Discussion
hyperalgesia, tension-type headache, pain, headache pain, Pericranial tenderness, headache
TENSION-TYPE HEADACHE
This randomized controlled trial aimed to evaluate the effectiveness of three treatment sessions of diacutaneous fibrolysis in headache frequency, pain intensity, cervical pressure pain thresholds and cervical mobility in patients with tension-type headache.The subjects who received the intervention obtained an improvement in the frequency of headache episodes, which is more remarkable considering that the control group worsened compared to the episodes suffered in the same period.An improvement in the intensity of the headache was obtained for the four recorded situations, this reduction being in favor of the intervention group. Furthermore, cervical range of motion improved and the sensibility of the assessed pericranial tissue decreased.In a recent review and meta-analysis, Kamonseki et al. [The intervention group’s frequency decreased significantly in 7.45 days (-10.38, -4.52), while the control group showed an increase of 2.31 days. It seems that the treatment of the musculature applied in the cranio-cervical region is an effective strategy to reduce the frequency of headache in subjects with tension-type headache. Other authors collect the frequency of headache suffered in two weeks or consider a specific percentage reduction in episodes to classify them as having improved [After applying the intervention protocol, a decrease in the usual headache, and the worst headache felt in the last 4 weeks was observed, the decrease was 1.76 for the usual headache and 1.81 for the worst headache. Manual therapy has been suggested to be effective in reducing headache intensity in this type of subjects. Different authors have obtained changes of 1 to 3.1 cm in this scale with manual therapy treatment. These studies were carried out between eight and twenty treatment sessions, compared to the three applied in our study [Two suboccipital massage sessions were performed, obtaining an immediate improvement of 1 cm in the visual analogue scale. Our treatment achieved improvements superior to this but with a slightly higher dose.Pericranial tenderness is one of the common symptoms in patients with tension-type headache. The pressure pain threshold is one of the most common ways of objectifying pain in mechanosensitive points. In the review published by Fernández de las Peñas et al. [On the other hand, we observed a decrease in mechanosensitivity for all the points evaluated in the intervention group except for the trapeziometacarpal joint between baseline and T1. As points to be highlighted, it is observed that in the intervention group between the baseline and T2, the mechanosensitivity to pressure had increased by 15.7% for the left temporal muscle, by 19.95% in the right frontal muscle, by 20.78% in the left frontal muscle and by 17.34% on the right parietal. For these points, a change greater than 15% was obtained concerning baseline for temporal muscle, frontal muscle, and right parietal suture. This percentage of change is considered the minimum clinically relevant change for pressure pain thresholds [It should be noted that for all movements, the intervention group improved range of motion. However, the control group maintains the range of cervical motion or even in some cases, experiences a reduction. Despite these trends, in most cases the minimum change detectable value is not reached, calculated with the CROM tool for subjects with cervical pain due to Fletcher et al. [Considering these promising findings, it could be recommended the use of diacutaneous fibrolysis treatment in tension-type headache. It seems that the three treatments with this type of therapy reduces the headache pain intensity after the intervention protocol and is maintained at one-month follow-up (T2). It also improves the cervical and upper cervical range of motion in all cervical movements. The pressure pain thresholds increase therefore, it seems that the local and distal hyperalgesia decrease.The present study has some limitations that need to be addressed. Our sample included subjects with medical diagnosis of tension-type headache without differentiating between frequent episodic or chronic type. It is possible that the differentiation between these subclassifications may be important in terms of the improvement of each type of patient [For future studies, it would be advisable to extend the follow-up period to analyze the long-term effects that treatment with diacutaneous fibrolysis may have, as well as to associate it with soft tissue self-treatment techniques that can maximize the effect obtained.