Myofascial Trigger Point-focused Head and Neck Massage for Recurrent Tension-type Headache

Abstract

Objective Myofascial trigger points (MTrPs) are focal disruptions in skeletal muscle that can refer pain to the head and reproduce the pain patterns of tension-type headache (TTH). The present study applied massage focused on MTrPs of subjects with TTH in a placebo-controlled, clinical trial to assess efficacy on reducing headache pain. Methods Fifty-six subjects with TTH were randomized to receive 12 massage or placebo (detuned ultrasound) sessions over six weeks, or to wait-list. Trigger point release (TPR) massage focused on MTrPs in cervical musculature. Headache pain (frequency, intensity and duration) was recorded in a daily headache diary. Additional outcome measures included self-report of perceived clinical change in headache pain and pressure-pain threshold (PPT) at MTrPs in the upper trapezius and sub-occipital muscles. Results From diary recordings, group differences across time were detected in headache frequency (p=0.026), but not for intensity or duration. Post hoc analysis indicated headache frequency decreased from baseline for both massage (p<0.0003) and placebo (p=0.013), but no difference was detected between massage and placebo. Subject report of perceived clinical change was a greater reduction in headache pain for massage than placebo or wait-list groups (p=0.002). PPT improved in all muscles tested for massage only (all p's<0.002). Discussion Two findings from this study are apparent: 1) MTrPs are important components in the treatment of TTH, and 2) TTH, like other chronic conditions, is responsive to placebo. Clinical trials on headache that do not include a placebo group are at risk for overestimating the specific contribution from the active intervention.

Responsiveness of Myofascial Trigger Points to Single and Multiple Trigger Point Release Massages

“…Recruited subjects were obtained from the clinical headache trial portion of the study. 16 In that trial, headache frequency was reduced for both massage and placebo-treated groups relative to waitlist control. Statistical power at 80% with 17 subjects per group was found in the initial study for the clinical parameter of headache frequency.…”

Muscle Triggers as a Possible Source of Pain in a Subgroup of Tension-type Headache Patients?

“…Other controlled studies reported that multimodal manual therapy, including TrP therapy, was effective in reducing headache pain parameters in individuals with CTTH [81,82]. The only randomized controlled trial related to TrP management found that application of TrP release massage focusing on the cervical musculature was effective for reducing the headache frequency in TTH; however, these authors also observed a placebo effect [83]. In most pain studies placebo effects are expected to be between 15 and 30% depending on the procedure.…”

Relationship of active trigger points with related disability and anxiety in people with tension-type headache

“…This can be related to the fact that studies have not been conclusive in terms of how blocking the nociception from the TrPs affects the headache pain. [39] …”