Effectiveness of the Treatment of Tension-type Headache With Manual and Manipulative Therapy
Condition: Tension-type Headache
MeSH terms: Tension-Type Headache; Headache
Study type: Interventional

Summary: 
      Background. Tension-type headache (TTH) is the most common form of primary headache and it is
      a real problem for the subjects suffering from it. Until now, physiotherapy treatments have
      included different techniques combined together, without establishing which of them is more
      effective.

      Objective. The purpose of this study is to know the effectiveness of manipulative and manual
      therapy treatments, with regard to pain perception and neck mobility in patients with
      tension-type headache.

      Methods: A double-blind, randomized clinical trial was conducted, with 84 patients diagnosed
      with tension-type headache, divided into three treatment groups -manual therapy, manipulative
      therapy, and a combination of both techniques-, and a placebo control group. Four treatment
      sessions were administered during four weeks, with post-treatment assessment, and follow-up
      at one month. Cervical ranges of motion were assessed (CROM device), as well as pain
      perception (McGill Pain Questionnaire), and frequency and intensity of headaches (weekly
      register).
    


Intervention name(s): Manual Therapy; Manual Therapy; Manual Therapy; placebo treatment
Intervention type(s): Other; Other; Other; Other
Intervention description(s): Manual therapy of Suboccipital soft tissue Inhibition is performed with patient in supine position. The patient's head leans against the physiotherapist's hands, which palpate suboccipital muscles by sliding fingertips until contacting posterior arch of atlas. At this point, a deep and progressive gliding pressure is applied, for 10 minutes. The purpose of this technique is to release suboccipital muscle spasm, which can be responsible for the mobility dysfunction of the occiput-atlas-axis joint.; Occiput-atlas-axis joint manipulation is performed in the same position as the previous technique. It is bilaterally administered and it consists of 2 phases: firstly, rotation with gentle head decompression with no flexo-extension and slight lateral flexion is performed, followed by small circumductions aimed at increasing arterial viscoelasticity and searching for adequate joint barrier through selective tension; secondly, a high speed thrust manipulation in pure rotation towards the side to be manipulated is performed, with a head helicoidal movement, with the aim of restoring the mobility of joints between occiput, atlas and axis, which enables to correct a global joint dysfunction.; Occiput-atlas-axis joint manipulation is performed in the same position as the previous technique. It is bilaterally administered and it consists of 2 phases: firstly, rotation with gentle head decompression with no flexo-extension and slight lateral flexion is performed, followed by small circumductions aimed at increasing arterial viscoelasticity and searching for adequate joint barrier through selective tension; secondly, a high speed thrust manipulation in pure rotation towards the side to be manipulated is performed, with a head helicoidal movement, with the aim of restoring the mobility of joints between occiput, atlas and axis, which enables to correct a global joint dysfunction.; The physiotherapist performed the vertebral artery test bilaterally, followed by a two-minute neck massage without lubricants and with no proven therapeutic effect, as a placebo for all study groups.
The control group received four sessions of placebo treatment, followed by ten minutes of resting position.
Other intervention name(s): Tension-type Headache; Tension-type Headache; manipulation; Tension-type Headache; Manipulation; Resting position; Tension-type Headache
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Tension-type headache, Effectiveness, Manual therapy