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Deep Neck Flexor Exercises Versus Myofascial Release of Suboccipital Muscles in Chronic Tension-type Headache

Primary Purpose

Chronic Tension-Type Headache

Status

Not yet recruiting

Phase

Not Applicable

Locations

Study Type

Interventional

Intervention

Suboccipital Myofascial Release(MFR) with sham Deep Neck Flexor(DNF)exercise

Deep Neck Flexor(DNF)exercise with sham Suboccipital Myofascial Release(MFR)

About this trial

This is an interventional treatment trial for Chronic Tension-Type Headache focused on measuring Chronic tension-type headache, Chronic primary headache, Forward head posture, Deep neck flexor exercise, Pressure biofeedback, Myofascial release, Pressure pain threshold, Quality of life, Disability

Eligibility Criteria

18 Years - 55 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Age between 18 and 55 years;
based on ICHD-3, Headache that occurs 15 days per month and lasts on average for >3 months (180 days per year), lasting hours to days, or unremitting, and has at least two of the following four characteristics recognized as CTTH: bilateral location, pressing or tightening (non-pulsating) quality, mild or moderate intensity, not aggravated by routine physical activity such as walking or climbing stairs and both of the following: no more than one of photophobia, phonophobia or mild nausea, neither moderate or severe nausea nor vomiting;
Dosage and type of prophylactic medication have not changed in the months before the beginning of the trial;
The participant does not intend to change the dosage and type of prophylactic medication during the study;
CVA less than 49 degrees,
Participants have the ability to understand and read Persian to complete the questionnaire.

Exclusion Criteria:

Participants with infrequent ETTH, or other primary or secondary types of headache;
Pain aggravated by movement of the head;
Severe pain or significant decrease in ROM of the cervical spine;
Previous trauma to the cervical spine;
History of injection, surgery, severe disc protrusion, or neck or shoulder fracture that affects treatment;
Metabolic or Neurological disorders such as Bow hunter's syndrome or epilepsy;
Taking more than 200 pieces of morphine or other strong analgesics per month;
Physiotherapy treatment for headache within 6 months before starting treatment;
Joint stiffness, atherosclerosis, or advanced osteoarthritis;
Manual contraindication includes: (a)The participant has substance or alcohol abuse; (b)For whatever reason, the participant does not want to be touched by the therapist; (c)Symptoms are severe and irritating; (d)Underlying diseases (such as rheumatoid arthritis) or metabolic disorders (such as osteoporosis or soft tissue laxity of the treatment area);
Pregnancy;
Spielberger State-Trait Anxiety Inventory (STAI) scores more than 85;
Absence of two consecutive sessions and more than treatment sessions.

Sites / Locations

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Arm Label

Suboccipital Myofascial Release

Deep Neck Flexor Exercise

Arm Description

The therapist places the supinated forearm on the bed and positions the tips of the middle three fingers inferior to the occiput bone and the head is supported by the thenar eminences

After placing the airbag of PBU under the occiput bone in the supine position and inflating it to a base pressure of 11 mmHg, the participant will increase the pressure to 12 mmHg by nodding action.

Outcomes

Primary Outcome Measures

Intensity of headache using by Numeric Pain Rating Scale(NPRS)

In the initial evaluation of the participants, the pain intensity will be determined based on the NPRS on a scale of 0-100. For this purpose, the participant is asked to mark their average pain intensity in the last month on a 100 cm line without scaling from zero to 100. The number zero indicates the absence of pain and the number 100 indicates the most pain the person has experienced in their life. The marked point is then measured with a ruler. Participants are asked to record their average intensity of pain during the past month on the Headache Questionnaire. Evaluation of the headache intensity will be done after treatment and in a 6 weeks follow-up by the headache diary; For this purpose, during the four weeks of treatment and up to 6 weeks after the treatment, the participant is asked to record the amount of headache intensity on a daily basis in this diary.

intensity of Forward Head Posture(FHP) using by Craniovertebral Angle(CVA)

The amount of is measured using the photogrammetric method of body profile for measuring the FHP. This method has high reliability (ICC = 0.83). This angle will be assessed in sitting posture from profile view, in this picture the spinous process of the seventh cervical vertebra and tragus of the ear is marked with landmarks. Photography is done with a camera (smartphone iPhone 13 pro, Apple Inc) with a magnification of 1 and is placed at a certain distance from the person on a fixed base. Finally, the images are transferred to a computer and the angle between the line connecting the ear tragus to the spinous process of the seventh cervical vertebra and the horizon line is measured using Kinovea software (ICC=.99).

Secondary Outcome Measures

Duration of headache using by headache questionnaire and diary

The duration of pain will be determined based on the average number of hours a person experiences a headache in a month. Participants are asked to record their average duration of pain during the past month on the Headache Questionnaire. Evaluation of the headache duration will be done after treatment and in a 6-week follow-up by the headache diary; For this purpose, during the four weeks of treatment and up to 6 weeks after the treatment, the participant is asked to record the amount of headache duration on a daily basis in this diary.

Frequency of headache using by headache questionnaire and diary

The frequency of headaches is based on the number of days in the month that the person experiences the headache. Participants are asked to record their average frequency of pain during the past month on the Headache Questionnaire. Evaluation of the headache frequency will be done after treatment and in a 6 week follow-up by the headache diary; For this purpose, during the four weeks of the treatment and up to 6 weeks after treatment, the participant is asked to record the amount of headache frequency on a daily basis in this diary.

