Effectiveness of manual therapy compared to usual care by the general practitioner for chronic tension-type headache: design of a randomised clinical trial. BMC Musculoskelet Disord 10:21

Healthcare Center Haarlemmermeer, Hoofddorp, the Netherlands.
BMC Musculoskeletal Disorders (Impact Factor: 1.72). 03/2009; 10(1):21. DOI: 10.1186/1471-2474-10-21
Source: PubMed


Patients with Chronic Tension Type Headache (CTTH) report functional and emotional impairments (loss of workdays, sleep disturbances, emotional well-being) and are at risk for overuse of medication. Manual therapy may improve symptoms through mobilisation of the spine, correction of posture, and training of cervical muscles.We present the design of a randomised clinical trial (RCT) evaluating the effectiveness of manual therapy (MT) compared to usual care by the general practitioner (GP) in patients with CTTH.
Patients are eligible for participation if they present in general practice with CTTH according to the classification of the International Headache Society (IHS).Participants are randomised to either usual GP care according to the national Dutch general practice guidelines for headache, or manual therapy, consisting of mobilisations (high- and low velocity techniques), exercise therapy for the cervical and thoracic spine and postural correction. The primary outcome measures are the number of headache days and use of medication. Secondary outcome measures are severity of headache, functional status, sickness absence, use of other healthcare resources, active cervical range of motion, algometry, endurance of the neckflexor muscles and head posture. Follow-up assessments are conducted after 8 and 26 weeks.
This is a pragmatic trial in which interventions are offered as they are carried out in everyday practice. This increases generalisability of results, but blinding of patients, GPs and therapists is not possible.The results of this trial will contribute to clinical decision making of the GP regarding referral to manual therapy in patients with chronic tension headache.

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Available from: Rene Castien, Mar 06, 2014
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    • "The selection and informed consent procedures, baseline and follow-up measurements, and the MT protocol of this study have been previously published [5]. The study protocol was approved by the Medical Ethics Committee of the VU University Medical Center in Amsterdam, The Netherlands. "
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    ABSTRACT: The aims of this study were to describe the course of chronic tension-type headache (CTTH) in participants receiving manual therapy (MT), and to develop a prognostic model for predicting recovery in participants receiving MT. Outcomes in 145 adults with CTTH who received MT as participants in a previously published randomised clinical trial (n=41) or in a prospective cohort study (n=104) were evaluated. Assessments were made at baseline and at 8 and 26 weeks of follow-up. Recovery was defined as a 50% reduction in headache days in combination with a score of 'much improved' or 'very much improved' for global perceived improvement. Potential prognostic factors were analyzed by univariable and multivariable regression analysis. After 8 weeks 78% of the participants reported recovery after MT, and after 26 weeks the frequency of recovered participants was 73%. Prognostic factors related to recovery were co-existing migraine, absence of multiple-site pain, greater cervical range of motion and higher headache intensity. In participants classified as being likely to be recovered, the posterior probability for recovery at 8 weeks was 92%, whereas for those being classified at low probability of recovery this posterior probability was 61%. It is concluded that the course of CTTH is favourable in primary care patients receiving MT. The prognostic models provide additional information to improve prediction of outcome.
    Full-text · Article · Feb 2012 · Pain
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    • "On the other hand, the 1-year prevalence of Chronic Tension-Type Headache (CTTH) is about 2-5% in the general population and in half of the CTTH cases, headache-related impairment in work performance is reported.4 In addition to considerable impact on daily functioning and work participation, CTTH is a risk factor for overuse of analgesic medication.4 "
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    ABSTRACT: Chronic tension-type headache (CTTH) is recognized as the most common type of headache and can be further defined as either episodic or chronic. Regarding the chronic nature of CTTH and intolerance or side effects of drugs that are used for treatment, other methods of treatment such as Transcutaneous Electrical Nerve Stimulation (TENS) has been used as a convenient and available method for treatment and prevention of CTTH. In the current study, we evaluated the efficacy of the imipramine versus TENS in the prevention of the CTTH as a prospective clinical trial. In this study, 138 patients with confirmed CTTH were randomized to be treated either with imipramine or TENS method. Sixty nine patients were treated with TENS and 69 cases were regarded as controls and were treated with imipramine. In the Imipramine group, treatment was performed by imipramine tablet, 25mg, twice daily. In the TENS group, patients were treated thrice weekly for ten weeks, each lasting 15 minutes in temporal and occipital regions. Three months after treatment, both the TENS and imipramine significantly reduced the severity of tension headache (p < 0.05). However, imipramine was significantly more effective than TENS in reduction of the headache severity (p < 0.05). It appears that TENS method may be a good alternative method for patients suffering from CTTH. To better evaluate the efficacy of this method in the prevention and treatment of CTTH, more studies are recommended.
    Full-text · Article · Jul 2011 · Journal of research in medical sciences
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    • "These approaches include combined techniques (e.g. spray and stretch), manual techniques, transcutaneous electrical stimulation (TENS), frequency-modulated neural stimulation, ultrasound or massage, injections, acupuncture and dry needling [9-14]. Analgesics are often used in the treatment of myofascial pain [15]. "
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    ABSTRACT: Myofascial pain is a common dysfunction with a lifetime prevalence affecting up to 85% of the general population. Current guidelines for the management of myofascial pain are not available. In this study we investigated how physicians on the basis of prescription behaviour evaluate the effectiveness of treatment options in their management of myofascial pain. We conducted a cross-sectional, nationwide survey with a standardized questionnaire among 332 physicians (79.8% male, 25.6% female, 47.5 +/- 9.6 years) experienced in treating patients with myofascial pain. Recruitment of physicians took place at three German meetings of pain therapists, rheumatologists and orthopaedists, respectively. Physicians estimated the prevalence of myofascial pain amongst patients in their practices, stated what treatments they used routinely and then rated the perceived treatment effectiveness on a six-point scale (with 1 being excellent). Data are expressed as mean +/- standard deviation. The estimated overall prevalence of active myofascial trigger points is 46.1 +/- 27.4%. Frequently prescribed treatments are analgesics, mainly metamizol/paracetamol (91.6%), non-steroidal anti-inflammatory drugs/coxibs (87.0%) or weak opioids (81.8%), and physical therapies, mainly manual therapy (81.1%), TENS (72.9%) or acupuncture (60.2%). Overall effectiveness ratings for analgesics (2.9 +/- 0.7) and physical therapies were moderate (2.5 +/- 0.8). Effectiveness ratings of the various treatment options between specialities were widely variant. 54.3% of all physicians characterized the available treatment options as insufficient. Myofascial pain was estimated a prevalent condition. Despite a variety of commonly prescribed treatments, the moderate effectiveness ratings and the frequent characterizations of the available treatments as insufficient suggest an urgent need for clinical research to establish evidence-based guidelines for the treatment of myofascial pain syndrome.
    Full-text · Article · Feb 2010 · BMC Musculoskeletal Disorders
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