Treatment of Tension-type Headache With Articulatory and Suboccipital Soft Tissue Therapy
Treatment of Tension-type Headache With Articulatory and Suboccipital Soft Tissue Therapy
Background. Headache is one of the most common causes of consultation in primary health care
 and neurology in Europe. Cervical muscle tension can maintain a restriction of joint motion
 at the suboccipital level, facilitating the referred head pain.

 Objective. To evaluate the effectiveness of two manual therapy treatments for tension-type
 headache.

 Methods. A randomized double-blind clinical trial was conducted, for a period of 4 weeks and
 a follow-up at one month post-treatment. Eighty-four patients with tension-type headache were
 assigned to 4 groups (3 treatment groups and 1 control group). Treatments included manual
 therapy of suboccipital soft tissue inhibition, occiput-atlas-axis global manipulation, and a
 combination of both techniques. Outcome measures were: impact of headache, disability caused
 by headache, ranges of motion of the craniocervical junction, frequency and intensity of
 headache, and associated headache symptoms.

 Results. After 8 weeks, there were significant improvements in impact of headache (p=0.01),
 disability (p=0.001), and craniocervical flexion (p=0.03) for the suboccipital soft tissue
 inhibition group; in headache impact and disability (p=0.000), pain intensity (p=0.02) and
 craniocervical flexion (p=0.004) and extension (p=0.04) for the occiput-atlas-axis group; and
 in impact (p=0.002), functional disability (p=0.000), headache frequency (p=0.002) and
 intensity (p=0.001), craniocervical flexion (p=0.008) and extension (p=0.003) and associated
 headache symptoms (p=0.01) for the combined therapy group, with effect sizes from medium to
 large.

 Conclusions. Occiput-atlas-axis and combined therapy group treatments are more effective than
 suboccipital soft tissue inhibition for tension-type headache. The treatment with
 suboccipital soft tissue inhibition, despite producing less significant results, also has
 positive effects on different aspects of headache.
Inclusion Criteria:

 -  Age between 18 and 65 years, episodes of headaches lasting from 30 minutes to 7 days,
 headache having at least two of the following characteristics: *bilateral location

 -  pressing non-pulsating quality

 -  mild or moderate intensity

 -  not aggravated by routine physical activity.

 -  Participants may present photophobia or phonophobia, nausea or vomiting, pericranial
 tenderness, with evolution of more than three months, and they must be under
 pharmacological control.

 Exclusion Criteria:

 -  Patients with other types of headache

 -  Headache that is aggravated by head movements

 -  Metabolic disorders or musculoskeletal complaints previous neck trauma

 -  Vertigo

 -  Dizziness

 -  Arterial hypertension

 -  Advanced degenerative osteoarthritis

 -  Neck joint stiffness

 -  Signs of malignancy

 -  Pregnancy

 -  Patients with cardiac devices

 -  Patients in process of pharmacological adaptation, and excessive emotional tension