How Gua Sha Helps Headaches & Steps to Gua Sha at Home
In my quest to try and keep head pain in check, I have tried what feels like dozens of home remedies.
A lot of them have only been mildly helpful or haven’t helped at all. A few have helped a lot.
One which has become an apparently useful tool in my head pain management toolbox which I don’t think a lot of headache sufferers likely are familiar with is gua sha.
In this article, I will tell you how this traditional remedy might be helpful for pain management, and how you can do it at home on your own.
What is Gua Sha? (Say: Gwah Shah)
Gua sha is a traditional Chinese medicine (TCM) technique. It is also sometimes called “kerokan,” “spooning,” “scraping,” or “coining.” Sometimes it is called “cupping,” but this can also refer to a completely different technique involving suction.
Gua sha is used for headaches, acute or chronic neck pain, back pain, TMJ pain, and a range of other conditions that involve muscle pain.
During gua sha, a practitioner (which can be you) pulls a ceramic spoon or similar instrument across the skin with moderate pressure in long strokes that can reach the underlying muscles.
This is done rapidly a number of times in order to increase circulation in the tissue.
During the process, sometimes, red marks (they can also have a purplish, brownish or even blackish tint) will appear. These look similar to bruises, but are actually called “petechiae.”
What is the difference? Bruising happens when there is damage to capillaries. Gua sha, performed properly, does not damage capillaries. Instead, through a process called “extravasation,” blood cells are pushed out of the capillaries while the capillaries themselves remain intact and unharmed.
These marks can look very dramatic. But unlike a bruise, they will fade relatively quickly.
They also should not be painful, nor should the process of gua sha itself. So try not to be intimidated by appearances.
Depending on a number of factors, the marks might linger for as long as a week, but often will be gone inside a couple of days.
In some cases, they may vanish within mere hours.
Some people report immediate pain relief from gua sha. Others report that they feel better over the days or weeks that follow.
Key Point: Gua sha is a traditional Chinese technique which involves scraping a spoon or similar object over your muscles in an attempt to boost circulation.
What is the Science Behind Gua Sha?
Whether gua sha sounds intuitive to you or not probably depends on your specific pain condition, history, cultural background, and experience level with massage and other techniques.
If you have had Swedish massage therapy, it may actually sound familiar. This is because it is similar to the effleurage massage technique which Swedish massage practitioners often open up with before going deep.
But if gua sha does not sound intuitive to you, you might wonder why pulling a spoon across your muscles and producing red marks would possibly make you feel better.
What is the science behind gua sha? Are there gua sha studies to back its possible benefits?
At this point, research into gua sha benefits is still in the early stages, as it is with many alternative therapies. Most studies which have been performed are small.
The Effect of Gua Sha Treatment on the Microcirculation of Surface Tissue: A Pilot Study in Healthy Subjects
This study made use of laser Doppler imaging (LDI) to look into microcirculation in surface tissue as a result of gua sha. 11 patients participated. The researchers found that, “Gua Sha caused a fourfold increase in microcirculation PUs at the treated area for the first 7.5 minutes following treatment and a significant increase in surface microcirculation during the entire 25 minutes of the study period following treatment (P < .001). Females showed significantly higher rates of response than males (P = .003).”
Interestingly, some participants experienced pain relief in “distal sites”—sites not directly treated with the gua sha. The researchers assert, “Decrease in myalgia at sites distal to a treated area is not due to distal increase in microcirculation. There is an unidentified pain-relieving biomechanism associated with Gua Sha.”
I have my own thoughts about the LDI study above—namely that the distal relief might be related to trigger points.
What is a “trigger point?”
It is basically another word for a muscle knot. Muscle knots happen to everyone. For a lot of people, they are fleeting in nature, and might occur as a response to an acute injury or stress on the muscle, and resolve rapidly and easily on their own.
But for others, trigger points are chronic in nature. They could be linked to a chronic injury, a problem with alignment or posture, myofascial pain syndrome (MPS), migraine headaches, fibromyalgia or another condition.
Healthcare practitioners debate the existence of trigger points, but you can quite literally feel such knots and tight bands of muscle tissue yourself, as can any skilled massage therapist.
If you have trigger points, it is common for them to refer pain to distant sites. Indeed, there are many trigger points in the neck, shoulders and back which are associated with head pain. You can view a guide to these referral patterns here.
Being as there is still debate about the existence of these trigger points as well as their nature, it doesn’t surprise me that they are not discussed in the research article. If you would like to learn about this topic in detail, you can see my write-up on the subject of trigger points and migraines.
