Impact of Cervical Sensory Feedback for Forward Head Posture on Headache Severity and Physiological Factors in Patients with Tension-type Headache: A Randomized, Single-Blind, Controlled Trial

Abstract

BackgroundTension-type headache (TTH) decreases the ability to concentrate and function during daily activities in affected patients. As most patients with TTH exhibit forward head posture (FHP). Various interventions have been proposed to resolve TTH. However, research regarding the efficacy of these interventions remains lacking. The present study aimed to investigate the association between FHP and TTH, and to evaluate the efficacy of various intervention methods on headache symptoms and other clinical variables in patients with TTH induced by FHP.Material/MethodsParticipants were randomly allocated to 3 groups: biofeedback (BF, n1=21), manual therapy (MT, n2=20) and, stretching (ST, n3=21). Interventions were conducted 3 times per week for 4 weeks. Craniovertebral angle (CVA), electroencephalographic findings for attention, stress, and pressure-pain threshold (PPT), headache on activities of daily living (Henry Ford Headache Disability Inventory, HDI), and quality of life (QoL) assessments were obtained pre-intervention, post-intervention, and at the 2-week follow-up.ResultsThe correlation between CVA and HDI after intervention (R2=0.324, P<0.001), and at 2-week follow-up (R2=0.115, P<0.01) are significant. BF was associated with significant improvements in CVA (F2,59=3.393, P<0.001, normalηP2=0.130), attention (F2,59=5.186, P<0.01, normalηP2=0.150), stress [skin temperature (F2,59=6.005, P<0.001, normalηP2=0.169) and skin conductance (F2,59=4.900, P<0.01, normalηP2=0.142)], PPT (F2,59=5.050, P<0.01, normalηP2=0.146), HDI (F2,59=3.303, P<0.01, normalηP2=0.101), and QoL (F2,59=3.409, P<0.05, normalηP2=0.104).ConclusionsOur findings indicate that BF was more effective than MT and ST in the treatment of TTH due to FHP. Such findings highlight the need to develop and promote a controlled exercise program to facilitate a return to normal daily activities in patients with TTH due to FHP.

Effectiveness of Manual Therapy and Acupuncture in Tension-Type Headache: A Systematic Review

“…The estimated lifetime prevalence of headaches is 66%, with tension-type headaches accounting for 36-78% of these. Approximately 90% of people have experienced headaches at least once in their lifetime and 14% of adults have TTH once per week [1][2][3]. This makes them the most common type of primary headache and the second most prevalent chronic condition.…”

Los costes indirectos de la cefalea tensional. Una revisión sistemática de la literatura

“… Manandhar et al 19 ; Rastenyté et al 21 . Henry Ford Headache Disability Inventory (HDI) Cuestionario con 25 items para describir la discapacidad de los pacientes con dolor de cabeza (de cualquier tipo) Lee & Lee 22 . Cuestionario HARDSHIP ( Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation ) Cuestionario que incluye varios dominios de carga de la enfermedad, incluida la discapacidad por dolor de cabeza Zebenigus et al 20 .…”

The Effect of Hamstring Relaxation Program on Headache, Pressure Pain Threshold, and Range of Motion in Patients with Tension Headache: A Randomized Controlled Trial

“…The patients with FHP exhibit weakness in the extensor (lower parts of semispinalis, splenius, and upper trapezius) and flexor muscles (longus colli, longus capitus, and rectus capitis anterior) of the neck, as well as shortening of the suboccipital and sternocleidomastoid muscles [ 34 ]. Such changes lead to increased pressure between the cervical vertebrae and the development of tender points within the neck region [ 7 ]. The improved pressure pain threshold is believed to be due to increased muscle length of the hamstring muscles, resulting in improved flat back and sway-back posture, which corrected the forward head posture to a normal position.…”

“…The main cause of tension-type headache is pain caused by the myofascial trigger point of the neck musculature, which is MTrP of suboccipital muscles (rectus capitis posterior major, rectus capitis posterior minor, obliquus capitis superior, and obliquus capitis inferior) [ 6 ]. These abnormal muscle spasm of MTrP are closely related to forward head postures in which the head moves forward [ 7 ].…”

“…The flat back posture, sway back posture in the standing position, and the slumped posture in the sitting position is protected (or moved forward) by allowing the lower cervical to be flexed and the upper cervical to be extended [ 15 , 17 ]. Causing abnormal spasm of other neck musculature including suboccipital muscles, resulting in tension-type headache [ 7 ]. Therefore, securing flexibility of hamstring with physical therapy interventions for tension-type headache is a very important factor [ 12 ].…”