on both sides of the middle axis next to the muscles that can be felt.               How to apply pressure to the point: Place both thumbs on the points to the left and right of the middle axis of the head. Massage the points using first steady pressure and then circling pressure, in clockwise and then counterclockwise movements, for one to two minutes each.
	Large Intestine 4 (LI4) - Valley of Union       How to locate the point: Make an O with your thumb and index finger so that a small bulge of muscle rises just above the web of skin between the index finger and thumb on the back of the hand. This bulge marks the site of Large Intestine 4.               How to apply pressure to the point: Take one hand in a tweezers grip between your thumb and index finger, with your thumb resting on Large Intestine 4 and the tip of the index finger on the other side of the hand as a balancing point, apply steady pressure and then circling pressure for one to two minutes each. Please note that acupressure to Large Intestine 4 should not be utilized during pregnancy as this can stimulate uterine contractions (4,5).