Measurements
TTH, hyperalgesia, pain, headache pain, headache
SECONDARY
The primary outcome was the frequency of the episodes of headache per month. As secondary outcomes the headache intensity, the pressure pain thresholds and cervical mobility were measured.For the frequency of headache episodes a simple headache diary was used to record the days with TTH per 4 weeks where the patient should indicate for each day whether or not a headache was present. This variable was recorded at times T0 and T2.The headache intensity was registered with a visual analogue scale, which is a valid and reliable tool for measuring headache pain intensity [Pressure pain threshold was measured using a handheld pressure algometer (Somedic AB, Farsta, Sweden) at different cervical region sites to reflect localized hyperalgesia and on the hand to reflect distal hyperalgesia. The probe (1 cm2) was placed right angle to the skin. The pressure was applied at a rate of 30 KPa/s, and participants were instructed to indicate when the sensation changed from a sensation of pressure to the first sensation of pain. The subject was in a supine position, and the pressure pain thresholds were assessed in trapeziometacarpal joint, suboccipital muscles, frontal muscles, temporal muscles, and parietal suture. All sites were first located and marked, topographical pressure pain points were mapped following previous studies description [The CROM (floating compass; Plastimo Airguide, Inc, Buffalo Groove, IL) device was used to measure the range of movement of the cervical spine, which has shown to have good intra- and interexaminer reliability (ICC > 0.80) in all the measurements [The Global Rating of Change Scale (GROC-Scale) was rated according to the question: “Compared to prior inclusion in the study, how much has your headache problem changed?” (Seven for improvement, seven for deterioration and one for without changes). The minimal clinically significant difference in patients with headache is ±4 on the GROC-scale. After the registration, the results were grouped into three categories: without clinical change, with clinical worsening and with clinical improvement [All these variables were recorded in T0, T1 and T2, except for the frequency, the visual analogue scale “worst moment”, “best moment” and “usual pain” that were registered in T0 and T2. The GROC-scale was assessed at T1 and T2 follow-ups.