From: Cephalalgia. 2010 Jul 20. [Epub ahead of print]
The 1-year prevalence of chronic tension-type headache is about 2–5% in the general population. In half of the chronic tension-type headache cases, headache related impairment in work performance is reported. In addition to considerable impact on daily functioning and work participation, chronic tension-type headache is 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.
In primary care treatment for patients with chronic tension-type headache is often provided by the general practitioner. The Dutch national general practice guideline for the management of headache describes diagnostic and therapeutic algorithms, consisting mainly of reassurance, lifestyle advice and medication. The effectiveness of this guideline for patients with chronic tension-type headache has not been investigated.
The pathogenesis of chronic tension-type headache remains unclear. Pathophysiological theories considering central and peripheral pain mechanisms are described and have been discussed in the literature. 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, mobilisation cervical spine, and training of cervical muscles) may be an important factor to modify central or peripheral pain mechanism in chronic tension-type headache.
Three randomized clinical trials have investigated the effectiveness of manual therapy in patients with chronic tension-type headache and reported benificial effects. However, because of variation in inclusion criteria, treatment techniques (high, low velocity mobilization, exercises, traction), and small sample sizes there is insufficient evidence to support the use of manual therapy in the treatment of chronic tension-type headache. Well-designed clinical trials are recommended to provide more substantial evidence for the effectiveness of manual therapy.
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 multicentre, 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.
