Original Article
Efficacy of Manual and Manipulative Therapy in the Perception of Pain and Cervical Motion in Patients With Tension-Type Headache: A Randomized, Controlled Clinical Trial

https://doi.org/10.1016/j.jcm.2014.01.004Get rights and content

Abstract

Objective

The purpose of this study was to evaluate the efficacy of manipulative and manual therapy treatments with regard to pain perception and neck mobility in patients with tension-type headache.

Methods

A randomized clinical trial was conducted on 84 adults diagnosed with tension-type headache. Eighty-four subjects were enrolled in this study: 68 women and 16 men. Mean age was 39.76 years, ranging from 18 to 65 years. A total of 57.1% were diagnosed with chronic tension-type headache and 42.9% with tension-type headache. Participants were divided into 3 treatment groups (manual therapy, manipulative therapy, a combination of manual and manipulative therapy) and a control group. Four treatment sessions were administered during 4 weeks, with posttreatment assessment and follow-up at 1 month. Cervical ranges of motion pain perception, and frequency and intensity of headaches were assessed.

Results

All 3 treatment groups showed significant improvements in the different dimensions of pain perception. Manual therapy and manipulative treatment improved some cervical ranges of motion. Headache frequency was reduced with manipulative treatment (P < .008). Combined treatment reported improvement after the treatment (P < .000) and at follow-up (P < .002). Pain intensity improved after the treatment and at follow-up with manipulative therapy (P < .01) and combined treatment (P < .01).

Conclusions

Both treatments, administered both separately and combined together, showed efficacy for patients with tension-type headache with regard to pain perception. As for cervical ranges of motion, treatments produced greater effect when separately administered.

Introduction

Tension-type headache (TTH) is the most prevalent type of the primary headache categorized by the International Headache Society,1 and it is a health problem with great socioeconomic impact.2, 3 Both episodic tension-type headache (ETTH) and chronic tension-type headache (CTTH) have important repercussions on the quality of life, affecting the working and social spheres, as well as the activities of daily living.4

As for the treatments administered, Lenssinck et al2 carried out a systematic review to assess the effectiveness of physiotherapy and spinal manipulation in the treatment of TTH and showed that there was no conclusive evidence of its effectiveness. However, later studies showed that treatment with manual therapy techniques combined may be effective in reducing the frequency, intensity, and duration of headaches and has a positive influence on the quality of life, disability, and global range of motion.5, 6, 7

There is evidence of the presence of active trigger points in suboccipital muscles in subjects with CTTH compared with healthy subjects.8 There is also evidence of the connection between TTH and head-neck musculoskeletal disorders and of a higher intensity and frequency of pressure pain in trapezius muscles.9 Likewise, the variations in head position are connected with cervical mobility in TTH patients.10 It has been observed that central sensitization caused by prolonged periods of pain may lead to headache chronification.11 Tension in suboccipital and neck muscles probably involves limitation of movement in the cervical region; and therefore, knowing the range of motion might be useful as a reference for the quality of neck muscles. The perception of pain and its different dimensions (ie, word descriptors for pain in headache) are aspects that should be assessed in patients with headache to better know the pain sensation experienced by the patient, as this can alter their quality of life.

The aim of this study was to evaluate the efficacy of the treatment with manual and manipulative therapy, administered separately and combined together, in patients with TTH through assessment of frequency, intensity, and perception of pain and cervical ranges of motion and, subsequently, to detect if changes after treatment are maintained at 1 month.

Section snippets

Methods

Four treatment sessions (1 session per week) were administered, with an interval of 7 days. Treatments were carried out by 2 physiotherapists with more than 10 years of experience in the treatment of headache with manual therapy. Each session lasted for approximately 20 minutes.

This study was supervised and approved by the research committee of the University of Murcia. Informed consent of patients was obtained before treatment, and all procedures were conduced according to the Declaration of

Results

Out of the 84 subjects initially participating in the study, 4 participants dropped out for different reasons (2 subjects dropped out from the manipulation group: 1 because of mild cervical pain after the treatment and 1 for personal reasons. And 2 subjects dropped out from the control group: 1 subject was lost because of transient ordinary disease, and 1 subject was lost for not feeling pain relief), as shown in Fig 2. In the month prior to the study, average pain intensity was rated at 6.49

Discussion

The results obtained in this study showed that TTH has specific pain characteristics, in accord with the classification of the International Headache Society1 about TTH and its diagnosis developed in 2004. Regarding pain perception, manipulative treatment, manual therapy, and combined treatment have shown efficacy in reducing pain in all the dimensions assessed, although the group with manipulative treatment stood out from the others. Pain intensity also improved in all groups, even in the

Conclusion

The findings of this study showed that treatment with manual therapy showed efficacy in most aspects of pain perception in TTH; however, manipulation and combined treatment were more beneficial. Treatment with manual therapy was better at improving cervical flexion, extension, and rotation, while manipulative treatment was better at improving extension, left lateral flexion, and rotation. The frequency of headache episodes decreased with the treatments including manipulation, maintaining this

Funding Sources and Conflicts of Interest

No funding sources or conflicts of interest were reported for this study.

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