Disability using by Henry Ford Hospital Headache Disability Inventory (HDI) questionnaire

The Persian version of the Henry Ford Hospital Headache Disability Inventory (HDI) questionnaire will be used to assess the amount of disability. The questionnaire has 25 questions that include functional and emotional subsets, and each "yes" answer is a 4-point answer, each "sometimes" answer is a 2-point answer, and each "no" answer is a zero-point answer. This questionnaire consists of 12 questions in the functional field with a maximum score of 48 and 13 questions in the emotional field with a maximum score of 52, which adds up to 100 points. The higher the score, the greater the disability due to the headache. If, as a result of the therapeutic approach, a score equal to or greater than 29 points is seen in this questionnaire, it indicates significant changes. The internal consistency of the Persian version of this questionnaire with Cronbach's alpha is 0.91 for the whole questionnaire, 0.82 for the functional area and 0.86 for the emotional area (ICC = 0.97).

Quality of life using by Headache Impact Test -6 (HIT-6) questionnaire

The Persian version of the Headache Impact Test -6 (HIT-6) questionnaire will be used. This short questionnaire includes 6 questions that are a reminder of the last 4 weeks. Scores are between 36 and 78, and higher scores indicate a higher intensity of headache and a greater impact of headache on a person's quality of life. This questionnaire is used to measure the effect of headache and its treatment on a person's functional status and quality of life, and its psychological characteristics have been extensively studied. The questions in this questionnaire cover problems including pain, ability to perform daily life activities, social functioning, energy/fatigue, cognitive function, and psychological problems. The reliability coefficient of this questionnaire in different researches through retesting, peer forms, and internal stability are 0.8, 0.9, and 0.89, respectively.

Pressure Pain Threshold(PPT) using by algometer

An algometer (JTECH Medical, made in the USA) is used to assess the pain pressure threshold of suboccipital muscles. In this method, the participant is lying on a Manual Physical Therapy Table (MPT) with a cavity for placing the face lying down and an algometer with a 1 cm^2 cross-sectional area vertically and at a speed of about 1 kg / cm^2 at the bottom of the occiput bone and outside of the upper trapezius muscle are placed on both sides. Pressure is applied until the feeling of pressure turns into a feeling of pain and the participant is asked to announce the moment of onset of pain. The measurement is repeated 3 times with an interval of 30 seconds, then the average is calculated. It should be noted that this device has high reliability (ICC = 0.78 - 0.93)

Full Information

NCT ID

NCT05383365

First Posted

April 21, 2022

Last Updated

February 15, 2023

Sponsor

Iran University of Medical Sciences

1. Study Identification

Unique Protocol Identification Number

NCT05383365

Brief Title

Deep Neck Flexor Exercises Versus Myofascial Release of Suboccipital Muscles in Chronic Tension-type Headache

Official Title

The Effectiveness of Deep Neck Flexor Exercises in Comparison With Myofascial Release of Suboccipital Muscle on Pain and Forward Head Posture in People With Chronic Tension-type Headache and Forward Head Posture

Study Type

Interventional

2. Study Status

Record Verification Date

February 2023

Overall Recruitment Status

Not yet recruiting

Study Start Date

June 1, 2023 (Anticipated)

Primary Completion Date

December 1, 2023 (Anticipated)

Study Completion Date

December 1, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title

Sponsor

Name of the Sponsor

Iran University of Medical Sciences

4. Oversight

Studies a U.S. FDA-regulated Drug Product

Studies a U.S. FDA-regulated Device Product

5. Study Description

Brief Summary

According to the study of the burden of diseases in 2018, tension-type headache(TTH) is the most common type of primary headache and ranks third in terms of prevalence among 328 diseases and injuries in 195 countries from 1990 to 2016. Suffering from this disorder (especially chronic type) reduces the quality of life of patients. The main objective of this study is to compare the effects of myofascial release of suboccipital muscles as a bottom-up intervention and Deep Neck Flexor(DNF) exercises with Pressure Biofeedback Unit(PBU) as a top-down intervention on headache parameters, the intensity of Forward Head Posture(FHP), disability, quality of life, and suboccipital Pressure Pain Threshold(PPT) in patients with chronic tension-type headache with forward head posture.

Detailed Description

Previous studies demonstrated that suboccipital active Trigger Points(TrPs) and forward head posture were associated with Chronic Tension-Type Headache(CTTH) and they can aggravate parameters of headache in these patients. The greater suboccipital muscle contraction, as would be exexpected in greater FHP, the more the nociceptive input into the trigeminal nucleus caudalis, and the lower the headache or pain threshold, consistent with increased central sensitization; Therefore it is important to evaluate the effectiveness of interventions on FHP and suboccipital active TrPs in patients with CTTH. The main objective of this study is to compare the effects of myofascial release of suboccipital muscles as a bottom-up intervention and deep neck flexor exercises with a pressure biofeedback unit as a top-down intervention. Primary outcomes will be the intensity of headache and FHP. headache duration and frequency, disability, quality of life, and pain pressure threshold will be considered as secondary outcomes. In this study, a double-dummy randomized clinical trial, 44 participants will be divided into two groups of DNF exercises with pressure biofeedback combined with sham MFR (first group) and sub-occipital MFR combined with sham DNF exercises(second group). The intervention will take place over a 4-week period, with three 1-hour sessions a week, totaling 12 treatment sessions. this study has a 6-week follow-up. This study is a double-blind study in which the participants, the person evaluating the outcome, and the statistician of the data will be blinded to the allocation of patients to the two treatment groups.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study

