Effectiveness of the Treatment of Tension-type Headache With Manual and Manipulative Therapy
Effectiveness of the Treatment of Tension-type Headache With Manual and Manipulative Therapy
Background. Tension-type headache (TTH) is the most common form of primary headache and it is
 a real problem for the subjects suffering from it. Until now, physiotherapy treatments have
 included different techniques combined together, without establishing which of them is more
 effective.

 Objective. The purpose of this study is to know the effectiveness of manipulative and manual
 therapy treatments, with regard to pain perception and neck mobility in patients with
 tension-type headache.

 Methods: A double-blind, randomized clinical trial was conducted, with 84 patients diagnosed
 with tension-type headache, divided into three treatment groups -manual therapy, manipulative
 therapy, and a combination of both techniques-, and a placebo control group. Four treatment
 sessions were administered during four weeks, with post-treatment assessment, and follow-up
 at one month. Cervical ranges of motion were assessed (CROM device), as well as pain
 perception (McGill Pain Questionnaire), and frequency and intensity of headaches (weekly
 register).
Inclusion Criteria:

 -  Subjects aged between 18 and 65 years

 -  Diagnosis of frequent ETTH and CTTH

 -  Having headache episodes on more than 1 day per month

 -  Headache episodes lasting from 30 minutes to 7 days

 -  Headaches having at least 2 of the following characteristics:

 -  Bilateral location of pain

 -  Pressing non pulsating quality

 -  Mild or moderate intensity

 -  Not aggravated by physical activity

 -  Sufferers may present photophobia, phonophobia, nausea or vomiting

 -  Headache may be associated with pericranial tenderness

 -  Suffering from TTH for over 3 months

 -  Subjects being under pharmacological control

 Exclusion Criteria:

 -  Patients with infrequent ETTH, and patients with probable TTH in its frequent and
 infrequent forms.

 -  Headache that is aggravated by head movements.

 -  Metabolic or musculoskeletal disorders with symptoms similar to headache

 -  Previous neck trauma

 -  Vertigo, dizziness, arterial hypertension.

 -  Joint stiffness, arteriosclerosis or advanced degenerative osteoarthritis

 -  Patients with heart devices

 -  Patients in process of pharmacological adaptation

 -  Excessive emotional tension

 -  Neurological disorders

 -  Laxity of neck soft tissues

 -  Radiological alterations

 -  General hypermobility or hyperlaxity

 -  Joint instability

 -  Pregnancy