On a biochemical level, trigger points are complicated, and to say that they are not well-understood is an understatement.
Indeed, any “understanding” that we have about them is still mostly in the realm of theory.
One of the definitive works we have on trigger points at this time is Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual.
As described by the American Society of Regional Anesthesia and Pain Medicine (ASRA), Simons came up with what is known as the “integrated trigger point hypothesis.” ASRA explains:
“An energy crisis perpetuates sustained contracture of the muscle fibers near an abnormal endplate. The excessive acetylcholine release and the sustained sarcomere contracture lead to increased local metabolic demands and compressed capillary circulation. With the decreased blood flow and sources of adenosine triphosphate, muscle fibers remain in a contracted state and are unable to return calcium to the sarcoplasmic reticulum for muscle relaxation. The local hypoxic condition leads to release of ischemic mediators that can sensitize peripheral nociceptors and generate pain.”
In other words, when you have a trigger point, the muscle tissue is suffering in large part from a decrease in circulation.
Because of this, the resources that the muscle tissue needs to release are unavailable, which sustains the trigger point in a vicious cycle.
So in my analysis, the results concerning microcirculation in the study I previously shared are interesting and potentially significant, but the study is too small to be definitive.
I also am not sure whether there is another pain-relieving mechanism that play as the researchers suggest, or whether gua sha might simply be reducing pain at distal sites by increasing circulation in the local referring trigger points.
If, for example, one scrapes a muscle in the neck which refers pain to the head when trigger points are present, one could, in theory, improve circulation in the trigger point, helping it to release. This in turn might result in a reduction in referred pain.
Want more details? Here are some more studies which may provide possible support for gua sha:
- Gua sha for neck pain: In this study, there were 24 patients in a control group and 24 patients in an experimental group that received one gua sha treatment. The control group received heat therapy instead. The researchers found, “Neck pain severity after one week improved significantly better in the Gua sha group compared with the control group (group difference −29.9 mm, 95% confidence interval: −43.3; −16.6 mm; P < 0.001). Significant treatment effects were also found for pain at motion, scores on the NDI, and dimensions of quality-of-life. The treatment was safe and well tolerated.”
- Gua sha for headaches: In a case study, “a patient who suffered from chronic headaches, highly profited from Gua Sha during her 14-day inpatient multimodal treatment. This case provides first evidence that Gua Sha is effective in the treatment of headaches.” Note that this was in a case of medication overuse headache.
- Gua sha for neck and back pain: This 2012 study, 40 patients participated who had either chronic neck or back pain. There was a waiting list control group and a treatment group. The study found, “Patients in both the CNP and the CLBP treatment groups reported pain reduction (p < 0.05) and improved health status from their one Gua Sha treatment, as compared to the waiting list group. Pain sensitivity improved in the TG in CNP, but not in CLBP patients, possibly due to higher pressure sensitivity in the neck area. No adverse events were reported.”
There are some other studies that look at gua sha benefits for other conditions—everything from Hepatitis B to symptoms of perimenopause.
Key Point: There is some initial research which suggests that gua sha may be effective for increasing local circulation and decreasing pain. Because the studies are small, they are not definitive. More research is needed.
Criticisms of Gua Sha
The first obvious (and valid) cautionary note concerning gua sha is exactly what I stated above. Research evidence to this point is limited. Because that is the case, scientifically, it would be incorrect to conclusively say that gua sha works. We simply do not know.
On the Wikipedia page for gua sha, someone has written outright, “Any apparent benefit from gua sha is due to the placebo effect.”
They have been linked this out to an article titled, “Gua sha: torture or treatment?” by a researcher named Edzard Ernst, who do does have credentials (he is an MD).
I have a couple of criticism of this article, the first being its title, which is overtly sensationalist. Why is this necessary in this context? How is it helpful?
I do agree with its author about the studies in question not being substantial enough on their own to provide conclusive support for gua sha. But I disagree with his assertion that the placebo effect is necessarily responsible for the results.
Why? Because, first of all, he has no proof of that either. But secondly, because I see problems with his explanation. Ernst writes the following:
“My explanation for the observed effects after Gua Sha is quite simple: imagine you have a headache and accidentally injure yourself – say you fall off your bike and the tarmac scrapes off an area of skin on your thigh. This hurts quite a bit and distracts you from your headache, perhaps even to such an extend that you do not feel it any more. As the wound heals, it gets a bit infected and thus hurts for several days; chances are that your headache will be gone for that period of time. Of course, the Gua Sha- effect would be larger because the factors mentioned above (exotic treatment, expectation etc.) but essentially the accident and the treatment work via similar mechanisms, namely distraction and counter-irritation. And neither Gua Sha nor injuring yourself on the tarmac are truly recommendable therapies, in my view.”