Chronic Tension-Type Headache

Keywords

Chronic tension-type headache, Chronic primary headache, Forward head posture, Deep neck flexor exercise, Pressure biofeedback, Myofascial release, Pressure pain threshold, Quality of life, Disability

7. Study Design

Primary Purpose

Treatment

Study Phase

Not Applicable

Interventional Study Model

Parallel Assignment

Masking

ParticipantOutcomes Assessor

Allocation

Randomized

Enrollment

44 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title

Suboccipital Myofascial Release

Arm Type

Experimental

Arm Description

The therapist places the supinated forearm on the bed and positions the tips of the middle three fingers inferior to the occiput bone and the head is supported by the thenar eminences

Arm Title

Deep Neck Flexor Exercise

Arm Type

Experimental

Arm Description

After placing the airbag of PBU under the occiput bone in the supine position and inflating it to a base pressure of 11 mmHg, the participant will increase the pressure to 12 mmHg by nodding action.

Intervention Type

Other

Intervention Name(s)

Suboccipital Myofascial Release(MFR) with sham Deep Neck Flexor(DNF)exercise

Intervention Description

The treatment includes Suboccipital MFR in the supine position.The therapist places the supinated forearm on the bed and positions the tips of the middle three fingers inferior to the occiput bone and the head is supported by the thenar eminences.The therapist will develop a line of tension through the suboccipital tissues by supinating the forearms and pulling apart two hands from each other;Then, for the second level in the first position of hands,pressure is applied to the anterior and superior direction.The pressure is held and increased until the therapist feels the decrease of muscle tone.These techniques last 10 minutes. Another intervention in this group is the sham DNF exercise with a Pressure Biofeedback Unit(PBU).Considering that minimum detective change with PBU is 15 mmHg; After placing the airbag of PBU under the occiput bone in the supine position and inflating it to a base pressure of 11 mmHg,the participant will increase the pressure to 12 mmHg by nodding action.

Intervention Type

Other

Intervention Name(s)

Deep Neck Flexor(DNF)exercise with sham Suboccipital Myofascial Release(MFR)

Intervention Description

The treatments include the DNF exercise with a PBU. The treatment is performed in the supine position and the airbag is placed under the occiput bone and is inflated to a base pressure of 20 mmHg. The participant will increase and hold the pressure to a special point by nodding action. The exercise is repeated for 3 sets, in each set 2 mm Hg is added to the pressure. The pressure will be increased from 22 to 32 mm Hg during 4-week of treatment, and each goal is held for 10 seconds and repeated 10 times. There will be 5 sec of rest between each repetition and 2 min of rest between each set. Another intervention in this group is sham MFR. The therapist's hands will be placed only inferior to the occipital bone and a superficial touch is applied without any upward or lateral pressure. sham treatment in this group, like the opposite group, lasts 10 minutes.

Primary Outcome Measure Information:

Title

Intensity of headache using by Numeric Pain Rating Scale(NPRS)

Description

Time Frame

Change in the intensity of headache after the end of 12 treatment sessions compared to baseline and change from Baseline at 6-week follow up

Title

intensity of Forward Head Posture(FHP) using by Craniovertebral Angle(CVA)

Description

Time Frame

Change in the intensity of Forward Head Posture after the end of 12 treatment sessions compared to baseline and change from Baseline at 6-week follow up

Secondary Outcome Measure Information:

Title

Duration of headache using by headache questionnaire and diary

Description

Time Frame

Change in the duration of headache after the end of 12 treatment sessions compared to baseline and change from Baseline at 6-week follow up

Title

Frequency of headache using by headache questionnaire and diary

Description

Time Frame

Change in the frequency of headache after the end of 12 treatment sessions compared to baseline and change from Baseline at 6-week follow up

Title

Disability using by Henry Ford Hospital Headache Disability Inventory (HDI) questionnaire

Description

Time Frame

Change in the disability after the end of 12 treatment sessions compared to baseline and change from Baseline at 6-week follow up

Title

Quality of life using by Headache Impact Test -6 (HIT-6) questionnaire

Description

Time Frame

Change in the quality of life after the end of 12 treatment sessions compared to baseline and change from Baseline at 6-week follow up

Title

Pressure Pain Threshold(PPT) using by algometer

Description

Time Frame

Change in the pain pressure threshold after the end of 12 treatment sessions compared to baseline and change from Baseline at 6-week follow up

