| PMC full text: | Published online 2014 Oct 2. doi: 10.1186/1129-2377-15-67
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Table 3
Results of manual therapy randomized controlled trials (RCTs) of chronic tension-type headache (CTTH)
| Country | Study population | Method | Intervention | Results |
|---|---|---|---|---|
| Spain 2009 [20] | 11 participants (3 M, 8 F) | RCT of 8 days duration conducted by a physiotherapist i.e. | All interventions received two treatments over 8 days lasting for 40 min | Headache intensity decreased statistical significant 24 hours after massage (p < 0.05), whereas detuned ultrasound had no statistical significant effect |
| Age 41-60 yrs | 2 treatments with one week interval, each followed by 24-hours post-treatment assessment | Head and neck massage | Mean headache intensity was reduced 24% after massage, and 3% after detuned ultrasound | |
| Mean 51 ± 15 yrs | Comparison of pre-and post-treatment at the treatment laboratory | Detuned ultrasound at head and neck area (control group) | Effect size 0.32 | |
| | Headache diagnosed by neurologist | | Drop outs (n = 0) | |
| USA 1989 [21] | 55 participants (15 M, 40 F) | RCT of 9 months duration conducted by a physiotherapist i.e. 3 months treatment 3, 6 months follow-up | All interventions received detoxification (when necessary) and amitriptyline (in some cases) | The efficacy parameter was the mean headache index defined as weekly frequency x intensity on a 0-10 numeric rating. Mean headache index at baseline was 30 |
| Age 23-62 yrs | Comparison of weekly treatments and follow-up | Biofeedback treatment (n = 9; 4 M and 5 F) | Biofeedback reduced the headache index defined as frequency x intensity by 83% and 76% post-treatment and 3 months follow-up, while physiotherapy combined with TENS reduced it by 97% and 93% and TENS by 94% and 92% respectively | |
| Mean age 36.9 yrs | Headache diary recordings | Physiotherapy including heat pack, soft tissue work and ultrasound with home exercises and home transcutaneus electrical nerve stimulation (TENS) treatment, average 12.8 sessions over 3 months (n = 28; 4 M and 24 F) | The improvement was sustained at 6 months in physiotherapy combined with TENS and TENS group, i.e. 95% and 97% reduction of the headache index | |
| Mean headache duration 8.4 yrs | | TENS treatment by physiotherapist, 12 sessions followed by additional home TENS treatment twice a day for another month (n = 18; 7 M and 11 F) | | |
| Retrospect headache diagnosis | | Drop outs of 6 months follow-up (n = 18; 7 M and 11 F) | Effect size not applicable | |
| | 12 participants had co-occurrence of menstrual migraine | | | |
| Turkey 2002 [22] | 35 female participants | RCT of 10 weeks duration conducted by a physiotherapist i.e. 2 weeks baseline, 4 weeks treatment, 4 weeks follow-up | All interventions received superficial heat and classic massage to the neck and upper back prior to intervention | Efficacy parameter was headache index defined as headache frequency x intensity |
| Age 19-59 yrs | Comparison of baseline, post-treatment and follow-up | Spinal connective tissue manipulation by a physiotherapist daily (n = 15) | Both the spinal connective tissue manipulation and cervical mobilization groups had statistical significant improvement, i.e. 38% vs. 54% post-treatment and 48% vs. 86% at 3 months follow-up | |
| Mean age 37.9 yrs | Headache diary recordings | Cervical mobilization according to Cyriax principle by a physiotherapist three times per week (n = 15) | No statistical significant differences between the two groups | |
| Mean headache duration 9.8 yrs | | Drop outs (n = 5) | Effect size 0.21 before to after treatment, 0.30 after treatment to follow-up, and 0.37 before treatment to follow-up | |
| | Headache diagnosed by neurologist | | | |
