Osteopathic Manipulative Therapy in Patients With Chronic Tension-Type Headache: A Pilot Study

Abstract

Context: Nonpharmacologic treatment, such as osteopathic manipulative therapy (OMTh; manipulative care provided by foreign-trained osteopaths) may be a beneficial complementary treatment for tension-type headache. However, to the authors' knowledge, the benefit of OMTh in the management of tension-type headache has not been explored, especially chronic tension-type headache (CTTH). Objective: To investigate the effectiveness of OMTh compared with traditional treatment in reducing pain intensity, frequency, and duration of CTTH, and to evaluate the objective postural measurement of the forward head posture (FHP) as an integral parameter in the assessment of the effects of OMTh and traditional management of CTTH. Methods: Patients with CTTH were registered at the Headache Centre of Trieste in Italy. At the time of the study, none of the patients had been taking any headache prophylaxis in the past 3 months. A 3-month baseline period was recorded by all patients with an ad hoc diary. Patients were randomly placed in the test or control group using a simple randomization program in Excel (Microsoft). Patients in the OMTh group underwent a 3-month period of OMTh, and patients in the control group were treated with amitriptyline. Pain intensity, frequency, and duration of headaches, as well as FHP were analyzed. Results: The study enrolled 10 patients (mean [SD] age, 42.6 [15.2] years) in the OMTh group and 10 patients (51.4 [17.3] years) in the control group. The final assessment of OMTh patients showed statistically significant changes in all headache parameters: pain intensity decreased from a mean (SD) score of 4.9 (1.4) to 3.1 (1.1) (P=.002); frequency decreased from 19.8 (6) to 8.3 (6.2) days per month (P=.002); and the duration of headaches decreased from 10 (4.2) to 6 (3) hours (P=.01). Significant improvement of all parameters was found in the control group as well: pain intensity decreased from a mean (SD) score of 5.9 (0.7) to 4.2 (1.75) (P=.03); frequency decreased from 23.4 (7.2) to 7.4 (8.7) days per month (P=.003); and duration decreased from 7.8 (2.9) to 3.6 (2.1) hours (P=.002). Forward head posture significantly improved in OMTh patients (P=.003). Conclusions: Our data suggested that OMTh may be an effective treatment to improve headaches in patients with CTTH. Our results also suggest that OMTh may reduce FHP.

Algometer Assessment of Pressure Pain Threshold After Onabotulinumtoxin-A and Physical Therapy Treatments in Patients With Chronic Migraine: An Observational Study

“…As regards the cervical area from C1 to C4, we found a significant improvement in PPT in the trapezius, levator scapulae, and left scalenus medius. We hypothesized that the PT in addition to the BoNT-A may facilitate the release of tissue contractions in the upper cervical spine, which, in turn, could lead to increased craniocervical PPT ( 30 , 31 , 36 ). The tensor fasciae latae muscle was the area outside of the trigeminal system chosen to assess the effect of the widespread pain.…”

“…A total of 15 1-h individual sessions were carried out by two expert physiotherapists. Since extensive research identifies dysfunctions throughout the spine in patients with chronic migraine ( 28 , 29 ), the manual therapy protocol started far from the trigeminal area, proceeding as follows: sacral area, diaphragm, dorsal and cervical spine, and cranial fascia (sub-occipital muscles and epicranial aponeurosis) ( 30 , 31 ). With respect to active exercise, graded exercises were used to increase trunk performance, such as verticality function and endurance, during prolonged sitting positions.…”

Instrumental assessment of physiotherapy and onabolulinumtoxin-A on cervical and headache parameters in chronic migraine

“…First, the pharmacological and the non-pharmacological treatments produce an important desensitization effect on the trigeminal area, through different mechanisms. The BoNT-A only treatment would seem to be more useful in relieving pain intensity through the inhibition of the neurogenic inflammation [14][15][16], while the PT, with manual therapy, would seem to be more useful in posture correction through a decrease of tissue contraction in the upper cervical spine and in pericranial areas [29]. In addition, the PT, with active exercise, may reduce the frequency and the duration of attacks due to an increase of neuromodulators levels in plasma [30].…”

“…Next, central posterior-anterior mobilizations were applied to the cervico-dorsal area at spinous processes from C2 to D12 segment [ 8 , 10 , 18 ]. Finally, soft tissue mobilizations were included on the sub-occipital muscles and on the epicranial aponeurosis [ 28 , 29 ].…”

Clinical observation of warming acupuncture and moxibustion at the temples combined with Deanxit in the treatment of tension headache with anxiety and depression: a retrospective study

“…Mental factors are the most common causes of TTH, including anxiety, tension, fatigue, and so on. Due to the low level of awareness of this disease, patients often exist a state of untreated tension for long periods, engendering headaches that cannot be completely cured (9,10). The risk of depression in patients with tension-type headache is more than 3 times higher than that in normal people, while the probability of tension-type headache in patients with depression is more than 3 times higher than that in non-depressive people.…”