10. Eligibility

Sex

All

Minimum Age & Unit of Time

18 Years

Maximum Age & Unit of Time

55 Years

Accepts Healthy Volunteers

Eligibility Criteria

Inclusion Criteria: Age between 18 and 55 years; based on ICHD-3, Headache that occurs 15 days per month and lasts on average for >3 months (180 days per year), lasting hours to days, or unremitting, and has at least two of the following four characteristics recognized as CTTH: bilateral location, pressing or tightening (non-pulsating) quality, mild or moderate intensity, not aggravated by routine physical activity such as walking or climbing stairs and both of the following: no more than one of photophobia, phonophobia or mild nausea, neither moderate or severe nausea nor vomiting; Dosage and type of prophylactic medication have not changed in the months before the beginning of the trial; The participant does not intend to change the dosage and type of prophylactic medication during the study; CVA less than 49 degrees, Participants have the ability to understand and read Persian to complete the questionnaire. Exclusion Criteria: Participants with infrequent ETTH, or other primary or secondary types of headache; Pain aggravated by movement of the head; Severe pain or significant decrease in ROM of the cervical spine; Previous trauma to the cervical spine; History of injection, surgery, severe disc protrusion, or neck or shoulder fracture that affects treatment; Metabolic or Neurological disorders such as Bow hunter's syndrome or epilepsy; Taking more than 200 pieces of morphine or other strong analgesics per month; Physiotherapy treatment for headache within 6 months before starting treatment; Joint stiffness, atherosclerosis, or advanced osteoarthritis; Manual contraindication includes: (a)The participant has substance or alcohol abuse; (b)For whatever reason, the participant does not want to be touched by the therapist; (c)Symptoms are severe and irritating; (d)Underlying diseases (such as rheumatoid arthritis) or metabolic disorders (such as osteoporosis or soft tissue laxity of the treatment area); Pregnancy; Spielberger State-Trait Anxiety Inventory (STAI) scores more than 85; Absence of two consecutive sessions and more than treatment sessions.

Central Contact Person:

First Name & Middle Initial & Last Name or Official Title & Degree

Mobina Ahmadi, MSc student

Phone

00989039182326

m.oahmadi@ymail.com

First Name & Middle Initial & Last Name or Official Title & Degree

Mohammadreza Pourahmadi, PhD

Phone

00989122245593

Pourahmadi.m@iums.ac.ir

Overall Study Officials:

First Name & Middle Initial & Last Name & Degree

Mobina Ahmadi, MSc student

Organizational Affiliation

MSc student

Official's Role

Principal Investigator

First Name & Middle Initial & Last Name & Degree

Mohammadreza Pourahmadi

Organizational Affiliation

Professor Assisstant

Official's Role

Study Director

12. IPD Sharing Statement

Plan to Share IPD

Yes

IPD Sharing Plan Description

The data sets of this study will be available on a reasonable request to the corresponding author

IPD Sharing Time Frame

starting 6 months after the publication

IPD Sharing Access Criteria

The data will be available for physical therapists working in academic institutions and also clinicians working in the field of musculoskeletal disorders and headaches. The raw data and results of this study can be used in future relevant systematic reviews. Thus, the raw data and results of this study will be available for researchers working in the field of tension-type headache. Applicants can contact Mobina Ahmadi by Email. Email Address:M.oahmadi@ymail.com Applicants should explain their project and how the data/documents of the study will be used in their project in detail. Then, the data/documents files will be sent by email to applicants on request. This process may take 10-12 working days.

Citations:

PubMed Identifier

33267788

Citation

Steiner TJ, Stovner LJ, Jensen R, Uluduz D, Katsarava Z; Lifting The Burden: the Global Campaign against Headache. Migraine remains second among the world's causes of disability, and first among young women: findings from GBD2019. J Headache Pain. 2020 Dec 2;21(1):137. doi: 10.1186/s10194-020-01208-0. No abstract available.

Results Reference

background

PubMed Identifier

23771276

Citation

Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013 Jul;33(9):629-808. doi: 10.1177/0333102413485658. No abstract available.

Results Reference

background

PubMed Identifier

17381554

Citation

Stovner Lj, Hagen K, Jensen R, Katsarava Z, Lipton R, Scher A, Steiner T, Zwart JA. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia. 2007 Mar;27(3):193-210. doi: 10.1111/j.1468-2982.2007.01288.x.

Results Reference

background

PubMed Identifier

28919117

Citation

GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017 Sep 16;390(10100):1211-1259. doi: 10.1016/S0140-6736(17)32154-2. Erratum In: Lancet. 2017 Oct 28;390(10106):e38.

Results Reference

background

PubMed Identifier

33544560

Citation

Ashina S, Buse DC, Bjorner JB, Bendtsen L, Lyngberg AC, Jensen RH, Lipton RB. Health-related quality of life in tension-type headache: a population-based study. Scand J Pain. 2021 Jan 25;21(4):778-787. doi: 10.1515/sjpain-2020-0166. Print 2021 Oct 26.

Results Reference

background

PubMed Identifier

30353868

Citation

GBD 2016 Headache Collaborators. Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018 Nov;17(11):954-976. doi: 10.1016/S1474-4422(18)30322-3. Erratum In: Lancet Neurol. 2021 Dec;20(12):e7.

Results Reference

background

PubMed Identifier

18093564

Citation

Fumal A, Schoenen J. Tension-type headache: current research and clinical management. Lancet Neurol. 2008 Jan;7(1):70-83. doi: 10.1016/S1474-4422(07)70325-3.

