Exercise Training With Physically Active Lifestyle to Reduce Headache and Quality of Life
Condition: Headache; Physical Activity; Quality of Life
MeSH terms: Headache
Study type: Interventional

Summary: 
      The aim of this intervention study is to examine whether tailored exercise therapy training
      is effective and cost-effective to decrease headache frequency and intensity, reduce
      medication used for chronic headache and patients´ absence from work, improve their neck
      muscle force, cervical spine mobility, functional ability and quality of life, and increase
      general physical activity in chronic headache women at regular work during a 6-month
      intervention.

      The intervention itself with pilot-tested upper-neck specific exercise regimen aims that
      patients would independently commit to train and exercise to reduce their headache, and thus
      increase their quality of life. In addition, reduced pain and frequency of headache may
      increase the objectively measured daily physical activity of chronic headache patients.
    

Detailed description: 
      Tension-type,migraine and cervicogenic headache are the most common reasons for visits to a
      primary care physician among working women. Headache has major economic impact due to
      patients' absence from work, and pharmacy claims. Neck symptoms induce three percent of all
      visits to a primary care physician and 1 % of all costs in health care, and moreover,
      institutionalizing increase costs of treatment. Active treatment may offer cost-effective
      option for outpatients. In addition, there is no data showing how much headache/neck pain
      restricts participation in physical activity (PA) or other activities in society.

      The purpose of this study is to investigate whether specific therapeutic exercises reduce
      cervicogenic headache cost-effectively, and simultaneously improve neck function and quality
      of life. The other aim is to evaluate the effect of exercises on daily PA in women with
      chronic headache.

      The following hypotheses will be tested:

        1. Specific therapeutic exercises based on individual training reduce cost-effectively
           cervicogenic headache and improve neck function, and quality of life on women at regular
           work during a 6-month intervention

        2. The intervention increases general physical activity of women with cervicogenic headache

        3. The intervention assists them to manage the headache by way of exercising during the
           follow-up.

        4. Physical activity of women with chronic cervicogenic headache is lower than average in
           Finnish population.

      The HEADEX intervention study is a randomized controlled trial. Volunteers, women at regular
      work and having ongoing status with chronic migraine and/or cervicogenic headache will be
      recruited using newspaper advertising, from the register of Finnish Migraine Society and
      occupational health care services in Helsinki, Tampere and Jyvaskyla. The study sample is
      restricted to women, as the headache is much more common in women. After recruitment, the
      eligibility of patients to participate is screened. In total, the aim is to obtain 120 women
      to participate. The two subsequent baseline assessments and follow-up of headaches with the
      diary between two months before the beginning of the intervention enable ensuring intensity
      and type of the headache and that it is chronic. Randomisation is centralised but the
      intervention will be accomplished and clustered in three study centres. Sample size has been
      estimated for the primary outcomes. The number of participant will be 60 women in treatment
      and 60 control group.

      The 6 months exercise intervention consists of 6 supervised progressive exercise training
      sessions and home training program, and the participants are instructed to increase their PA.
      The main emphasis of the exercise program is to improve and relearn postural and movement
      control of neck, and later on strengthen the postural muscles. The exercise intervention
      consists of six supervised progressive exercise training sessions to teach rehabilitative
      training technique with similar home training program. Before the intervention, information
      on work ergonomics will be enquired and if needed, changes will be recommended. The control
      group will receive Transcutaneous Nervous Stimulation treatment (6 times) as a placebo
      treatment (intensity 0), and recommendation to maintain their PA at previous level. The
      follow-up is identical for both groups, and information on exercise frequency is collected up
      to 24 months follow-up.
    

Intervention name(s): Training group; Control
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The 60-minute training sessions include a few mobilization techniques for upper neck. In detail, three different exercises concentrated on postural and motor control will be taught during the first two training sessions. Progressively, two additional exercise movements aiming at postural and motor control will be taught in the next session. After eight weeks, two muscle strength exercises utilising therapeutic rubber band will be included into the program. The aim of the rubber band exercises is eventually to achieve the load of 80% of maximal voluntary contraction. The participants in the training group are also instructed to increase their amount of physical activity progressively according to the current physical activity recommendations.; The control group will receive six sessions of Transcutaneous Nervous Stimulation treatment (TNS) as a placebo treatment (0) and the participants in control group are recommended and encouraged to maintain their previous normal level of physical activity and exercise habits throughout the study without any supervision or home training programs.
Other intervention name(s): Movement control of neck; Muscle training of the postural muscles of upper neck; Physical activity
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: headache; women; exercise; fear avoidance; physical activity