Effectiveness of Trigger Point Manual Treatment on the Frequency, Intensity, and Duration of Attacks in Primary Headaches: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

BackgroundA variety of interventions has been proposed for symptomatology relief in primary headaches. Among these, manual trigger points (TrPs) treatment gains popularity, but its effects have not been investigated yet.ObjectiveThe aim was to establish the effectiveness of manual TrP compared to minimal active or no active interventions in terms of frequency, intensity, and duration of attacks in adult people with primary headaches.MethodsWe searched MEDLINE, COCHRANE, Web Of Science, and PEDro databases up to November 2017 for randomized controlled trials (RCTs). Two independent reviewers appraised the risk-of-bias (RoB) and the grading of recommendations, assessment, development, and evaluation (GRADE) to evaluate the overall quality of evidence.ResultsSeven RCTs that compared manual treatment vs minimal active intervention were included: 5 focused on tension-type headache (TTH) and 2 on Migraine (MH); 3 out of 7 RCTs had high RoB. Combined TTH and MH results show statistically significant reduction for all outcomes after treatment compared to controls, but the level of evidence was very low. Subgroup analysis showed a statistically significant reduction in attack frequency (no. of attacks per month) after treatment in TTH (MD −3.50; 95% CI from −4.91 to −2.09; 4 RCTs) and in MH (MD −1.92; 95% CI from −3.03 to −0.80; 2 RCTs). Pain intensity (0–100 scale) was reduced in TTH (MD −12.83; 95% CI from −19.49 to −6.17; 4 RCTs) and in MH (MD −13.60; 95% CI from −19.54 to −7.66; 2RCTs). Duration of attacks (hours) was reduced in TTH (MD −0.51; 95% CI from −0.97 to −0.04; 2 RCTs) and in MH (MD −10.68; 95% CI from −14.41 to −6.95; 1 RCT).ConclusionManual TrPs treatment of head and neck muscles may reduce frequency, intensity, and duration of attacks in TTH and MH, but the quality of evidence according to GRADE approach was very low for the presence of few studies, high RoB, and imprecision of results.

Active Trigger Points Are Associated With Anxiety and Widespread Pressure Pain Sensitivity in Women, but not Men, With Tension Type Headache

“…Therefore, it is possible that clinical presentation of muscle TrPs could be slightly different between women and men with TTH, and hence, careful clinical examination should be conducted. Second, a recent meta‐analysis provided preliminary evidence suggesting that manual treatment of active TrPs may be effective for TTH; however, the quality of evidence was still low because of the presence of few studies and the imprecision of results . It is possible that the results of our study provide a potential explanation for discrepancies in the effects of TrP treatment.…”

Acute Effect of the Compression Technique on the Electromyographic Activity of the Masticatory Muscles and Mouth Opening in Subjects with Active Myofascial Trigger Points

“…Among various manual treatments for MFP associated with MTrPs, the most commonly used are compression technique, myofascial release, acupressure, muscle energy technique, and specific soft tissue mobilization techniques [14]. However, manual treatments for MTrPs have varying degrees of effectiveness and it is hard to identify the most effective rehabilitation method for MTrPs.…”

“…Among the manual treatments for MTrPs and MFP, the compression technique (CT), myofascial release, acupressure, muscle energy technique, and specific soft tissue mobilization techniques are most often used. A systematic review and meta-analysis of randomized controlled trials reported that manual MTrPs treatment of head and neck muscles may reduce the frequency, intensity, and duration of tension-type headache, but the quality of evidence was very low [14]. Moreover, it is currently impossible to identify the most effective treatment technique for MTrPs among those proposed.…”

Diagnosis and treatment of migraine: Russian experts' recommendations

“…Постизометрическая релаксация применяется у пациентов с мигренью и сочетанным выраженным перикраниальным мышечно-тоническим синдромом [108]. Метод направлен на расслабление перикраниальных мышц, упражнения включают два этапа -сокращение и расслабление напряженных мышц.…”