Results Reference

background

PubMed Identifier

11037746

Citation

Bendtsen L. Central sensitization in tension-type headache--possible pathophysiological mechanisms. Cephalalgia. 2000 Jun;20(5):486-508. doi: 10.1046/j.1468-2982.2000.00070.x.

Results Reference

background

PubMed Identifier

17359516

Citation

Fernandez-de-las-Penas C, Cuadrado ML, Arendt-Nielsen L, Simons DG, Pareja JA. Myofascial trigger points and sensitization: an updated pain model for tension-type headache. Cephalalgia. 2007 May;27(5):383-93. doi: 10.1111/j.1468-2982.2007.01295.x. Epub 2007 Mar 14.

Results Reference

background

PubMed Identifier

8316392

Citation

Rasmussen BK. Migraine and tension-type headache in a general population: precipitating factors, female hormones, sleep pattern and relation to lifestyle. Pain. 1993 Apr;53(1):65-72. doi: 10.1016/0304-3959(93)90057-V.

Results Reference

background

PubMed Identifier

16897622

Citation

Wober C, Holzhammer J, Zeitlhofer J, Wessely P, Wober-Bingol C. Trigger factors of migraine and tension-type headache: experience and knowledge of the patients. J Headache Pain. 2006 Sep;7(4):188-95. doi: 10.1007/s10194-006-0305-3. Epub 2006 Aug 11.

Results Reference

background

PubMed Identifier

15613190

Citation

Marcus DA, Scharff L, Mercer S, Turk DC. Musculoskeletal abnormalities in chronic headache: a controlled comparison of headache diagnostic groups. Headache. 1999 Jan;39(1):21-7. doi: 10.1046/j.1526-4610.1999.3901021.x.

Results Reference

background

PubMed Identifier

1589462

Citation

Griegel-Morris P, Larson K, Mueller-Klaus K, Oatis CA. Incidence of common postural abnormalities in the cervical, shoulder, and thoracic regions and their association with pain in two age groups of healthy subjects. Phys Ther. 1992 Jun;72(6):425-31. doi: 10.1093/ptj/72.6.425.

Results Reference

background

PubMed Identifier

32754534

Citation

Chu ECP, Lo FS, Bhaumik A. Plausible impact of forward head posture on upper cervical spine stability. J Family Med Prim Care. 2020 May 31;9(5):2517-2520. doi: 10.4103/jfmpc.jfmpc_95_20. eCollection 2020 May.

Results Reference

background

PubMed Identifier

16472338

Citation

Fernandez-de-las-Penas C, Alonso-Blanco C, Cuadrado ML, Pareja JA. Forward head posture and neck mobility in chronic tension-type headache: a blinded, controlled study. Cephalalgia. 2006 Mar;26(3):314-9. doi: 10.1111/j.1468-2982.2005.01042.x.

Results Reference

background

PubMed Identifier

16618263

Citation

Fernandez-de-las-Penas C, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA. Trigger points in the suboccipital muscles and forward head posture in tension-type headache. Headache. 2006 Mar;46(3):454-60. doi: 10.1111/j.1526-4610.2006.00288.x.

Results Reference

background

PubMed Identifier

17257237

Citation

Fernandez-de-las-Penas C, Alonso-Blanco C, Cuadrado ML, Pareja JA. Neck mobility and forward head posture are not related to headache parameters in chronic tension-type headache. Cephalalgia. 2007 Feb;27(2):158-64. doi: 10.1111/j.1468-2982.2006.01247.x.

Results Reference

background

PubMed Identifier

14687010

Citation

Torelli P, Jensen R, Olesen J. Physiotherapy for tension-type headache: a controlled study. Cephalalgia. 2004 Jan;24(1):29-36. doi: 10.1111/j.1468-2982.2004.00633.x.

Results Reference

background

Citation

Fernández-de-las-Peñas C, Arendt-Nielsen L, Gerwin RD. Tension-type and cervicogenic headache: pathophysiology, diagnosis, and management: Jones & Bartlett Publishers; 2010.

Results Reference

background

PubMed Identifier

32527071

Citation

Fernandez-de-Las-Penas C, Florencio LL, Plaza-Manzano G, Arias-Buria JL. Clinical Reasoning Behind Non-Pharmacological Interventions for the Management of Headaches: A Narrative Literature Review. Int J Environ Res Public Health. 2020 Jun 9;17(11):4126. doi: 10.3390/ijerph17114126.

Results Reference

background

PubMed Identifier

28900782

Citation

Lai AKM, Arnold AS, Wakeling JM. Why are Antagonist Muscles Co-activated in My Simulation? A Musculoskeletal Model for Analysing Human Locomotor Tasks. Ann Biomed Eng. 2017 Dec;45(12):2762-2774. doi: 10.1007/s10439-017-1920-7. Epub 2017 Sep 12.

Results Reference

background

PubMed Identifier

24256171

Citation

Castien R, Blankenstein A, van der Windt D, Heymans MW, Dekker J. The working mechanism of manual therapy in participants with chronic tension-type headache. J Orthop Sports Phys Ther. 2013 Oct;43(10):693-9. doi: 10.2519/jospt.2013.4868. Epub 2013 Sep 9.

Results Reference

background

PubMed Identifier

31838486

Citation

Lee E, Lee S. Impact of Cervical Sensory Feedback for Forward Head Posture on Headache Severity and Physiological Factors in Patients with Tension-type Headache: A Randomized, Single-Blind, Controlled Trial. Med Sci Monit. 2019 Dec 15;25:9572-9584. doi: 10.12659/MSM.918595.