Following are my counterpoints based on my experiences:
- First of all, my experiences with gua sha have not been painful—at least no more so than a massage. If this is “torture,” so is a back rub. So there is no competing pain sensation when the gua sha is in progress. Also, once the technique is completed, it leaves no sensation behind it at all.
- Secondly, when I am in the throes of a migraine, I desperately try to create a counter-sensation of any kind, even to the point of almost compulsively clawing holes in my skin (not gua sha, naturally—just a behaviour I manifest). Doing this does not effectively alleviate the pain. It works more as a stim for helping me regulate myself psychologically and emotionally. It doesn’t make me feel better physically—it helps me to prevent a complete and total meltdown of the mind.
So, my question would be: How does scratching through my skin until it bleeds not alleviate my pain via some kind of placebo distraction, while gua sha, which does not hurt, has a beneficial effect?
I cannot prove or disprove anything by providing my anecdotes. But you have my thoughts on Ernst now.
You also can read through the rest of the page to see arguments and counterarguments from both sides. There are hundreds of comments, including basic arguments over definitions.
Key Point: Gua sha’s limited research is a valid criticism. There are also people who believe that the placebo effect is responsible for its perceived beneficial results.
My Personal Experiences with Gua Sha
As there is not sufficient scientific evidence to declare “gua sha works!” or “gua sha doesn’t work,” personal anecdotes are as useful as anything in a discussion of this soft tissue technique.
So, just as an example, I will share my own experiences with gua sha.
For reference, to my best understanding, these are my pain issues:
- Migraine headaches
- Cervicogenic head pain
- Tension headaches
- A misaligned jaw
- Myofascial pain syndrome (MPS) with chronic, referring trigger points
I experience trigger points with taut bands of muscle in my neck, shoulders and back to some degree the majority of the time.
I have classic pain referral patterns. You can view the most common ones at the links below:
… Plus the rest on this page.
Note that my localized pain is very mild, if I notice any at all. I experience it almost all in my head and face. It can be mild, moderate or severe.
So, when I do gua sha, I use these reference pages to decide which muscles to target. I have made the following observations concerning my experiences with gua sha (your mileage may vary!):
- It is common for me to feel some instant mild to moderate pain relief when doing this technique, sometimes even while experiencing moderate to severe head pain. Again, this cannot be the result of a competing pain sensation since I’m not experiencing one.
- Directly after gua sha, sometimes, the pain relief persists. Other times, it wears off partly or completely within a relatively short time period of time (like 10-30 minutes).
- After a few hours or within the next day or two, it is common for me to feel much improved, regardless of whether the initial pain relief wore off quickly or not.
- It is mostly likely for me to get pain relief from gua sha if the red marks show up.
- Gua sha can occasionally make pain worse. It is possible to overdue it, which seems to happen if I exert too much pressure and/or tackle muscles that should be left alone (I suspect that structural abnormalities in my body may over-strain certain muscles, and pressing on them damages them—that or they have chronically damaged tissue that should be steered clear of).
- Gua sha doesn’t always produce red marks or relief even on extremely tight muscles. It is unclear to me why this is the case. Sometimes a tight muscle will seemingly “ignore” gua sha for days, and then, eventually, respond, following which there will finally be some relief. My theory is that a muscle which is too tight may simply not respond to this therapy, just as it might resist other methods of trigger point release, but if it loosens up a little on its own, gua sha might become effective on it. But I have no idea whether that notion holds any truth.
It is common for me to have referred pain issues which have been persisting for a week or more which finally respond and tone down after a couple of hours or days once I do gua sha.
So, this gives you an idea of what one possible individual experience of gua sha might be like, as well as a few pointers (i.e. don’t overdo it).
But keep in mind that your own individual experience could be very different from mine, so you should not base your expectations on my results.
So, you want to give gua sha a try?
I am not professionally trained, and therefore, do not feel I can tell you responsibly, “This is how to do gua sha!” But, what I can do is tell you how I perform this technique on myself.
I can also give you some recommendations which will prevent injury to your skin and muscles.
Please note that if you have problems involve blood not clotting, you should avoid gua sha to be on the safe side. You also should consider avoiding it if you are using blood thinners.
To do gua sha, you will need the following supplies:
- Something to use for scraping
- An oil for your skin
- A mirror
- A second, handheld mirror (optional)
What can you use as a gua sha tool?
