title: Therapeutic Exercise Training to Reduce Chronic Headache in Working Women: Design of a Randomized Controlled Trial.
abstract: BACKGROUND
  Cervicogenic headache and migraine are common causes of visits to physicians and physical therapists. Few randomized trials utilizing active physical therapy and progressive therapeutic exercise have been previously published. The existing evidence on active treatment methods supports a moderate effect on cervicogenic headache.
  
  
  OBJECTIVE
  The aim of this study is to investigate whether a progressive, group-based therapeutic exercise program decreases the intensity and frequency of chronic headache among women compared with a control group receiving a sham dose of transcutaneous electrical nerve stimulation (TENS) and stretching exercises.
  
  
  METHODS
  A randomized controlled trial with 6-month intervention and follow-up was developed. The participants were randomly assigned to either a treatment group or a control group.
  
  
  METHODS
  The study is being conducted at 2 study centers.
  
  
  METHODS
  The participants are women aged 18 to 60 years with chronic cervicogenic headache or migraine.
  
  
  METHODS
  The treatment group's exercise program consisted of 6 progressive therapeutic exercise modules, including proprioceptive low-load progressive craniocervical and cervical exercises and high-load exercises for the neck muscles. The participants in the control group received 6 individually performed sham TENS treatment sessions.
  
  
  METHODS
  The primary outcome is the intensity of headache. The secondary outcomes are changes in frequency and duration of headache, neck muscle strength, neck and shoulder flexibility, impact of headache on daily life, neck disability, fear-avoidance beliefs, work ability, and quality of life. Between-group differences will be analyzed separately at 6, 12, and 24 months with generalized linear mixed models. In the case of count data (eg, frequency of headache), Poisson or negative binomial regression will be used.
  
  
  CONCLUSIONS
  The therapists are not blinded.
  
  
  CONCLUSIONS
  The effects of specific therapeutic exercises on frequency, intensity, and duration of chronic headache and migraine will be reported.
authors.affiliation: M. Rinne, PT, PhD, UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, Tampere 33500, Finland. marjo.rinne@uta.fi.
authors.forename: Marjo
authors.initials: M
authors.lastname: Rinne
authors.affiliation: S. Garam, PT, MSc, Helsinki Metropolia University of Applied Sciences, Helsinki, Finland.
authors.forename: Sanna
authors.initials: S
authors.lastname: Garam
authors.affiliation: A. Häkkinen, PT, PhD, Department of Health Science, University of Jyväskylä, Jyväskylä, Finland, and Department of Physical Medicine and Rehabilitation, Central Finland Health Care District, Jyväskylä, Finland.
authors.forename: Arja
authors.initials: A
authors.lastname: Häkkinen
authors.affiliation: J. Ylinen, MD, PhD, Department of Physical Medicine and Rehabilitation, Central Finland Health Care District.
authors.forename: Jari
authors.initials: J
authors.lastname: Ylinen
authors.affiliation: K. Kukkonen-Harjula, MD, PhD, UKK Institute for Health Promotion Research.
authors.forename: Katriina
authors.initials: K
authors.lastname: Kukkonen-Harjula
authors.affiliation: R. Nikander, PT, PhD, Department of Health Science, University of Jyväskylä; Department of Physical Medicine and Rehabilitation, Central Finland Health Care District; and GeroCenter Foundation for Aging Research and Development, Jyväskylä, Finland.
authors.forename: Riku
authors.initials: R
authors.lastname: Nikander
mesh_terms: D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D008881:Migraine Disorders / Q000517:prevention & control / Q000523:psychology / Q000628:therapy*; D053580:Muscle Strength; D009334:Neck Muscles / Q000503:physiopathology; D010147:Pain Measurement; D051298:Post-Traumatic Headache / Q000517:prevention & control / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D012107:Research Design; D012782:Shoulder / Q000503:physiopathology; D014931:Women, Working; D014938:Work Capacity Evaluation; D055815:Young Adult