Introduction
TTH, tension-type headache, pain, headache, migraine, medication-overuse headache
MIGRAINE, TENSION-TYPE HEADACHE, TENSION-TYPE HEADACHE, OTHER HEADACHE
Tension-type headache is the most common headache worldwide [The Eurolight project highlights that the total annual cost of headache, according to prevalence estimates, is €173 billion, divided between migraine (€111 billion; 64%), TTH (€21 billion; 12%), medication-overuse headache (37 billion euros; 21%) and other headaches (3 billion euros; 2%) [The most common abnormal finding in these patients is the increased sensitivity of the pericranial structures; this sensitivity seems to increase uniformly throughout the cranial and cervical region, affecting skin, muscle, tendon, and fascial tissue [Therapeutic approaches include pharmacological and non-pharmacological interventions [Physical therapy is the most used non-pharmacological treatment of tension-type headache and includes several treatment strategies such as manual therapy, postural exercise, relaxation, physical training, and mixed physiotherapy approaches [Diacutaneous fibrolysis is a physiotherapeutic technique developed following Cyriax Deep Friction Massage principles [The body of evidence supporting the clinical effectiveness of diacutaneous fibrolysis has increased in recent years. Nevertheless, to the best of the authors’ knowledge, no study to date has investigated the effects of diacutaneous fibrolysis in patients with tension-type headache. Therefore, the purpose of this randomized controlled trial was to evaluate the effects of diacutaneous fibrolysis on headache frequency, intensity, cervical pressure pain thresholds (PPTs) and cervical mobility in patients with tension-type headache. The hypothesis is that three sessions of diacutaneous fibrolysis would effectively reduce headache frequency and intensity, tissue sensitivity, and improve cervical range of motion in tension-type headache patients.