title: Effectiveness of manual therapy for chronic tension-type headache: a pragmatic, randomised, clinical trial.
abstract: OBJECTIVE
  To evaluate the effectiveness of manual therapy (MT) in participants with chronic tension-type headache (CTTH).
  
  
  METHODS
  We conducted a multicentre, pragmatic, randomised, clinical trial with partly blinded outcome assessment. Eighty-two participants with CTTH were randomly assigned to MT or to usual care by the general practitioner (GP). Primary outcome measures were frequency of headache and use of medication. Secondary outcome measures were severity of headache, disability and cervical function.
  
  
  RESULTS
  After 8 weeks (n = 80) and 26 weeks (n = 75), a significantly larger reduction of headache frequency was found for the MT group (mean difference at 8 weeks, -6.4 days; 95% CI -8.3 to -4.5; effect size, 1.6). Disability and cervical function showed significant differences in favour of the MT group at 8 weeks but were not significantly different at 26 weeks.
  
  
  CONCLUSIONS
  Manual therapy is more effective than usual GP care in the short- and longer term in reducing symptoms of CTTH. Dutch Trial Registration no. TR 1074.
authors.affiliation: Healthcare Centre Haarlemmermeer, The Netherlands. r.castien@vumc.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: Anneke
authors.initials: A
authors.lastname: Grooten
authors.forename: Joost
authors.initials: J
authors.lastname: Dekker
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D058006:General Practice; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations / Q000379:methods*; D012720:Severity of Illness Index; D018781:Tension-Type Headache / Q000188:drug therapy / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal