Discussion
Headaches, headaches, pain, headache pain, chronic headache, headache, migraine
MINOR, CHRONIC HEADACHE, OTHER HEADACHE, CHRONIC HEADACHES, MIGRAINE
This randomized trial on working-age women with chronic headache showed that after 6 months of progressive training for the neck–shoulder region, headache pain intensity, our primary outcome, decreased slightly in the exercise group, but also in the control group, which received a placebo dose of transcutaneous electrical nerve stimulation. However, after the 6 months of training, weekly headaches occurred less frequently in the exercise group than in the control group. The duration of headache episodes decreased in both groups.To the best of our knowledge, our randomized trial is the largest clinical headache trial to apply a specific progressive exercise program for the neck–shoulder region. We succeeded in retaining the majority of the participants throughout the 6-month intervention. Before randomization, volunteers were carefully screened for eligibility in three phases.The progression of exercise intensity in the exercise group was slow. Low-load exercises were prescribed for the first three modules about 10 weeks and strengthening exercises for the neck–shoulder region were prescribed for the remaining weeks of the intervention. The exercise program was well tolerated, confirming the findings of previous studies indicating that women with chronic headache tolerate training of the neck–shoulder region.We investigated effects of a specific neck–shoulder exercise program instead of aerobic exercisesIn our study, the there was no change in pain intensity after the progressive program including strengthening exercises. Varangot-Reille et al.Headaches occurred less frequently in the exercise group compared to controls. The mean reduction in weekly headache days was 47% in the exercise group. Such a reduction in headache frequency could have a great impact on daily life. The observed reduction was also clinically relevant.The Neck Disability Index improved more in the exercise group when compared to the control group, but the change did not reach clinical relevance.The strengths of this rigorously conducted randomized controlled trial are large number of participants with chronic headache, low proportion of withdrawals, and blinded data analyses. A further strength is the use of a placebo treatment instead of a waiting list. However, our study has limitations. At the time the study design was planned, the best evidence preferred headache intensity as the primary outcome.Our therapeutic exercise program for the neck–shoulder region decreased headache frequency, but not headache intensity when compared to the control group, which received placebo-dosed transcutaneous electrical nerve stimulation. The participants had different kinds of chronic headaches, including migraine with recurrent headache episodes. The reason for the minor effects of the intervention in terms of headache intensity is unknown. However, we can speculate that since the participants had migraine among other headache types, headache intensity may have stayed quite high during headache episodes, even if the frequency of headache episodes decreased. This can have an impact on the mean weekly headache intensity. We conclude that this progressive exercise program for the neck–shoulder region is feasible and safe to perform, and could be used as a treatment option for women with chronic headache. We suggest that further therapeutic exercise research could focus on different subgroups of headaches, as mechanisms vary by headache types.