Craniosacral therapy for migraine: Protocol development for an exploratory controlled clinical trial

Table 2 Summary of procedural sequence at each visit for craniosacral therapy (CST), 2007–2008

1.	Brief review of recent headache symptoms and general symptoms and assessment of any adverse effects of treatment
2.	Evaluation of the craniosacral rhythm*, including amplitude, quality, and rate
3.	Arcing, palpating for active lesions – checking for fascial restrictions^†
4.	Fascia releases at pelvis, dural tube traction, L5-S1 decompression, sacro-iliac decompression^§
5.	Fascia releases at lower respiratory, thoracic inlet, hyoid, and cranial base
6.	Vertical membrane (falx cerebri) system evaluation and treatment using frontal and parietal bone and soft tissue manipulations
7.	Horizontal membrane system (tentorium) evaluation and treatment using sphenoid and temporal bone and soft tissue manipulations
8.	Mandibular compression and decompression
9.	Hard palate intra-oral evaluation and treatment
	a. illary-palatine: flexion/extension, torsion, shear, compression
	b. vomer evaluation: flexion/extension, torsion, shear, compression
	c. palatine
	d. zygoma and nasal bones
10.	Dural tube evaluation – mobility, tension and restrictions^#
11.	Still-point induction**
12.	Global assessment with percentage improvement

* The craniosacral rhythm is palpated by the practitioner (at the feet) and assessed for rate, quality, and symmetry. A normal rate is 8–12 cycles per minutes. A normal rhythm shows a balanced vitality.
† Arcing is a gentle traction technique for detecting fascial restrictions.
§ Decompression allows for the release of joint and soft-tissue restrictions.
# Dural tube, the sheath of connective tissue surrounding the spinal cord, is evaluated through manual palpation of the spine between the occiput and the sacrum.
** Still point induction is a manual technique performed at the occiput, designed to bring the craniosacral rhythm to a therapeutic pause.

ISSN: 2662-7671