Results Reference

background

PubMed Identifier

29662720

Citation

Cosio D, Lin E. Role of Active Versus Passive Complementary and Integrative Health Approaches in Pain Management. Glob Adv Health Med. 2018 Apr 10;7:2164956118768492. doi: 10.1177/2164956118768492. eCollection 2018.

Results Reference

background

PubMed Identifier

33935056

Citation

Cho SH. The effect of suboccipital muscle inhibition and posture correction exercises on chronic tension-type headaches. J Back Musculoskelet Rehabil. 2021;34(6):989-996. doi: 10.3233/BMR-191667.

Results Reference

background

PubMed Identifier

33806089

Citation

Choi W. Effect of 4 Weeks of Cervical Deep Muscle Flexion Exercise on Headache and Sleep Disorder in Patients with Tension Headache and Forward Head Posture. Int J Environ Res Public Health. 2021 Mar 25;18(7):3410. doi: 10.3390/ijerph18073410.

Results Reference

background

PubMed Identifier

25792906

Citation

Victoria Espi-Lopez G, Arnal-Gomez A, Arbos-Berenguer T, Gonzalez AAL, Vicente-Herrero T. Effectiveness of Physical Therapy in Patients with Tension-type Headache: Literature Review. J Jpn Phys Ther Assoc. 2014;17(1):31-38. doi: 10.1298/jjpta.Vol17_005.

Results Reference

background

PubMed Identifier

33118601

Citation

Elizagaray-Garcia I, Beltran-Alacreu H, Angulo-Diaz S, Garrigos-Pedron M, Gil-Martinez A. Chronic Primary Headache Subjects Have Greater Forward Head Posture than Asymptomatic and Episodic Primary Headache Sufferers: Systematic Review and Meta-analysis. Pain Med. 2020 Oct 1;21(10):2465-2480. doi: 10.1093/pm/pnaa235.

Results Reference

background

PubMed Identifier

12221344

Citation

Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, Emberson J, Marschner I, Richardson C. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine (Phila Pa 1976). 2002 Sep 1;27(17):1835-43; discussion 1843. doi: 10.1097/00007632-200209010-00004.

Results Reference

background

PubMed Identifier

19632880

Citation

Jull GA, Falla D, Vicenzino B, Hodges PW. The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain. Man Ther. 2009 Dec;14(6):696-701. doi: 10.1016/j.math.2009.05.004. Epub 2009 Jul 25.

Results Reference

background

PubMed Identifier

34095302

Citation

Alghadir AH, Iqbal ZA. Effect of Deep Cervical Flexor Muscle Training Using Pressure Biofeedback on Pain and Forward Head Posture in School Teachers with Neck Pain: An Observational Study. Biomed Res Int. 2021 May 22;2021:5588580. doi: 10.1155/2021/5588580. eCollection 2021.

Results Reference

background

PubMed Identifier

31054485

Citation

Liang Z, Galea O, Thomas L, Jull G, Treleaven J. Cervical musculoskeletal impairments in migraine and tension type headache: A systematic review and meta-analysis. Musculoskelet Sci Pract. 2019 Jul;42:67-83. doi: 10.1016/j.msksp.2019.04.007. Epub 2019 Apr 25.

Results Reference

background

PubMed Identifier

30876933

Citation

Kalmanson OA, Khayatzadeh S, Germanwala A, Scott-Young M, Havey RM, Voronov LI, Patwardhan AG. Anatomic considerations in headaches associated with cervical sagittal imbalance: A cadaveric biomechanical study. J Clin Neurosci. 2019 Jul;65:140-144. doi: 10.1016/j.jocn.2019.02.003. Epub 2019 Mar 12.

Results Reference

background

PubMed Identifier

29740386

Citation

Falsiroli Maistrello L, Geri T, Gianola S, Zaninetti M, Testa M. Effectiveness of Trigger Point Manual Treatment on the Frequency, Intensity, and Duration of Attacks in Primary Headaches: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Neurol. 2018 Apr 24;9:254. doi: 10.3389/fneur.2018.00254. eCollection 2018.

Results Reference

background

PubMed Identifier

31401702

Citation

Falsiroli Maistrello L, Rafanelli M, Turolla A. Manual Therapy and Quality of Life in People with Headache: Systematic Review and Meta-analysis of Randomized Controlled Trials. Curr Pain Headache Rep. 2019 Aug 10;23(10):78. doi: 10.1007/s11916-019-0815-8.

Results Reference

background

PubMed Identifier

32924640

Citation

Kamonseki DH, Lopes EP, van der Meer HA, Calixtre LB. Effectiveness of manual therapy in patients with tension-type headache. A systematic review and meta-analysis. Disabil Rehabil. 2022 May;44(10):1780-1789. doi: 10.1080/09638288.2020.1813817. Epub 2020 Sep 12.

Results Reference

background

PubMed Identifier

25603749

Citation

Ajimsha MS, Al-Mudahka NR, Al-Madzhar JA. Effectiveness of myofascial release: systematic review of randomized controlled trials. J Bodyw Mov Ther. 2015 Jan;19(1):102-12. doi: 10.1016/j.jbmt.2014.06.001. Epub 2014 Jun 13.

