Title

Effectiveness of Osteopathic Manipulative Treatment and/or Patient-Directed Self Care in Managing Tension Headaches

Date of Award

2014

Degree Type

Thesis

Degree Name

Master of Science (MS)

First Advisor

Lauren Noto-Bell, DO

Second Advisor

Susan Hingley, PhD

Third Advisor

Donald Allison, DO

Abstract

INTRODUCTION: Headaches are pervasive, multifactorial, and cause upwards of $55 billion in losses due to decreased employee productivity. Tension headaches are the most prevalent type of headache, and are believed to result from muscular and/or articular dysfunctions from elsewhere being perceived as originating from the cranium. The current believed mechanism is that the anatomy and innervations of the head and neck play a large role in the type, degree, and location of pain. Currently, the treatment for tension headaches includes non-steroidal anti-inflammatory drugs (NSAIDs), acupuncture, massage, relaxation, and strengthening exercises. In a number of studies, osteopathic manipulative treatment (OMT) has been shown to effectively treat and prevent headaches.

METHODS & MATERIALS: Subjects for this prospective, partially blinded, randomized controlled clinical trial with an optional cross-over period were randomized into four first-phase treatment groups: (1) OMT, (2) Relief Pyramid (a home based treatment device), (3) breathing exercises, or (4) placebo. Subjects were observed for four weeks to determine their baseline, and then followed in their treatment group for four weeks. By their own choosing, they could then enter a second (cross-over) phase for an additional four weeks (for a maximum of 12 weeks total), in which groups 1 and 4 received the Relief Pyramid, and groups 2 and 3 received OMT. Improvement was determined by analysis of longitudinal data from Headache Disability Index (HDI) questionnaires, Headache Diaries, and somatic dysfunction evaluations by osteopathic physicians. The Headache Diaries were further used to elucidate how many headaches actually met the Intemational Headache Society's clinical criteria for diagnosis as tension headaches.

RESULTS: Nineteen subjects were enrolled, and analysis was ultimately done on fourteen; nine completed the full 12-week observation period. There were initially 2.91 headaches per week on average, with an average intensity of 5.4. out of 10, and an average duration of 10.17 hours. The most frequently cited location of pain correlated to trigger points in the upper trapezius muscle. Over the course of the investigation, all subjects' emotional disability decreased. Most subjects experienced a decreased articular somatic dysfunction, but a slight increase in muscular somatic dysfunction. All subjects in the second phase experienced decreases in articular somatic dysfunction. Regardless of treatment modality, there was a decrease in the average frequency of all headaches; however, OMT resulted in a more prominent decrease in frequency of true tension headaches. There was a decrease in intensity of true tension headaches throughout the study for all subjects. The duration of true tension headaches was reduced by greater than 15 minutes for all subjects. Lastly, the average maximum duration of true tension headache experienced for all subjects was reduced by two hours and fifteen minutes.

DISCUSSION: This study showed that using a combination of treatments (rather than any one treatment alone) provided clinically relevant improvements in the lives of the subjects who participated. Interestingly, data tended to reveal a decrease in emotional disability, but a negligible effect on functional disability suggesting that while subjects may have felt better, they still restricted their activities. While the Relief Pyramid alone did not provide much in the way of improvement, when followed by OMT, there were decreases in both tension headache frequency and intensity suggesting that there is possibly some benefit from utilizing this home treatment for patients who suffer from chronic tension headaches. A limitation of this study was that subjects received a single OMT treatment. which is not the norm in a real clinical situation, and this might have minimized any benefits resulting from OMT treatment. Furthermore, the low number of subjects participating in this study led to imbalances in the distribution of groups and made it difficult to achieve statistically significant results. However, the data suggest that an extension of these studies might be able to establish the benefits of OMT as a treatment for chronic headache pain.

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