Guide to Tension Type Headache Osteopathy and Prescriptive Exercise by Osteopaths

What is a Tension Type Headache?

A tension type headache is the most common type of headache and the one we think of as a normal, everyday headache. It may feel like a constant ache that affects both sides of the head. You may also feel the neck muscles tighten and a feeling of pressure behind the eyes. A tension headache normally won’t be severe enough to prevent you doing everyday activities. It usually lasts for 30 minutes to several hours, but can last for several days.

Who gets Tension Type headaches?

Most people are likely to have experienced a tension headache at some point. They can develop at any age, but are more common in teenagers and adults. Women tend to suffer from them more commonly than men. It’s estimated that about half the adults in the UK experience tension-type headaches once or twice a month, and about 1 in 3 get them up to 15 times a month. About 2 or 3 in every 100 adults experience tension-type headaches more than 15 times a month for at least three months in a row. This is known as having chronic tension-type headaches.

What causes tension headaches?

The exact cause of tension-type headaches isn’t clear, but certain things have been known to trigger them, including:
• stress and anxiety
• squinting
• poor posture
• tiredness
• dehydration
• missing meals
• lack of physical activity
• bright sunlight
• noise
• certain smells

Frequency of Tension Type Headache

There is relationship between headache frequency and the emotional burden of condition was indirectly mediated by depression and sleep quality, but not anxiety, in individuals with Chronic Tension Type Headache. Sleep quality mediates th erelationship between pain interference and the frequency of headaches (Palacios-Ceña et al. 2017).

Tension Type Headache and Posture

Look at the diagram below which shows mechanisms of how tension type headaches develop as a result of poor posture.
tension type headache

Osteopathy and Manual Therapy as treatment for Tension Type Headache

Osteopathy and manual therapy for tension type headache is an uninvasive and conservative treatment option with very few side effects. The techniques used by the Osteopaths at Cam Osteopathy Ltd. could involve massage, muscle inhibition, myofascial release, pin and stretch, neck and mid back mobilization.

Osteopathic Treatment of Myofascial Trigger Points occurring with Tension Type Headache

The approach include treating the inactivation of active trigger points in the upper trapezius, sternocleidomastoids, temporalis, sub occipitals, extra-ocular superior oblique or extraocular lateral rectus muscles. Additionally cervical mobilization/manipulation and exercises targeted to the neck flexor or extensor synergy may be appropriate (Fernández-de-Las-Peñas et Courtney, 2014).

Treatment of the myofascial triggers points with massage can reduce the severity of pain associated with Tension Type Headache. As single and multiple massage applications increase Pain Pressure Threshold (PPT) at Muscular Trigger Points (MTrPs). The pain threshold of MTrPs have a great capacity to increase; even after multiple massage treatments additional gain in PPT was observed (Moraska et al. 2017).

Quality of Life following treatment for Tension Type Headache

Manual therapy techniques have some influence on different aspects of quality of life in people with TTH. Considering the overall quality of life, the sub-occipital inhibitory treatment was the most effective. When considering individual dimensions of quality of life, the combined treatment showed the greatest change. Separately, the application of the sub-occipital inhibitory and manipulative treatment provided similar results (Espí-López et al. 2016).

Effects of Manual therapy on Tension Type Headache

Manual therapies were associated with moderate effectiveness at short term, but similar effectiveness at longer follow-up for reducing headache frequency, intensity and duration in tension type headache than pharmacological medical drug care (Mesa-Jiménez et al. 2015).

Comparing the effect of Manual Therapy with Medication for Tension Type Headache Management

In a systemic review by Chaibi et Russell (2014), they concluded that manual therapy has an efficacy in the management of Chronic Tension Type Headache that equals prophylactic medication with tricyclic antidepressant.

Evidence Base for Manual Therapy as an invention for Tension Type Headache

One systematic review suggests that Osteopathic Manual Therapy can reduce future pain episodes and related disability in adults with headache (Cerritelli et al. 2017). Whereas Clar et al. (2014) summarises that there was Inconclusive, (but favourable) evidence for manual therapy (osteopathic care, spinal mobilisation) in treating tension-type headache and Inconclusive (unclear) evidence for spinal manipulation in treating tension-type headache.

Hence, why the Osteopaths at Cam Osteopathy Ltd. tend to avoid using spinal manipulation techniques as a treatment option for tension type headaches.

Prescriptive Exercise for Tension Type Headache

Cervical traction and Mckenzie exercise induce stretching around muscles at the base of the skull (known as the occiput).

Cervical traction,  and McKenzie exercise applied to either low frequency and high frequency episodic tension-type headache patients where some muscles showed significant changes (Choi and Choi, 2016).

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Reference List

Cerritelli FLacorte ERuffini NVanacore N (2017)Osteopathy for primary headache patients: a systematic review. J Pain Res  Mar 14;10:601-611

Chaibi A, Russell MB (2014). Manual therapies for primary chronic headaches: a systematic review of randomized controlled trials. J Headache Pain. Oct 2; 15:67.

Choi SY, Choi JH (2016). The effects of cervical traction, cranial rhythmic impulse, and Mckenzie exercise on headacheand cervical muscle stiffness in episodic tension-type headache patients. J Phys Ther Sci. Mar;28(3):837-43

Clar C, Tsertsvadze A, Court R, Hundt GL, Clarke A, Sutcliffe P (2014). Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report. Chiropr Man Therap. Mar 28; 22(1):12.

Espí-López GV1, Rodríguez-Blanco C, Oliva-Pascual-Vaca A, Molina-Martínez F, Falla D (2016). Do manual therapy techniques have a positive effect on quality of life in people with tension-type headache? A randomized controlled trial. Eur J Phys Rehabil Med. Aug; 52(4):447-56. Epub 2016 Feb 29.

Fernández-de-Las-Peñas C, Courtney CA (2014). Clinical reasoning for manual therapy management of tension type and cervicogenic headache. J Man Manip Ther. Feb;22(1):44-50.

Mesa-Jiménez JA, Lozano-López C, Angulo-Díaz-Parreño S, Rodríguez-Fernández ÁL, De-la-Hoz-Aizpurua JL, Fernández-de-Las-Peñas C (2015). Multimodal manual therapy vs. pharmacological care for management of tension type headache: A meta-analysis of randomized trials. Cephalalgia. Dec; 35 (14):1323-32.

Moraska AF, Schmiege SJ, Mann JD, Butryn N, Krutsch JP (2017).  Responsiveness of Myofascial Trigger Points to Single and Multiple Trigger Point Release Massages: A Randomized, Placebo Controlled Trial. Am J Phys Med Rehabil.  Feb 28

Palacios-Ceña M, Fernández-Muñoz JJ, Castaldo M, Wang K, Guerrero-Peral Á, Arendt-Nielsen L, Fernández-de-Las-Peñas C (2017). The association of headache frequency with pain interference and the burden of disease is mediated by depression and sleep quality, but not anxiety, in chronic tension type headacheHeadache Pain. Dec;18(1):19

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