Treatment of Tension-type Headache With Articulatory and Suboccipital Soft Tissue Therapy
Condition: Tension-type Headache
MeSH terms: Tension-Type Headache; Headache
Study type: Interventional

Summary: 
      Background. Headache is one of the most common causes of consultation in primary health care
      and neurology in Europe. Cervical muscle tension can maintain a restriction of joint motion
      at the suboccipital level, facilitating the referred head pain.

      Objective. To evaluate the effectiveness of two manual therapy treatments for tension-type
      headache.

      Methods. A randomized double-blind clinical trial was conducted, for a period of 4 weeks and
      a follow-up at one month post-treatment. Eighty-four patients with tension-type headache were
      assigned to 4 groups (3 treatment groups and 1 control group). Treatments included manual
      therapy of suboccipital soft tissue inhibition, occiput-atlas-axis global manipulation, and a
      combination of both techniques. Outcome measures were: impact of headache, disability caused
      by headache, ranges of motion of the craniocervical junction, frequency and intensity of
      headache, and associated headache symptoms.

      Results. After 8 weeks, there were significant improvements in impact of headache (p=0.01),
      disability (p=0.001), and craniocervical flexion (p=0.03) for the suboccipital soft tissue
      inhibition group; in headache impact and disability (p=0.000), pain intensity (p=0.02) and
      craniocervical flexion (p=0.004) and extension (p=0.04) for the occiput-atlas-axis group; and
      in impact (p=0.002), functional disability (p=0.000), headache frequency (p=0.002) and
      intensity (p=0.001), craniocervical flexion (p=0.008) and extension (p=0.003) and associated
      headache symptoms (p=0.01) for the combined therapy group, with effect sizes from medium to
      large.

      Conclusions. Occiput-atlas-axis and combined therapy group treatments are more effective than
      suboccipital soft tissue inhibition for tension-type headache. The treatment with
      suboccipital soft tissue inhibition, despite producing less significant results, also has
      positive effects on different aspects of headache.
    


Intervention name(s): Manual Therapy; Manual Therapy; Manual Therapy; Placebo control
Intervention type(s): Other; Other; Other; Other
Intervention description(s): All patients were assessed in the same conditions before the treatment, after the treatment (at 4 weeks), and at follow-up (after 8 weeks). Four treatment sessions (one session per week). Prior to each treatment session, 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 SI treatment aims to release the suboccipital muscle spasm10 that maintains the occiput-atlas-axis joint dysfunction. This technique, which was administered for 10 minutes, uses a deep and progressive gliding pressure applied with the fingertips towards the posterior arch of atlas.; All patients were assessed in the same conditions before the treatment, after the treatment (at 4 weeks), and at follow-up (after 8 weeks). Four treatment sessions (one session per week). Prior to each treatment session, 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 OAA manipulation was bilaterally administered and it attempts to restore the motion dysfunction of this complex. It is a structural technique performed on a vertical line along the odontoid process of axis; neither flexion nor extension is used, and lateroflexion is minimal.; All patients were assessed in the same conditions before the treatment, after the treatment (at 4 weeks), and at follow-up (after 8 weeks). Four treatment sessions (one session per week). Prior to each treatment session, 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 combination of both treatments aims to determine whether this combination has greater effects than the separate application of each treatment. After receiving the treatment, the subjects in the experimental groups stayed for five minutes in the supine resting position, in neutral ranges of cervical flexion, extension, lateral flexion and rotation.; All patients were assessed in the same conditions before the treatment, after the treatment (at 4 weeks), and at follow-up (after 8 weeks). Four treatment sessions (one session per week). Prior to each treatment session, 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.
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Effectiveness; Tension-type headache; Manual therapy