Effects of different physiotherapy methods on pain intensity and neck disability in women with tension-type headaches

Abstract

Introduction. Tension-type headache (TTH) is the most prevalent type of primary headache in adults [1]. The pain is typically pressing or tightening in quality, of mild to moderate intensity and does not worsen with the routine physical activity [2]. TTH affects about one person in five worldwide. TTH is more common in women as compared to men (female-to-male 3 to 1) [3]. Physiotherapy or massage can produce a very quick and effective result, relieving tension in the cervical spine, headaches, relaxing the muscles in the event of excessive tension [4,5]. The aim of the study - to evaluate the effect of different physiotherapy methods on the change of pain intensity and neck disability in women experiencing tension-type headaches. Research methods and organization. The research was approved by Lithuanian University of Health Sciences Bioethics Center (BEC-SR(M)-73). The study was conducted in 2021 May-August at Plungė district municipality hospital and consulting polyclinic. Twenty-one women (21-41 years old) experiencing tension-type headaches (3-8 points according to VAS) were included in this study. Headache intensity was measured by using Visual Analog Scale (VAS), Neck Disability Index (NDI) was used for measuring self-related disability. Subjects were divided into two experimental groups: neck stretching and isometric exercises (group I, n=11) and neck and shoulder strap stretching exercises with trigger point relaxation (group II, n=10). All subjects had 12 individual physiotherapy sessions, 3 times a week, once a day for 30 minutes. Statistical analysis was performed using SPSS 23 version. The Mann-Whitney test was used to compare two independent samples. The Wilcoxon criterion was used to compare the two dependent samples. Quantitative data were presented as median (Xme), the minimum value (Xmin), the maximum value (Xmax) and the mean (m) – Xme (Xmin-Xmax; m). The significance level was set to 0.05. Results. Before physiotherapy headache intensity in group I was 6 (5-7; 6.0) points, after physiotherapy – 3 (2-4; 2.8) points. Neck stretching and isometric exercises reduced the intensity of pain in women with TTH from severe to mild (Z=-3.002; p=0.003). Before physiotherapy pain intensity in group II was 6 (5-8; 6.2) points, after physiotherapy – 3.5 (2-5; 3.4) points. Neck and shoulder strap stretching exercises with trigger point relaxation also reduced the intensity of pain in women experiencing TTH from severe to mild (Z=-2.842; p=0.004). After applying different physiotherapy methods, the change in headache intensity was the same in both groups (U=36.5; p=0.197). Before physiotherapy self-related disability in group I was 24 (18-27; 23.5) points, after physiotherapy – 14 (9-18; 13.9) points. Neck stretching and isometric exercises reduced self-related disability in women experiencing TTH from moderate to mild (Z=-2.938, p=0.003). Before physiotherapy self-related disability in group II was 19.4 (14-24; 19.6) points, after physiotherapy – 11 (6-11; 11.1) points. Neck and shoulder strap stretching exercises with trigger point relaxation also reduced self-related disability in women experiencing TTH from moderate to mild (Z=-2.812, p=0.005). However, self-related neck disability in group I and group II differed before the study (U=20; p=0.013), but did not differ after physiotherapy (U=27; p=0.051), i.e. self-related neck disability in group I was higher at the beginning of the study. After applying different physiotherapy methods the change in self-relates neck disability was the same in both study groups (U=36.5; p=0.197). Conclusions: The study showed that both physiotherapy techniques, neck stretching and isometric exercise vs neck and shoulder strap stretching exercises with trigger point relaxation, had similar effects on tension-type headache intensity and neck disability.