title: Effectiveness of manual therapy compared to usual care by the general practitioner for chronic tension-type headache: design of a randomised clinical trial.
abstract: BACKGROUND
  Patients with Chronic Tension Type Headache (CTTH) report functional and emotional impairments (loss of workdays, sleep disturbances, emotional well-being) and are at risk for overuse of medication. Manual therapy may improve symptoms through mobilisation of the spine, correction of posture, and training of cervical muscles.We present the design of a randomised clinical trial (RCT) evaluating the effectiveness of manual therapy (MT) compared to usual care by the general practitioner (GP) in patients with CTTH.
  
  
  METHODS
  Patients are eligible for participation if they present in general practice with CTTH according to the classification of the International Headache Society (IHS).Participants are randomised to either usual GP care according to the national Dutch general practice guidelines for headache, or manual therapy, consisting of mobilisations (high- and low velocity techniques), exercise therapy for the cervical and thoracic spine and postural correction. The primary outcome measures are the number of headache days and use of medication. Secondary outcome measures are severity of headache, functional status, sickness absence, use of other healthcare resources, active cervical range of motion, algometry, endurance of the neckflexor muscles and head posture. Follow-up assessments are conducted after 8 and 26 weeks.
  
  
  CONCLUSIONS
  This is a pragmatic trial in which interventions are offered as they are carried out in everyday practice. This increases generalisability of results, but blinding of patients, GPs and therapists is not possible.The results of this trial will contribute to clinical decision making of the GP regarding referral to manual therapy in patients with chronic tension headache.
authors.affiliation: Healthcare Center Haarlemmermeer, Hoofddorp, the Netherlands. casko.heem@wxs.nl
authors.forename: René F
authors.initials: RF
authors.lastname: Castien
authors.forename: Daniëlle A W M
authors.initials: DA
authors.lastname: van der Windt
authors.forename: Joost
authors.initials: J
authors.lastname: Dekker
authors.forename: Bert
authors.initials: B
authors.lastname: Mutsaers
authors.forename: Anneke
authors.initials: A
authors.lastname: Grooten
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005081:Exercise Therapy; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations; D010821:Physicians, Family; D011187:Posture; D011320:Primary Health Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D016059:Range of Motion, Articular; D012107:Research Design; D012720:Severity of Illness Index; D018582:Sick Leave; D018781:Tension-Type Headache / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult