Treatment of Tension-type Headache With Articulatory and Suboccipital Soft Tissue Therapy

University of Valencia

Status: Completed

Conditions: Tension-type Headache

Treatments: Other: Placebo control; Other: Manual Therapy

Study type: Interventional

Funder types: Other

Identifiers

NCT01550276

UVT001

Details and patient eligibility

About

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.

Enrollment: 84 patients

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age between 18 and 65 years, episodes of headaches lasting from 30 minutes to 7 days, headache having at least two of the following characteristics: *bilateral location

  • pressing non-pulsating quality
  • mild or moderate intensity
  • not aggravated by routine physical activity.

• Participants may present photophobia or phonophobia, nausea or vomiting, pericranial tenderness, with evolution of more than three months, and they must be under pharmacological control.

Exclusion criteria

• Patients with other types of headache
• Headache that is aggravated by head movements
• Metabolic disorders or musculoskeletal complaints previous neck trauma
• Vertigo
• Dizziness
• Arterial hypertension
• Advanced degenerative osteoarthritis
• Neck joint stiffness
• Signs of malignancy
• Pregnancy
• Patients with cardiac devices
• Patients in process of pharmacological adaptation, and excessive emotional tension

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Factorial Assignment

Masking: Triple Blind

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84 participants in 4 patient groups, including a placebo group

Suboccipital soft tissue inhibition

Experimental group

Description:

The SI treatment aims to release the suboccipital muscle spasm that maintains the occiput-atlas-axis joint dysfunction.

Treatment:

Other: Manual Therapy

Other: Manual Therapy

Other: Manual Therapy

Occiput-atlas-axis global manipulation

Experimental group

Description:

The OAA manipulation was bilaterally administered and it attempts to restore the motion dysfunction of this complex

Treatment:

Other: Manual Therapy

Other: Manual Therapy

Other: Manual Therapy

The combination of both treatments

Experimental group

Treatment:

Other: Manual Therapy

Other: Manual Therapy

Other: Manual Therapy

control group

Placebo Comparator group

Treatment:

Other: Placebo control