A Randomized, Controlled Trial of Massage Therapy as a Treatment for Migraine Sheleigh P. Lawler, Ph.D. Department of Psychology The University of Auckland and Cancer Prevention Research Centre University of Queensland Linda D. Cameron, Ph.D. Department of Psychology The University of Auckland ABSTRACT Background: Migraine is a distressing disorder that is of- ten triggered by stress and poor sleep. Only one randomized controlled trial (RCT) has assessed the effects of massage therapy on migraine experiences, which yielded some promis- ing findings. Purpose: An RCT was designed to replicate and extend the earlier findings using a larger sample, additional stress-related indicators, and assessments past the final ses- sion to identify longer-term effects of massage therapy on stress and migraine experiences. Methods: Migraine sufferers (N = 47) who were randomly assigned to massage or control conditions completed daily assessments of migraine experi- ences and sleep patterns for 13 weeks. Massage participants attended weekly massage sessions during Weeks 5 to 10. State anxiety, heart rates, and salivary cortisol were assessed before and after the sessions. Perceived stress and coping efficacy were assessed at Weeks 4, 10, and 13. Results: Compared to control participants, massage participants exhibited greater improvements in migraine frequency and sleep quality during the intervention weeks and the 3 follow-up weeks. Trends for beneficial effects of massage therapy on perceived stress and coping efficacy were observed. During sessions, massage in- duced decreases in state anxiety, heart rate, and cortisol. Con- clusions: The findings provide preliminary support for the utility of massage therapy as a nonpharmacologic treatment for individuals suffering from migraines. (Ann Behav Med 2006, 32(1):50–59) INTRODUCTION Migraine is a prevalent and distressing disorder that can profoundly affect well-being and general functioning (1). Ap- proximately 18% of women and 7% of men in the United States experience migraine headaches (2), which typically involve pul- sating pain on one side of the head that is aggravated by physical activity and accompanied by nausea, vomiting, and photo- and phonophobia (3,4). Migraine attacks are extremely variable in their frequency, intensity, and duration. Stress is a primary trig- ger for migraine attacks, and it can exacerbate their intensity and duration as well as their frequency. Migraine attacks usually are the most frequent between the ages of 25 and 55, which are often considered to be an individual’s most productive work years (2). According to data from the American Migraine Study II (2), 53% of respondents reported that their migraines caused sub- stantial impairment in activities and that they required bed rest during attacks. Approximately 30% reported missing at least 1 day of work or school in the previous 3 months because of mi- graines, and 50% reported that work or school activity was re- duced. Migraine clearly poses a significant burden to individu- als, their families, and society. Although many pharmacologic treatments are available, migraine sufferers may choose to use nonpharmacologic treat- ments because they cannot take specific medications due to poor tolerance, medical contraindications, pregnancy or breastfeed- ing, high cost, or the interference of side effects with daily rou- tines. Migraineurs with significant stress, poor coping skills, or a history of excessive medication use (which can aggravate mi- graines) may also benefit from nonpharmacologic therapy (5). Massage is one of several behavioral techniques to receive atten- tion as a potential treatment for migraine (5–7). As a relaxation technique, massage may assist in preventing migraines by re- ducing sympathetic arousal and other physiological responses that can contribute to their onset (8). Massage may also promote changes in cognitive appraisals of events, and these appraisals may reduce stress in the days following the massage and thus add further protection from migraine attacks. Research investigating the therapeutic effects of massage therapy for migraine headaches is scarce. To date, only one ran- domized controlled trial (RCT) of massage therapy for migraine treatment has been conducted (9). Although the trial revealed that massage reduced migraine frequency and some physiologi- cal factors associated with stress, it used a small sample and evaluated only a limited number of the cognitive, behavioral, and physiological factors involved in stress regulation that may be responsible for the massage effects on migraine experiences. This study represents a further, preliminary step in evaluating the impact of massage on migraine experience as well as on sympathetic arousal, stress and coping processes, and sleep be- havior in individuals with migraine conditions. 50 We thank the New Zealand College of Massage for their contribution to this project. Reprint Address: S. P. Lawler, Ph.D., Cancer Prevention Research Cen- tre, School of Population Health, Level 3, Public Health Building, The University of Queensland, Herston Road, Herston, QLD 4006, Austra- lia. E-mail: s.lawler@uq.edu.au © 2006 by The Society of Behavioral Medicine.