Myofascial trigger point-focused head and neck massage for recurrent tension-type headache: a randomized, placebo-controlled clinical trial

Abstract

Objective: Myofascial trigger points (MTrPs) are focal disruptions in the skeletal muscle that can refer pain to the head and reproduce the pain patterns of tension-type HA (TTH). The present study applied massage focused on MTrPs of patients with TTH in a placebo-controlled, clinical trial to assess efficacy on reducing headache (HA) pain.

Methods: Fifty-six patients with TTH were randomized to receive 12 massage or placebo (detuned ultrasound) sessions over 6 weeks, or to wait-list. Trigger point release massage focused on MTrPs in cervical musculature. HA pain (frequency, intensity, and duration) was recorded in a daily HA diary. Additional outcome measures included self-report of perceived clinical change in HA pain and pressure-pain threshold at MTrPs in the upper trapezius and suboccipital muscles.

Results: From diary recordings, group differences across time were detected in HA frequency (P=0.026), but not for intensity or duration. Post hoc analysis indicated that HA frequency decreased from baseline for both massage (P<0.0003) and placebo (P=0.013), but no difference was detected between massage and placebo. Patient report of perceived clinical change was greater reduction in HA pain for massage than placebo or wait-list groups (P=0.002). Pressure-pain threshold improved in all muscles tested for massage only (all P's<0.002).

Discussion: Two findings from this study are apparent: (1) MTrPs are important components in the treatment of TTH, and (2) TTH, like other chronic conditions, is responsive to placebo. Clinical trials on HA that do not include a placebo group are at risk for overestimating the specific contribution from the active intervention.

Figure 1

Study timeline for the 14 week clinical trial depicting the four week baseline, two 3-week treatment phases, the four week run-out, and time points for outcome measure assessments. Key: HA – headache; PPT – pressure-pain threshold; QoL – quality of life; PCC- perceived clinical change.

Figure 2

Subject flow diagram illustrating subjects assessed for eligibility, randomization to groups (massage, placebo, and wait-list), and number analyzed in the study.

Figure 3

Headache frequency means ± standard error over the four study phases (baseline, first and second halves of treatment, run-out) for the three study groups (massage, placebo, and wait-list). Values represent the average number of headache days per week during the respective time frame. Significant change from baseline was detected for massage (p=0.0003) and placebo (p=0.013), but not for wait-list (p=0.098).