You need an object with an edge which is curved, but not sharp. That means that a metal lid for a bottle, jar or can, for instance, is not a suitable choice. Neither is a metal spoon.
Here are couple of examples of objects which would be suitable as gua sha tools:
- A ceramic soup spoon (this is what I use)
- A scraping tool made specifically for gua sha (they are usually made of polished stone like jade or rose quartz).
What about a jade roller for skincare? While this might seem like a related tool, it isn’t. I guarantee it won’t work at all for gua sha for chronic pain.
Why do you need an oil for your skin?
If you do not oil your skin, you will generate too much friction. This can lead to redness and inflammation in your skin, and can irritate the underlying soft tissue as well.
You can use any type of healthy oil that you want. This could be jojoba oil, baby oil, olive oil, coconut oil, or anything else.
What about lotion or a soothing balm like Tiger Balm?
In a pinch, you can get away with it. But it will dry up faster than the oil, leaving your skin and muscles susceptible to abrasion again. It also just doesn’t do as good a job.
STEP BY STEP: Here are the gua sha steps I follow:
- I rub some oil on the areas I will treat. Sometimes, I also apply heat for a few minutes. This seems to make it easier to get gua sha to work.
- I press with the spoon and pull it down in a long stroke over the muscle I am treating, typically in the direction of that muscle. I do this quickly. I apply moderate pressure. On a scale of 0-10, I imagine it is something like a “4-6.” This is in keeping with current thinking about trigger point release. It is believed that pressing down too hard could actually make circulation issues worse in trigger points. Plus, if you press too hard, you’ll just end up bruising yourself, which won’t help.
- I repeat many strokes across a muscle, each immediately after the other. I don’t count these; I just make a determination about when the job is done (see below).
- If about half a minute of work isn’t generating any/much redness from a muscle, nothing is likely going to happen with it. I move away from it. If I am getting some redness out of a muscle, I keep going until the color isn’t getting any deeper. I then work on patches higher or lower on that muscle and/or on nearby muscles until I have tackled as much of the problem region as possible effectively. I then move on to check other frequent problem areas.
- If I am scraping my back, I use a handheld mirror to check in my bathroom mirror whether marks are appearing. I do this so that I don’t have to twist my neck to check behind me, which would just exacerbate what I am trying to treat.
The entire process above usually takes around 5-15 minutes, depending on what needs to be done.
There are certain areas I always avoid, because they behave as if they are chronically injured. Any times I have messed with them, it has been to my detriment. And if I ever get a “Don’t do that!” signal from my body, I immediately stop what I am doing.
After gua sha, you can just go back about your regular activities. No after-treatment should be necessary.
I’ve noticed that the longer an area has been acting up before I managed to successfully treat it, the darker the marks usually are and the longer they take to fade away. But usually, within around 3-4 days, even the worst of them are barely visible or are gone.
Will Other People Look At My Marks With Concern?
One thing that freaked me out about gua sha when I started with it was, “What are other people going to think when they see these marks?”
I thought they’d be mistaken for burn marks, marks of abuse, or marks of self-injury. So, I covered them up, and didn’t even tell anyone about this thing I was doing. I should note that I live in a Western country.
I stopped worrying about it when my Japanese chiropractor noticed the marks one day and recognized them.
There are stories of Western doctors mistaking gua sha for abuse.
But I have never had any issues or questions from any doctors since I stopped hiding the marks. Everyone I have dealt with has been content with a quick explanation, so I think in most cases, it is generally fine if they are seen.
As for hiding them from other people, I don’t anymore. Once again, a quick explanation generally suffices. Most people don’t notice anyway.
Plus, for me, it is therapeutic psychologically to have the signs of pain actually be visible.
Chronic pain disorders are so often invisible, and I prefer to increase awareness of conditions like myofascial pain syndrome and migraine headaches.
Other Home Remedies to Try for Head Pain
Gua sha may work well for you, as it has for me. But gua sha isn’t for everyone. And even if you do get results from it, it is just one tool in your chronic pain management toolbox. To get the best potential improvements in your life, you will want to take a multi-pronged strategy.
Along with gua sha, you can also try the following ideas for managing head pain at home:
- Heat or cold therapy
- Lidocaine patches or topical balms or ointments
- OTC medications
- Herbal treatments such as Vitex, butterbur, boswellia, feverfew, or ginger
- Lifestyle adjustments with diet and exercise
These and many other recommendations are detailed in our blog, so keep exploring the rest of our articles for natural and alternative remedies for head pain. Whether you try gua sha or not, I wish you the best of luck on your pain management journey.