Tension-type headache (TTH) is a disease that poses a great threat on quality of life with a significant socioeconomic impact. It is considered a primary headache, meaning that it is independent – not caused by any other disorder.
Signs and symptoms of a TTH include: Dull, aching head pain, sensation of tightness or pressure across your forehead or on the lateral aspect and/or back of your head, tenderness on your scalp, neck and shoulder muscles.
The most common tension type headaches are episodic (ETTH), where the frequency is less than 15 days per month, and chronic (CTTH), where the frequency is more than 15 days per moth month. With CTTH the episodes of pain range from 30 minutes to 7 days. The headache is considered to be chronic if there are 2 or more of the following characteristics: bilateral location, non-pulsatile pressure, mild or moderate pain and does not increase with physical activity.
Migraine and TTH are the leading types of primary headaches, and have a high incidence and prevalence in general population. Not only have impact on social and health but also have an important repercussion in the public health system. Because of them, high averages of appointments are made, leading to a large number of medical prescriptions which cause high costs and unnecessary consumption of pain-killers.
Muscle dysfunctions play an important role in headaches. Even ETTH could become chronic in the presence of a muscle disorder. In fact, it has been indicated that TTH patients have neck and head trigger points with higher levels of pain. Research indicates that central sensitivity caused by long periods of suffering pain can make the process chronic.
Manual therapy (MT) represents one of the main treatments for TTH. It is based on the treatment of neuro-musculoskeletal dysfunction through muscle and joint analytical manipulations based on their biomechanical study.
Espí-López and colleagues performed a systematic review to determine the effectiveness of manual therapy for the relief of TTH. The result revealed that manual therapy is effective in reducing TTH symptoms such as pain frequency and intensity. In the studies that have applied joint mobilization, it was noted the improvement of cervical range of motion. Furthermore, other parameters such as quality of life, impact and pain disability and psychological aspects have improved with MT.
In conclusion, scientific research supports the use of manual therapy to improve the quality of life of tension-type headache patients and to reduce the socioeconomic cost of the disease.
Dr. D Muller, BSc, DC, Webster Certified, ICPA Member
References:
Headache Classification Subcommittee of the International Headache Society: The International Classification of Headache Disorders, 2nd edition, is published by International Headache Society in Cephalalgia; 2004, 24 (suppl 1): 1-160. Available in: http://ihs-classification.org/_downloads/mixed/WatermarkedShortForm%20ICHD-II.pdf [PubMed]
The impact of migraine and other primary headaches on the health system and in social and economic terms].Volcy-Gómez M. Rev Neurol. 2006 Aug 16-31; 43(4):228-35.
Myofascial trigger points are very prevalent in patients with chronic tension-type headache: a double-blinded controlled study. Couppé C, Torelli P, Fuglsang-Frederiksen A, Andersen KV, Jensen R. Clin J Pain. 2007 Jan; 23(1):23-7.
Abnormal pain processing in chronic tension-type headache: a high-density EEG brain mapping study. Buchgreitz L, Egsgaard LL, Jensen R, Arendt-Nielsen L, Bendtsen L. Brain. 2008 Dec; 131(Pt 12):3232-8.
Victoria Espí-López G, Arnal-Gómez A, Arbós-Berenguer T, González ÁAL, Vicente-Herrero T. Effectiveness of Physical Therapy in Patients with Tension-type Headache: Literature Review. Journal of the Japanese Physical Therapy Association. 2014;17(1):31-38. doi:10.1298/jjpta.Vol17_005.
Donkin RD, Tech M, Parkin-Smith GF, Tech M, Gomes AN: Possible effect of chiropractic manipulation and combined manual traction and manipulation on tension-type headache: A pilot study. J Neuromusculoskeletal Sys. 2002, 10(3): 89-97.