| Denmark 2004 [23] | CTTH (n = 24) (10 M, 14 F) | RCT of 6 months duration conducted by a physiotherapist i.e. 1 month baseline, 2 months treatment, 3 months follow-up | Standardised physiotherapy including massage, relaxation and stretching twice a week for 4 weeks followed by twice a week physical group exercise for 4 weeks (n = 18) | Headache days were statistical significantly reduced in the physiotherapy group post-treatment and at follow-up as compared to the observation group (p < 0.001) |
| Age 24-63 | Comparison of baseline, post-treatment and follow-up | Observation period, kept diary for 8 weeks followed by the same intervention (n = 19) | 54% of participants responded with >50% reduction of headache days | |
| Mean age 44.9 yrs | Headache diary recordings | Drop outs (n = 11) (5 M, 6 F) | Headache duration and intensity were unchanged in both groups | |
| Duration of headache 23.1 yrs | | | Women responded statistical significantly better than men (p = 0.01) | |
| Mean headache frequency 15.8 days per month | | | Effect size not applicable | |
| | Headache diagnosed by a neurologist | | | |
| Netherland 2006 [24] | TTH (n = 42) and episodic tension-type headache (n = 39) | RCT of 7½ months duration conducted by twenty physiotherapist’s i.e. Initial baseline 6 weeks treatment, 6 months follow-up, Comparison of pre- and post-treatment and follow-up | Craniocervical training program by a physiotherapist including low-load endurance exercises for cervicoscapular and craniocervical region with twice daily home exercise combined with postural correction exercises (n = 39) | Both groups had statically significant post-treatment improvement of headache frequency, duration and intensity |
| Mean age 45.9 yrs | Headache diary recordings | Physiotherapy including massage, oscillation techniques described by Maitland and postural correction (n = 40) | In the craniocervical training group 82% and 85% had ≥50% reduction in headache frequency post-treatment and at follow-up, as compared to 52% and 35% in the physiotherapy group. | |
| Mean headache frequency 20.7 days per month | | Drop outs (n = 2) | The effect was a statistical significant better in those with CTTH as compared to those with episodic tension-type headache (p < 0.0001). | |
| Headache diagnosed by physician | | | No individual data are presented for CTTH | |
| | | | | Effect size not applicable |
| Netherland 2011 [25] | 82 participants (18 M, 64 F) | RCT of 8½ months duration conducted by four physiotherapist’s i.e. 2 weeks baseline, 2 months treatment, 6 months follow-up | Usual care by general practitioner which consisted of information, re-assurance, advise, lifestyle changes and prescription of analytics and NSAIDs if necessary 2-3 visits (n = 37) | The manual therapy group had statistical significant improvement of headache frequency, duration and intensity post-treatment and at follow-up as compared to usual care group (p < 0.001, p = 0.003, and p = 0.013). This effect was maintained at follow-up (p < 0.001 and p = 0.027), except for duration. |
| Age 20-63 yrs | Comparison of baseline, post-treatment and follow-up | Manual therapy by a physiotherapist consisting of mobilization of cervical and thoracic column, exercises and postural correction for max 9 sessions of 30 min (n = 38) | At post-treatment and follow-up the headache frequency was reduced 77% and 77% in the manual therapy group as compared to 23% and 35% in usual care group. | |
| Mean age 40.4 yrs | Headache diary recordings | Drop outs (n = 7) | At post-treatment and at follow-up 88% and 82% of the manual therapy group had >50% reduction in headache frequency, and 28% and 41% of the usual care group. | |
| Mean headache duration 12.8 yrs | | | At post-treatment and follow-up duration was reduced 46% and 55% in the manual therapy group as compared to 5% and 27% in the usual care group. | |
| Mean headache frequency 24 days per month | | | At post-treatment and follow-up intensity was reduced 43% and 49% in the manual therapy group as compared to 16% and 30% in the usual care group. | |
| Headache diagnosed by physician | | | Frequency, duration and intensity effect size was 0.62, 0.27 and 0.44 at post-treatment and 0.50, 0.19 and 0.26 at follow-up | |
| 21 participants had co-occurrence of migraine |