Results Reference

background

PubMed Identifier

27200490

Citation

Williams ACC, Craig KD. Updating the definition of pain. Pain. 2016 Nov;157(11):2420-2423. doi: 10.1097/j.pain.0000000000000613. No abstract available.

Results Reference

background

Citation

Kendall FP ME, Provance PJG, Rodgers MM, Romani, RA ea. Muscles testing and function with posture and pain. Fifth ed2005.

Results Reference

background

Citation

Neumann D. Kinesiology of the Musculoskeletal System - Foundations for Rehabilitation. Kinesiology of the Musculoskeletal System ed: elsevier; 2016.

Results Reference

background

PubMed Identifier

12747245

Citation

Lutz BJ, Bowers BJ. Understanding how disability is defined and conceptualized in the literature. Rehabil Nurs. 2003 May-Jun;28(3):74-8. doi: 10.1002/j.2048-7940.2003.tb02037.x.

Results Reference

background

PubMed Identifier

34816697

Citation

Jabbari S, Salahzadeh Z, Sarbakhsh P, Rezaei M, Farhoudi M, Ghodrati M. Validity and Reliability of Persian Version of Henry Ford Hospital Headache Disability Inventory Questionnaire. Arch Iran Med. 2021 Oct 1;24(10):752-758. doi: 10.34172/aim.2021.111.

Results Reference

background

PubMed Identifier

31187410

Citation

Haraldstad K, Wahl A, Andenaes R, Andersen JR, Andersen MH, Beisland E, Borge CR, Engebretsen E, Eisemann M, Halvorsrud L, Hanssen TA, Haugstvedt A, Haugland T, Johansen VA, Larsen MH, Lovereide L, Loyland B, Kvarme LG, Moons P, Norekval TM, Ribu L, Rohde GE, Urstad KH, Helseth S; LIVSFORSK network. A systematic review of quality of life research in medicine and health sciences. Qual Life Res. 2019 Oct;28(10):2641-2650. doi: 10.1007/s11136-019-02214-9. Epub 2019 Jun 11.

Results Reference

background

PubMed Identifier

24237583

Citation

Zandifar A, Banihashemi M, Haghdoost F, Masjedi SS, Manouchehri N, Asgari F, Najafi MR, Ghorbani A, Zandifar S, Saadatnia M, White MK. Reliability and Validity of the Persian HIT-6 Questionnaire in Migraine and Tension-type Headache. Pain Pract. 2014 Sep;14(7):625-31. doi: 10.1111/papr.12120. Epub 2013 Nov 18.

Results Reference

background

PubMed Identifier

17899675

Citation

Ylinen J. Pressure algometry. Aust J Physiother. 2007;53(3):207. doi: 10.1016/s0004-9514(07)70032-6. No abstract available.

Results Reference

background

PubMed Identifier

25440210

Citation

Espi-Lopez GV, Gomez-Conesa A, Gomez AA, Martinez JB, Pascual-Vaca AO, Blanco CR. Treatment of tension-type headache with articulatory and suboccipital soft tissue therapy: A double-blind, randomized, placebo-controlled clinical trial. J Bodyw Mov Ther. 2014 Oct;18(4):576-85. doi: 10.1016/j.jbmt.2014.01.001. Epub 2014 Jan 10.

Results Reference

background

PubMed Identifier

19614696

Citation

Bendtsen L, Bigal ME, Cerbo R, Diener HC, Holroyd K, Lampl C, Mitsikostas DD, Steiner TJ, Tfelt-Hansen P; International Headache Society Clinical Trials Subcommittee. Guidelines for controlled trials of drugs in tension-type headache: second edition. Cephalalgia. 2010 Jan;30(1):1-16. doi: 10.1111/j.1468-2982.2009.01948.x.

Results Reference

background

Citation

Berggreen S, Wiik E, Lund H. Treatment of myofascial trigger points in female patients with chronic tension-type headache - a randomized controlled trial. Advances in Physiotherapy. 2012;14(1):10-7.

Results Reference

background

PubMed Identifier

30691768

Citation

Kamali F, Mohamadi M, Fakheri L, Mohammadnejad F. Dry needling versus friction massage to treat tension type headache: A randomized clinical trial. J Bodyw Mov Ther. 2019 Jan;23(1):89-93. doi: 10.1016/j.jbmt.2018.01.009. Epub 2018 Jan 31.

Results Reference

background

PubMed Identifier

27491303

Citation

Alvarez-Melcon AC, Valero-Alcaide R, Atin-Arratibel MA, Melcon-Alvarez A, Beneit-Montesinos JV. Effects of physical therapy and relaxation techniques on the parameters of pain in university students with tension-type headache: A randomised controlled clinical trial. Neurologia (Engl Ed). 2018 May;33(4):233-243. doi: 10.1016/j.nrl.2016.06.008. Epub 2016 Aug 1. English, Spanish.

Results Reference

background

Citation

DeStefano LAGPE. Greenman's principles of manual medicine. Philadelphia, Pa.; London: Lippincott Williams & Wilkins; 2010.

Results Reference

background

Citation

Maitland GDMGD. Maitland's vertebral manipulation. Oxford; Boston: Butterworth-Heinemann; 2001.

