The Effectiveness of Deep Neck Flexor Exercises in Comparison With Myofascial Release of Suboccipital Muscle on Pain and Forward Head Posture in People With Chronic Tension-type Headache and Forward Head Posture
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Chronic Tension-Type Headache
- Sponsor
- Iran University of Medical Sciences
- Enrollment
- 44
- Primary Endpoint
- intensity of Forward Head Posture(FHP) using by Craniovertebral Angle(CVA)
- Status
- Not yet recruiting
- Last Updated
- last year
Overview
Brief Summary
According to the study of the burden of diseases in 2018, tension-type headache(TTH) is the most common type of primary headache and ranks third in terms of prevalence among 328 diseases and injuries in 195 countries from 1990 to 2016. Suffering from this disorder (especially chronic type) reduces the quality of life of patients.
The main objective of this study is to compare the effects of myofascial release of suboccipital muscles as a bottom-up intervention and Deep Neck Flexor(DNF) exercises with Pressure Biofeedback Unit(PBU) as a top-down intervention on headache parameters, the intensity of Forward Head Posture(FHP), disability, quality of life, and suboccipital Pressure Pain Threshold(PPT) in patients with chronic tension-type headache with forward head posture.
Detailed Description
Previous studies demonstrated that suboccipital active Trigger Points(TrPs) and forward head posture were associated with Chronic Tension-Type Headache(CTTH) and they can aggravate parameters of headache in these patients. The greater suboccipital muscle contraction, as would be exexpected in greater FHP, the more the nociceptive input into the trigeminal nucleus caudalis, and the lower the headache or pain threshold, consistent with increased central sensitization; Therefore it is important to evaluate the effectiveness of interventions on FHP and suboccipital active TrPs in patients with CTTH. The main objective of this study is to compare the effects of myofascial release of suboccipital muscles as a bottom-up intervention and deep neck flexor exercises with a pressure biofeedback unit as a top-down intervention. Primary outcomes will be the intensity of headache and FHP. headache duration and frequency, disability, quality of life, and pain pressure threshold will be considered as secondary outcomes. In this study, a double-dummy randomized clinical trial, 44 participants will be divided into two groups of DNF exercises with pressure biofeedback combined with sham MFR (first group) and sub-occipital MFR combined with sham DNF exercises(second group). The intervention will take place over a 4-week period, with three 1-hour sessions a week, totaling 12 treatment sessions. this study has a 6-week follow-up. This study is a double-blind study in which the participants, the person evaluating the outcome, and the statistician of the data will be blinded to the allocation of patients to the two treatment groups.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Age between 18 and 55 years;
- •based on ICHD-3, Headache that occurs 15 days per month and lasts on average for \>3 months (180 days per year), lasting hours to days, or unremitting, and has at least two of the following four characteristics recognized as CTTH: bilateral location, pressing or tightening (non-pulsating) quality, mild or moderate intensity, not aggravated by routine physical activity such as walking or climbing stairs and both of the following: no more than one of photophobia, phonophobia or mild nausea, neither moderate or severe nausea nor vomiting;
- •Dosage and type of prophylactic medication have not changed in the months before the beginning of the trial;
- •The participant does not intend to change the dosage and type of prophylactic medication during the study;
- •CVA less than 49 degrees,
- •Participants have the ability to understand and read Persian to complete the questionnaire.
Exclusion Criteria
- •Participants with infrequent ETTH, or other primary or secondary types of headache;
- •Pain aggravated by movement of the head;
- •Severe pain or significant decrease in ROM of the cervical spine;
- •Previous trauma to the cervical spine;
- •History of injection, surgery, severe disc protrusion, or neck or shoulder fracture that affects treatment;
- •Metabolic or Neurological disorders such as Bow hunter's syndrome or epilepsy;
- •Taking more than 200 pieces of morphine or other strong analgesics per month;
- •Physiotherapy treatment for headache within 6 months before starting treatment;
- •Joint stiffness, atherosclerosis, or advanced osteoarthritis;
- •Manual contraindication includes: (a)The participant has substance or alcohol abuse; (b)For whatever reason, the participant does not want to be touched by the therapist; (c)Symptoms are severe and irritating; (d)Underlying diseases (such as rheumatoid arthritis) or metabolic disorders (such as osteoporosis or soft tissue laxity of the treatment area);
Outcomes
Primary Outcomes
intensity of Forward Head Posture(FHP) using by Craniovertebral Angle(CVA)
Time Frame: Change in the intensity of Forward Head Posture after the end of 12 treatment sessions compared to baseline and change from Baseline at 6-week follow up
The amount of is measured using the photogrammetric method of body profile for measuring the FHP. This method has high reliability (ICC = 0.83). This angle will be assessed in sitting posture from profile view, in this picture the spinous process of the seventh cervical vertebra and tragus of the ear is marked with landmarks. Photography is done with a camera (smartphone iPhone 13 pro, Apple Inc) with a magnification of 1 and is placed at a certain distance from the person on a fixed base. Finally, the images are transferred to a computer and the angle between the line connecting the ear tragus to the spinous process of the seventh cervical vertebra and the horizon line is measured using Kinovea software (ICC=.99).
Intensity of headache using by Numeric Pain Rating Scale(NPRS)
Time Frame: Change in the intensity of headache after the end of 12 treatment sessions compared to baseline and change from Baseline at 6-week follow up
In the initial evaluation of the participants, the pain intensity will be determined based on the NPRS on a scale of 0-100. For this purpose, the participant is asked to mark their average pain intensity in the last month on a 100 cm line without scaling from zero to 100. The number zero indicates the absence of pain and the number 100 indicates the most pain the person has experienced in their life. The marked point is then measured with a ruler. Participants are asked to record their average intensity of pain during the past month on the Headache Questionnaire. Evaluation of the headache intensity will be done after treatment and in a 6 weeks follow-up by the headache diary; For this purpose, during the four weeks of treatment and up to 6 weeks after the treatment, the participant is asked to record the amount of headache intensity on a daily basis in this diary.
Secondary Outcomes
- Pressure Pain Threshold(PPT) using by algometer(Change in the pain pressure threshold after the end of 12 treatment sessions compared to baseline and change from Baseline at 6-week follow up)
- Frequency of headache using by headache questionnaire and diary(Change in the frequency of headache after the end of 12 treatment sessions compared to baseline and change from Baseline at 6-week follow up)
- Disability using by Henry Ford Hospital Headache Disability Inventory (HDI) questionnaire(Change in the disability after the end of 12 treatment sessions compared to baseline and change from Baseline at 6-week follow up)
- Quality of life using by Headache Impact Test -6 (HIT-6) questionnaire(Change in the quality of life after the end of 12 treatment sessions compared to baseline and change from Baseline at 6-week follow up)
- Duration of headache using by headache questionnaire and diary(Change in the duration of headache after the end of 12 treatment sessions compared to baseline and change from Baseline at 6-week follow up)