File
Rinne M1, Garam S2, Kukkonen-Harjula K3, Tokola K1, Häkkinen A4, Ylinen J5, Nikander R4,6
1UKK Institute for Health Promotion Research, Tampere, Finland, 2Metropolia University of Applied Sciences, Physiotherapy, Helsinki, Finland, 3South Karelia Social and Health Care District (Eksote), Rehabilitation, Lappeenranta, Finland, 4University of Jyväskylä, Faculty of Sport and Health Sciences, Jyväskylä, Finland, 5Central Hospital of Central Finland, Department of Physical Medicine and Rehabilitation, Jyväskylä, Finland, 6GeroCenter Foundation for Aging Research and Development, Jyväskylä, Finland
Background: Headaches place a great burden on health care. Although physical therapy regimens are commonly used among patients with chronic recurrent headaches, there is no definitive evidence on which physical therapy approach is the most effective.
Purpose: To investigate whether progressive postural control and specific neck muscle strengthening exercise program reduces headache among women with chronic recurrent headaches in comparison to a placebo dose of transcutaneous electrical nerve stimulation. The secondary aim was to study the effects of exercise programs on neck function and disability.
Methods: The 6-month randomized controlled trial was conducted in two study centers including 116 women (mean age 44 y) with chronic recurrent cervicogenic or tension-type headaches and/or migraine. The participants were randomized to an exercise (n=57) or a control group (n=59). The participants in the exercise group were taught six progressive home training programs with postural control, muscle strengthening, and stretching exercises. The control group received sham transcutaneous electrical nerve stimulation treatment, and the same stretching exercises as the exercise group. The primary outcome was headache including its intensity (numeric rating scale from 0 to 10), weekly frequency, and duration of episodes, assessed using diaries. Secondary outcome measures were the range of movements in the cervical spine, isometric endurance of flexor and extensor muscles of the neck, and Neck Disability Index. Generalized linear mixed models with covariates were used in statistical analyses for headache outcome measures, and the other measures were analyzed by analysis of covariance. Cohen's d was used to calculate the effect size.
Results: In intention-to-treat analyses, the intensity remained unchanged in both groups, but the participants in the exercise group reduced their mean frequency of weekly headaches from 4.5 to 2.5, whereas the reduction in the control group was from 4.2 to 3.0 (p 0.01 for between-group difference), d for reduction was 0.59. The duration of headache declined in both groups roughly by 10 hours and he between-group difference was not statistically significant. The mean rotation movement increased 8 degrees (p=0.02), isometric neck flexor muscle endurance 22 seconds (p 0.01), and neck disability index improved 1.6 points (p=0.03) more in the exercise than in the control group.
Conclusion(s): The frequency of weekly headache reduced in the exercise group clinically relevantly which might alleviate the discomfort of the women with chronic recurrent headache. Postural and specific muscle training was feasible, and can be prescribed as a treatment alternative for women with chronic recurrent headaches. Further research is needed to investigate whether the headache frequency reduction persists. These findings should be replicated to explore if the beneficial training effects could be found among both women with non-migraine headaches and women with migraines.
Implications: This was a real-life trial, and women with recurrent chronic headache were recruited using advertising. The trial relied on home exercises supported by instructions given in a booklet and training videos, and therefore, the costs of the training program are low.
Keywords: Headache, exercise, physiotherapy
Funding acknowledgements: This trial was supported by a grant from the Social Insurance Institution of Finland.
Purpose: To investigate whether progressive postural control and specific neck muscle strengthening exercise program reduces headache among women with chronic recurrent headaches in comparison to a placebo dose of transcutaneous electrical nerve stimulation. The secondary aim was to study the effects of exercise programs on neck function and disability.
Methods: The 6-month randomized controlled trial was conducted in two study centers including 116 women (mean age 44 y) with chronic recurrent cervicogenic or tension-type headaches and/or migraine. The participants were randomized to an exercise (n=57) or a control group (n=59). The participants in the exercise group were taught six progressive home training programs with postural control, muscle strengthening, and stretching exercises. The control group received sham transcutaneous electrical nerve stimulation treatment, and the same stretching exercises as the exercise group. The primary outcome was headache including its intensity (numeric rating scale from 0 to 10), weekly frequency, and duration of episodes, assessed using diaries. Secondary outcome measures were the range of movements in the cervical spine, isometric endurance of flexor and extensor muscles of the neck, and Neck Disability Index. Generalized linear mixed models with covariates were used in statistical analyses for headache outcome measures, and the other measures were analyzed by analysis of covariance. Cohen's d was used to calculate the effect size.
Results: In intention-to-treat analyses, the intensity remained unchanged in both groups, but the participants in the exercise group reduced their mean frequency of weekly headaches from 4.5 to 2.5, whereas the reduction in the control group was from 4.2 to 3.0 (p 0.01 for between-group difference), d for reduction was 0.59. The duration of headache declined in both groups roughly by 10 hours and he between-group difference was not statistically significant. The mean rotation movement increased 8 degrees (p=0.02), isometric neck flexor muscle endurance 22 seconds (p 0.01), and neck disability index improved 1.6 points (p=0.03) more in the exercise than in the control group.
Conclusion(s): The frequency of weekly headache reduced in the exercise group clinically relevantly which might alleviate the discomfort of the women with chronic recurrent headache. Postural and specific muscle training was feasible, and can be prescribed as a treatment alternative for women with chronic recurrent headaches. Further research is needed to investigate whether the headache frequency reduction persists. These findings should be replicated to explore if the beneficial training effects could be found among both women with non-migraine headaches and women with migraines.
Implications: This was a real-life trial, and women with recurrent chronic headache were recruited using advertising. The trial relied on home exercises supported by instructions given in a booklet and training videos, and therefore, the costs of the training program are low.
Keywords: Headache, exercise, physiotherapy
Funding acknowledgements: This trial was supported by a grant from the Social Insurance Institution of Finland.
Topic: Pain & pain management; Musculoskeletal
Ethics approval required: Yes
Institution: Pirkanmaa Hospital District, Finland
Ethics committee: Ethical Committee of Pirkanmaa Hospital District, Finland
Ethics number: Code R12006
All authors, affiliations and abstracts have been published as submitted.
