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Caballero L1,2, Antón Puescas PE3,4, Bravo Cucci SD5
1Escuela de Terapia Física, Universidad Peruana de Ciencias Aplicadas, Lima, Peru, 2Hospital Guillermo Kaelin de la Fuente, Lima, Peru, 3Universidad Nacional Mayor de San Marcos, Lima, Peru, 4Hospital Central Fuerza Aérea del Perú, Lima, Peru, 5Escuela de Terapia Física, Universidad Peruana de Ciencias Aplicadas UPC, Lima, Peru
Background: The tension-type headache (TTH) is a neurological disorder characterized by a predisposition to suffer episodes of headache of mild to moderate intensity with some associated symptoms, and although the fundamental cause of TTH is still uncertain, there is evidence of its association with musculoskeletal dysfunctions of the cervical spine, as a decrease in the range of motion of the cervical spine, presence of myofascial trigger points (TrP) in the cervical muscles, in addition to the reduction of the muscle activity of the deep cervical flexors. It has been seen myofascial structures involved in a tension type headache, likewise numerous studies suggest that the referred pain induced by the stimulation of the TrP reproduces the headache in patients with TTH.
Purpose: The purpose of this study is to compare the effect of the application of upper trapezius TrP inactivation techniques and suboccipital inhibitory distraction (SID) associated with deep cervical flexor training (DCF) versus conventional physical therapy in patients with tension-type headache.
Methods: The study population consisted of 60 patients with TTH, those patients were randomly asigned into two treatment groups; one experimental group (EG) and another control group (CG). The first group received conventional physical therapy (hot therapy pack, massage and self-stretching) plus SID technique, upper trapezius TrP inactivation technique and DCF training, while the control group received only conventional physical therapy, and each participant received 8 sessions for 4 weeks. The assesments were made before, at the intermediate and at the end of the treatment using the headache impact test (HIT-6), the neck disability index (NDI) and the visual analogue scale (VAS) for pain intensity.
Results: Both EG and CG groups showed significant differences before and after the treatment in VAS, HIT-6 and NDI (p 0.001). Comparing between groups (EG and CG) at the end of the treatment, differences were shown statistically significant in favor of EG: in VAS the EG decreased by 78.9% compared to the CG with 43.1% (p 0.001), the HIT-6 EG decreased 29.1% compared to the CG with 11.5% (p 0.001) and the NDI decreased 75.7% compared to CG with 23.4% (p 0.001). Both groups reported a lower frequency of headache.
Conclusion(s): Both interventions have positive results for the treatment of tension-type headache, but the treatment with application of the upper trapezius (TrP) inactivation techniques and suboccipital inhibitory distraction (SID) associated with deep cervical flexor training (DCF) and conventional therapy was the most effective. It is suggested to investigate new treatment schemes that include techniques of manual therapy, exercise and muscle inactivation techniques.
Implications: The intervention of physical therapy should be integrated into the treatment of tension headache as first-line treatment, conventional schemes can integrate the techniques described in this study to get better benefits.
Keywords: Tension-type headache, manual therapy, headache
Funding acknowledgements: Universidad Peruana de Ciencias Aplicadas UPC
Purpose: The purpose of this study is to compare the effect of the application of upper trapezius TrP inactivation techniques and suboccipital inhibitory distraction (SID) associated with deep cervical flexor training (DCF) versus conventional physical therapy in patients with tension-type headache.
Methods: The study population consisted of 60 patients with TTH, those patients were randomly asigned into two treatment groups; one experimental group (EG) and another control group (CG). The first group received conventional physical therapy (hot therapy pack, massage and self-stretching) plus SID technique, upper trapezius TrP inactivation technique and DCF training, while the control group received only conventional physical therapy, and each participant received 8 sessions for 4 weeks. The assesments were made before, at the intermediate and at the end of the treatment using the headache impact test (HIT-6), the neck disability index (NDI) and the visual analogue scale (VAS) for pain intensity.
Results: Both EG and CG groups showed significant differences before and after the treatment in VAS, HIT-6 and NDI (p 0.001). Comparing between groups (EG and CG) at the end of the treatment, differences were shown statistically significant in favor of EG: in VAS the EG decreased by 78.9% compared to the CG with 43.1% (p 0.001), the HIT-6 EG decreased 29.1% compared to the CG with 11.5% (p 0.001) and the NDI decreased 75.7% compared to CG with 23.4% (p 0.001). Both groups reported a lower frequency of headache.
Conclusion(s): Both interventions have positive results for the treatment of tension-type headache, but the treatment with application of the upper trapezius (TrP) inactivation techniques and suboccipital inhibitory distraction (SID) associated with deep cervical flexor training (DCF) and conventional therapy was the most effective. It is suggested to investigate new treatment schemes that include techniques of manual therapy, exercise and muscle inactivation techniques.
Implications: The intervention of physical therapy should be integrated into the treatment of tension headache as first-line treatment, conventional schemes can integrate the techniques described in this study to get better benefits.
Keywords: Tension-type headache, manual therapy, headache
Funding acknowledgements: Universidad Peruana de Ciencias Aplicadas UPC
Topic: Pain & pain management; Pain & pain management; Musculoskeletal: spine
Ethics approval required: Yes
Institution: Hospital Nacional Madre Niño 'San Bartolomé'
Ethics committee: Comité de ética institucional e investigación
Ethics number: 13136-16
All authors, affiliations and abstracts have been published as submitted.
