title: The effect of manipulation plus massage therapy versus massage therapy alone in people with tension-type headache. A randomized controlled clinical trial.
abstract: BACKGROUND
  Manipulative techniques have shown promising results for relief of tension-type headache (TTH), however prior studies either lacked a control group, or suffered from poor methodological quality. The aim of this study was to compare the effect of spinal manipulation combined with massage versus massage alone on range of motion of the cervical spine, headache frequency, intensity and disability in patients with TTH.
  
  
  METHODS
  Randomized, single-blinded, controlled clinical trial.
  
  
  METHODS
  University clinic.
  
  
  METHODS
  We enrolled 105 subjects with TTH.
  
  
  METHODS
  Participants were divided into two groups: 1) manipulation and massage; 2) massage only (control). Four treatment sessions were applied over four weeks. The Headache Disability Inventory (HDI) and range of upper cervical and cervical motion were evaluated at baseline, immediately after the intervention and at a follow-up, 8 weeks after completing the intervention.
  
  
  RESULTS
  Both groups demonstrated a large (ƒ=1.22) improvement on their HDI scores. Those that received manipulation reported a medium-sized reduction (ƒ=0.33) in headache frequency across all data points (P<0.05) compared to the control group. Both groups showed a large within-subject effect for upper cervical extension (ƒ=0.62), a medium-sized effect for cervical extension (ƒ=0.39), and large effects for upper cervical (ƒ=1.00) and cervical (ƒ=0.27) flexion. The addition of manipulation resulted in larger gains of upper cervical flexion range of motion, and this difference remained stable at the follow-up.
  
  
  CONCLUSIONS
  These findings support the benefit of treating TTH with either massage or massage combined with a manipulative technique. However, the addition of manipulative technique was more effective for increasing range of motion of the upper cervical spine and for reducing the impact of headache.
  
  
  CONCLUSIONS
  Although massage provided relief of headache in TTH sufferers, when combined with cervical manipulation, there was a stronger effect on range of upper cervical spine motion.
authors.affiliation: Department of Physiotherapy, University of Valencia, Valencia, Spain - deborah.falla@bccn.uni-goettingen.de.
authors.forename: Gemma V
authors.initials: GV
authors.lastname: Espí-López
authors.forename: Rosario
authors.initials: R
authors.lastname: Zurriaga-Llorens
authors.forename: Lucas
authors.initials: L
authors.lastname: Monzani
authors.forename: Deborah
authors.initials: D
authors.lastname: Falla
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D008405:Massage / Q000379:methods*; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D012720:Severity of Illness Index; D016037:Single-Blind Method; D018781:Tension-Type Headache / Q000175:diagnosis* / Q000534:rehabilitation*; D016896:Treatment Outcome