Monday, August 15, 2016

Have a Migraine?

Do you ever have clients complain of repeated headaches? Chronic migraines, chronic tension-type headaches, and chronic cluster headaches are also known as primary chronic headaches.

These primary chronic headache conditions affect about 3% of the general population, occurring predominately in females. These conditions have a significant impact on quality of life as well as economic and social costs.

This month's Massage Therapy Foundation article review focuses on a systematic review by
Norwegian researchers Chaibi and Russell of the efficacy of manual therapy randomized clinical trials (RCT) for primary chronic headaches published in The Journal of Headache and Pain in 2014.

Chaibi and Russell note that about 80% of people affected by primary chronic headaches consult their primary physician, in which pharmacological management is often the first line of treatment. However, they point out that nearly half of medication users overuse medication, putting them at risk of overuse for headache attacks. As such, non-pharmacological management should be considered as a viable option for managing this condition. The authors contend that non-pharmacological management for primary chronic headaches have the advantage of few and usually minor adverse effects and no adverse pharmacological interactions.

Chaibi and Russell conducted a literature search on CINHAL, Cochrane, Medline, Ovid and PubMed, which ultimately identified six RCTs. All six studies investigated chronic tension-type headache. The primary focus for their review was the frequency of headaches and secondarily, intensity and/or duration. The literature search found one study that applied massage therapy and five studies that applied physiotherapy. Though all were published in English, the studies were conducted around the world, including United States, Spain, Turkey, Denmark, and the Netherlands from 1989 to 2011. Of these six studies, four were considered to be of good methodological quality. The studies were pragmatic or used no intervention for a control group, and only two studies avoided using another intervention along with the manual therapy which may result in bias and makes interpretation of the results more difficult.

Review of the selected RCT studies suggest that massage and physiotherapy are effective treatment options in managing chronic tension-type headaches. One of the RCTs showed that physiotherapy reduced headache frequency and intensity better than usual care. The efficacy of physiotherapy at post-treatment and at six months follow-up was shown to equal the efficacy of antidepressants. While the massage study only had 11 subjects, it did show a greater reduction in headache intensity than the ultrasound control group. Based on this systematic review, the authors recommend that manual therapies be considered equally with medication management in headache treatment.

The authors indicated that their literature review might have possible biases, as they did not attempt to identify unpublished RCTs. They also reported that though they performed a comprehensive search, it is possible they overlooked one or more RCTs, especially those published in non-English.

Chaibi and Russell suggest the quality of methodology used in studies assessing manual therapies for headache disorders are frequently criticized for being too low. They recommend future manual therapy RCTs follow the recommendations of the International Headache Society with a focus on headache frequency primarily and secondarily, duration and intensity. Additionally, they state that manual therapy studies are needed for chronic migraine with and without medication overuse.

This review provides important findings suggesting that massage and physiotherapy are effective treatment options in managing chronic tension-type headaches. These findings support the use of these therapies by practitioners to help clients treat chronic tension-type headaches in clinical and non-clinical settings.

Are you interested in learning more about the uses of manual therapies to alleviate pain and promote quality of life for patients? To learn more about the effects of massage therapy, you can read the Massage Therapy Foundation review article archives, review accepted MTF Research Grant abstracts, or search PubMed for massage therapy studies.

Looking for quality online continuing education? Consider the Basics of Research Literacy course. This online continuing education course is for all massage practitioners and educators offered by the Massage Therapy Foundation and Education and Training solutions. You can explore the basics of incorporating principles of research literacy into your practice or school curriculum at your own pace. For more information and to sign up for the class, visit

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