title: Specific strength training compared with interdisciplinary counseling for girls with tension-type headache: a randomized controlled trial.
abstract: BACKGROUND
  Childhood tension-type headache (TTH) is a prevalent and debilitating condition for the child and family. Low-cost nonpharmacological treatments are usually the first choice of professionals and parents. This study examined the outcomes of specific strength training for girls with TTH.
  
  
  METHODS
  Forty-nine girls aged 9-18 years with TTH were randomized to patient education programs with 10 weeks of strength training and compared with those who were counseled by a nurse and physical therapist. Primary outcomes were headache frequency, intensity, and duration; secondary outcomes were neck-shoulder muscle strength, aerobic power, and pericranial tenderness, measured at baseline, after 10 weeks intervention, and at 12 weeks follow-up. Health-related quality of life (HRQOL) questionnaires were assessed at baseline and after 24 months.
  
  
  RESULTS
  For both groups, headache frequency decreased significantly, P=0.001, as did duration, P=0.022, with no significant between-group differences. The odds of having headache on a random day decreased over the 22 weeks by 0.65 (0.50-0.84) (odds ratio [95% confidence interval]). For both groups, neck extension strength decreased significantly with a decrease in cervicothoracic extension/flexion ratio to 1.7, indicating a positive change in muscle balance. In the training group, shoulder strength increased $10% in 5/20 girls and predicted [Formula: see text] increased $15% for 4/20 girls. In the training group, 50% of girls with a headache reduction of $30% had an increase in [Formula: see text] >5%. For the counseling group, this was the case for 29%. A 24-month follow-up on HRQOL for the pooled sample revealed statistically significant improvements. Fifty-five percent of the girls reported little to none disability.
  
  
  CONCLUSIONS
  The results indicate that both physical health and HRQOL can be influenced significantly by physical exercise and nurse counseling. More research is needed to examine the relationship between physical exercise, [Formula: see text], and TTH in girls. Thus, empowering patient education to promote maximum possible outcomes for all children needs more attention.
authors.affiliation: Department of Health Sciences, Lund University, Lund, Sweden; Department of Pediatrics E, Children's Headache Clinic, University of Copenhagen, Herlev and Gentofte Hospitals, Copenhagen, Denmark; Department of Physiotherapy and Occupational Therapy, University of Copenhagen, Glostrup Hospital, Copenhagen, Denmark; Department of Physiotherapy, University of Copenhagen, Herlev and Gentofte Hospitals, Copenhagen, Denmark.
authors.forename: Birte
authors.initials: B
authors.lastname: Tornøe
authors.affiliation: National Research Centre for the Working Environment, Copenhagen, Denmark; Physical Activity and Human Performance group, SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
authors.forename: Lars L
authors.initials: LL
authors.lastname: Andersen
authors.affiliation: National Research Centre for the Working Environment, Copenhagen, Denmark.
authors.forename: Jørgen H
authors.initials: JH
authors.lastname: Skotte
authors.affiliation: Department of Neurology, Danish Headache Centre, University of Copenhagen, Glostrup Hospital, Copenhagen, Denmark.
authors.forename: Rigmor
authors.initials: R
authors.lastname: Jensen
authors.affiliation: Huge Consulting, ApS, Haslev, Denmark.
authors.forename: Claus
authors.initials: C
authors.lastname: Jensen
authors.affiliation: Department of Neurology, Danish Headache Centre, University of Copenhagen, Glostrup Hospital, Copenhagen, Denmark.
authors.forename: Bjarne K
authors.initials: BK
authors.lastname: Madsen
authors.affiliation: Department of Health Sciences, Lund University, Lund, Sweden.
authors.forename: Gunvor
authors.initials: G
authors.lastname: Gard
authors.affiliation: Department of Pediatrics E, Children's Headache Clinic, University of Copenhagen, Herlev and Gentofte Hospitals, Copenhagen, Denmark.
authors.forename: Liselotte
authors.initials: L
authors.lastname: Skov
authors.affiliation: Department of Health Sciences, Lund University, Lund, Sweden.
authors.forename: Inger
authors.initials: I
authors.lastname: Hallström
keywords: cardiovascular fitness; child; empowering patient education; headache; health and physical therapy; muscular fitness; neck and shoulder muscles