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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

PainSci » bibliography » Espí-López et al 2014
Tags: spinal adjustment, headache, spine, treatment, head, head/neck, pain problems

Two articles on PainSci cite Espí-López 2014: 1. The Complete Guide to Chronic Tension Headaches2. What Happened To My Barber?

PainSci notes on Espí-López 2014:

This is one of the only trials of spinal manipulation for tension headache in recent history (since discouraging reviews in the past). It’s positive, but — considering the source — the risk of bias here seems rather high. The same authors wrote a review that came to positive conclusions on this topic, but no one else has (see Posadzki 2011, Lenssinck 2004, Fernández-de-Las-Peñas 2006). The abstract reports only the statistical significance of their positive results, rather than their clinical significance (an effect large enough to actually matter to anyone). Browsing their data, I think it’s an ambiguous mix: some of the outcomes they measured (quite a few) show modest but probably meaningful benefits … while several others struck me as clinically trivial.

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

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 tension-type 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 < .008). Combined treatment reported improvement after the treatment (P < .000) and at follow-up (P < .002). Pain intensity improved after the treatment and at follow-up with manipulative therapy (P < .01) and combined treatment (P < .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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