The effectiveness of physiotherapy and manipulation in patients with tension-type headache: a systematic review

Lenssinck, Marie-Louise B.; Damen, Léonie; Verhagen, Arianne P.; Berger, Marjolein Y.; Passchier, Jan; Koes, Bart W.

doi:10.1016/j.pain.2004.09.026

Cited by 99 publications

(76 citation statements)

References 27 publications

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“…This finding further supports systematic reviews that have reported inconsistent and inconclusive effectiveness of physical treatments in tension-type headache aimed at mobilization. 14, 24,26 Considering these results and reported risks of cervical high-velocity thrust mobilization techniques, 1 clinicians should reconsider the use of these techniques in participants with CTTH.…”

Section: Discussion Main Findingsmentioning

confidence: 99%

The Working Mechanism of Manual Therapy in Participants With Chronic Tension-Type Headache

Castien

Blankenstein²,

Windt³

et al. 2013

J Orthop Sports Phys Ther

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Chronic tension-type headache (CTTH) is associated with cervical spine impairments, including restricted range of motion (ROM) of the cervical spine, reduced neck flexor endurance, and greater forward head posture. 13,15,17,27,30 These associations have led to the development of a biomechanical model for CTTH. According to this conceptual model, cervical dysfunction elicits headache through peripheral or central pain mechanisms; therefore, improvement of cervical dysfunction by physical treatment should reduce headache. 5,18,19 Based on this model, we conducted a randomized clinical trial (RCT) to determine the effectiveness of multimodal manual therapy, including mobilization of the cervical spine, isometric training of neck flexors, and posture correction. A reduction in headache days of 50% or greater was the clinically relevant outcome.2 A significant difference of 87.5% versus 27.5% in outcome was found in favor of manual therapy, compared to usual care by the general practitioner, in participants with CTTH. 8The extent to which specific elements (mobilization, isometric training of neck flexors, or posture correction) contribute to the effectiveness of manual therapy is unknown, and information about the working mechanisms of manual therapy in participants with headache is urgently needed. 5,19 The biomechanical model mentioned above suggests that increased ROM of the cervical spine, increased neck flexor endurance, and a less pronounced forward head posture may offer potential explanations for the effect of manual therapy in reducing headache frequency. To explore the working mechanism of manual therapy, we investigated whether the above aspects of cervical spine function (cervical ROM, neck flexor endurance, and forward head posture) were mediators of the effect of manual therapy on headache frequency. METHODS Participants For the mediation analyses, we used the combined data obtained from 2 studies, a multicenter, prag-T T STUDY DESIGN: Prospective longitudinal study. T T OBJECTIVE:To explore the working mechanism of manual therapy, we investigated whether 3 cervical spine variables were mediators of the effect of manual therapy on headache frequency. T T BACKGROUND: Manual therapy has beenshown to reduce headache frequency in participants with chronic tension-type headache (CTTH). To what extent specific elements of treatment contribute to the effectiveness of manual therapy in CTTH is unknown. T T METHODS:One hundred eighty-two participants with CTTH participated in a prospective longitudinal study: 142 underwent manual therapy and 40 participants received usual care by their general practitioner. Regression analysis was performed according to the steps described by Baron and Kenny, and the proportion of mediated effect was estimated for 3 potential mediators: (1) cervical range of motion, (2) neck flexor endurance, and (3) forward head posture. Outcome was defined as a 50% or greater reduction in headache days.

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Section: Discussion Main Findingsmentioning

confidence: 99%

The Working Mechanism of Manual Therapy in Participants With Chronic Tension-Type Headache

Castien

Blankenstein²,

Windt³

et al. 2013

J Orthop Sports Phys Ther

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“…2,3 Both episodic tension-type headache (ETTH) and chronic tension-type headache (CTTH) have important repercussions on the quality of life, affecting the working and social spheres, as well as the activities of daily living. 4 As for the treatments administered, Lenssinck et al 2 carried out a systematic review to assess the effectiveness of physiotherapy and spinal manipulation in the treatment of TTH and showed that there was no conclusive evidence of its effectiveness.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Manual and Manipulative Therapy in the Perception of Pain and Cervical Motion in Patients With Tension-Type Headache: A Randomized, Controlled Clinical Trial

Espí-López

Gómez–Conesa

2014

Journal of Chiropractic Medicine

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Objective: The purpose of this study was to evaluate the efficacy of manipulative and manual therapy treatments with regard to pain perception and neck mobility in patients with tensiontype headache. Methods: A randomized clinical trial was conducted on 84 adults diagnosed with tension-type headache. Eighty-four subjects were enrolled in this study: 68 women and 16 men. Mean age was 39.76 years, ranging from 18 to 65 years. A total of 57.1% were diagnosed with chronic tension-type headache and 42.9% with tension-type headache. Participants were divided into 3 treatment groups (manual therapy, manipulative therapy, a combination of manual and manipulative therapy) and a control group. Four treatment sessions were administered during 4 weeks, with posttreatment assessment and follow-up at 1 month. Cervical ranges of motion pain perception, and frequency and intensity of headaches were assessed. Results: All 3 treatment groups showed significant improvements in the different dimensions of pain perception. Manual therapy and manipulative treatment improved some cervical ranges of motion. Headache frequency was reduced with manipulative treatment (P b .008). Combined treatment reported improvement after the treatment (P b .000) and at follow-up (P b .002). Pain intensity improved after the treatment and at follow-up with manipulative therapy (P b .01) and combined treatment (P b .01). Conclusions: Both treatments, administered both separately and combined together, showed efficacy for patients with tension-type headache with regard to pain perception. As for cervical ranges of motion, treatments produced greater effect when separately administered.

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“…Chiropractic and spinal manipulation, for example, is often used for various pain syndromes, despite some literature reviews that fail to show any benefit over sham procedures and also show the potential for harm. 4,5 Another heavily investigated therapy is acupuncture, which is generally considered more invasive and carries with it the potential for adverse events.…”

Section: Résumémentioning

confidence: 99%

Complementary and alternative medicine therapies for the anesthesiologist and pain practitioner: a narrative review

Woodbury

Soong

Fishman

et al. 2015

Can J Anesth/J Can Anesth

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The effectiveness of physiotherapy and manipulation in patients with tension-type headache: a systematic review

Cited by 99 publications

References 27 publications

The Working Mechanism of Manual Therapy in Participants With Chronic Tension-Type Headache

The Working Mechanism of Manual Therapy in Participants With Chronic Tension-Type Headache

Efficacy of Manual and Manipulative Therapy in the Perception of Pain and Cervical Motion in Patients With Tension-Type Headache: A Randomized, Controlled Clinical Trial

Complementary and alternative medicine therapies for the anesthesiologist and pain practitioner: a narrative review

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