Results Reference

background

Citation

Youssef A. Photogrammetric Quantification of Forward Head Posture is Side Dependent in Healthy Participants and Patients with Mechanical Neck Pain. International Journal of Physiotherapy. 2016;3.

Results Reference

background

PubMed Identifier

31166989

Citation

Puig-Divi A, Escalona-Marfil C, Padulles-Riu JM, Busquets A, Padulles-Chando X, Marcos-Ruiz D. Validity and reliability of the Kinovea program in obtaining angles and distances using coordinates in 4 perspectives. PLoS One. 2019 Jun 5;14(6):e0216448. doi: 10.1371/journal.pone.0216448. eCollection 2019.

Results Reference

background

PubMed Identifier

19735531

Citation

Lundqvist C, Benth JS, Grande RB, Aaseth K, Russell MB. A vertical VAS is a valid instrument for monitoring headache pain intensity. Cephalalgia. 2009 Oct;29(10):1034-41. doi: 10.1111/j.1468-2982.2008.01833.x. Epub 2009 Mar 12.

Results Reference

background

PubMed Identifier

8190284

Citation

Jacobson GP, Ramadan NM, Aggarwal SK, Newman CW. The Henry Ford Hospital Headache Disability Inventory (HDI). Neurology. 1994 May;44(5):837-42. doi: 10.1212/wnl.44.5.837.

Results Reference

background

PubMed Identifier

25929269

Citation

Florencio LL, Giantomassi MC, Carvalho GF, Goncalves MC, Dach F, Fernandez-de-Las-Penas C, Bevilaqua-Grossi D. Generalized Pressure Pain Hypersensitivity in the Cervical Muscles in Women with Migraine. Pain Med. 2015 Aug;16(8):1629-34. doi: 10.1111/pme.12767. Epub 2015 Apr 30.

Results Reference

background

PubMed Identifier

16956783

Citation

Ylinen J, Nykanen M, Kautiainen H, Hakkinen A. Evaluation of repeatability of pressure algometry on the neck muscles for clinical use. Man Ther. 2007 May;12(2):192-7. doi: 10.1016/j.math.2006.06.010. Epub 2006 Sep 7.

Results Reference

background

PubMed Identifier

8472080

Citation

Garrett TR, Youdas JW, Madson TJ. Reliability of measuring forward head posture in a clinical setting. J Orthop Sports Phys Ther. 1993 Mar;17(3):155-60. doi: 10.2519/jospt.1993.17.3.155.

Results Reference

background

PubMed Identifier

30248030

Citation

Jeong ED, Kim CY, Kim SM, Lee SJ, Kim HD. Short-term effects of the suboccipital muscle inhibition technique and cranio-cervical flexion exercise on hamstring flexibility, cranio-vertebral angle, and range of motion of the cervical spine in subjects with neck pain: A randomized controlled trial. J Back Musculoskelet Rehabil. 2018;31(6):1025-1034. doi: 10.3233/BMR-171016.

Results Reference

background

Citation

Stanborough M. Direct Release Myofascial Technique-An Illustrated Guide for Practitioners. first ed: elsevier; 2004.

Results Reference

background

PubMed Identifier

34391287

Citation

Faustino D, Vieira A, Candotti CT, Detogni Schmit EF, Rios Xavier MF, Lunelli VA, Loss JF. Repeatability and reproducibility of the pressure biofeedback unit. J Bodyw Mov Ther. 2021 Jul;27:560-564. doi: 10.1016/j.jbmt.2021.04.017. Epub 2021 Apr 28.

Results Reference

background

PubMed Identifier

32952469

Citation

Rezaeian T, Mosallanezhad Z, Nourbakhsh MR, Ahmadi M, Nourozi M. The Impact of Soft Tissue Techniques in the Management of Migraine Headache: A Randomized Controlled Trial. J Chiropr Med. 2019 Dec;18(4):243-252. doi: 10.1016/j.jcm.2019.12.001. Epub 2020 Aug 1.

Results Reference

background

PubMed Identifier

1393842

Citation

Pryse-Phillips W, Findlay H, Tugwell P, Edmeads J, Murray TJ, Nelson RF. A Canadian population survey on the clinical, epidemiologic and societal impact of migraine and tension-type headache. Can J Neurol Sci. 1992 Aug;19(3):333-9.

Results Reference

background

PubMed Identifier

8334575

Citation

Edmeads J, Findlay H, Tugwell P, Pryse-Phillips W, Nelson RF, Murray TJ. Impact of migraine and tension-type headache on life-style, consulting behaviour, and medication use: a Canadian population survey. Can J Neurol Sci. 1993 May;20(2):131-7. doi: 10.1017/s0317167100047697.

Results Reference

background

PubMed Identifier

23823250

Citation

Huguet A, McGrath PJ, Stinson J, Tougas ME, Doucette S. Efficacy of psychological treatment for headaches: an overview of systematic reviews and analysis of potential modifiers of treatment efficacy. Clin J Pain. 2014 Apr;30(4):353-69. doi: 10.1097/AJP.0b013e318298dd8b.

Results Reference

background

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Deep Neck Flexor Exercises Versus Myofascial Release of Suboccipital Muscles in Chronic Tension-type Headache

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