Effectiveness of manual therapy for chronic tension-type headache

Chronic tension-type headache has a considerable impact on daily functioning and work participation, it is also a risk factor for overuse of analgesic medication. Only about 20% of the chronic tension-type headache patients seek medical care for their headache. This low consultation rate may be explained by insufficient information on the effectiveness of treatments or by previous negative health care experiences.

The pathogenesis of chronic tension-type headache remains unclear, however, in recent research a correlation between chronic tension-type headache and impairment of the cranio-cervical musculoskeletal function (forward head position, trigger points trapezius muscle, neck mobility) has been demonstrated. In combination with results obtained in previous studies the present data support the hypothesis that improvement of the cranio-cervical musculoskeletal function by a manual therapy intervention (postural correction, mobilization of cervical spine, and training of cervical muscles) may be an important factor to modify central or peripheral pain mechanism in chronic tension-type headache.

The purpose of this study in Cephalgia was to evaluate the effectiveness of manual therapy in participants with chronic tension-type headache, the authors of this study conducted a multicenter, pragmatic, randomised, clinical trial with partly blinded outcome assessment. Eighty-two participants with chronic tension-type headache were randomly assigned to manual therapy or to usual care by the general practitioner. Primary outcome measures were frequency of headache and use of medication. Secondary outcome measures were severity of headache, disability and cervical function.

After 8 weeks (n = 80) and 26 weeks (n = 75), a significantly larger reduction of headache frequency was found for the manual therapy group. Disability and cervical function showed significant differences in favour of the manual therapy group at 8 weeks but were not significantly different at 26 weeks. Manual therapy is more effective than usual general practitioner care in the short and longer term in reducing symptoms of chronic tension-type headache.

Reference: Castien RF, van der Windt DA, Grooten A, Dekker J. Effectiveness of manual therapy for chronic tension-type headache: A pragmatic, randomised, clinical trial. Cephalalgia. 2010 Jul 20.

Dr. David P. Chen
Chiropractor in Laurel, MD 20708
Laurel Regional Chiropractic