title: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: *College of Nursing, University of Colorado at Denver ‡Department of Anesthesiology, School of Medicine, University of Colorado at Denver, Aurora †Boulder College of Massage Therapy, Boulder, CO §Department of Neurology, School of Medicine, University of North Carolina, Chapel Hill, NC.
authors.forename: Albert F
authors.initials: AF
authors.lastname: Moraska
authors.forename: Lea
authors.initials: L
authors.lastname: Stenerson
authors.forename: Nathan
authors.initials: N
authors.lastname: Butryn
authors.forename: Jason P
authors.initials: JP
authors.lastname: Krutsch
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Schmiege
authors.forename: John D
authors.initials: JD
authors.lastname: Mann
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008405:Massage / Q000379:methods*; D008499:Medical Records; D010147:Pain Measurement; D017288:Pain Threshold; D011788:Quality of Life; D057566:Self Report; D018781:Tension-Type Headache / Q000628:therapy*; D016896:Treatment Outcome; D061028:Trigger Points; D014850:Waiting Lists