M.Tech. (Homoeopathy) / Chronic tension-type headaches (CTTHs) affect 30-40% of the population and account for a number of absences from, and decreased performances at, work and school as well as recreational activities. CTTHs typically occur at least 15 times a month or at least every second day, and present as an achey or tight sensation that is felt around the head. The pain may last from 30 minutes to several days and varies in intensity. Conventional treatment is palliative, consisting of analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs), which may produce adverse effects and analgesic rebound headaches. Lacticum acidum 30CH is a homoeopathic remedy that has been shown to have potential benefits in the treatment of CTTHs. Homaccords are the preparation of one remedy in multiple increasing potencies in a single vehicle. There has been no research done to date on Lacticum acidum Homaccord in the treatment of CTTHs. The aim of this study was to determine the efficacy of Lacticum acidum Homaccord in the treatment of CTTHs, using the modified Headache Diary and the Headache Disability Inventory. The study was a randomised, double-blind, placebo-controlled matched pair study which took place at the Homoeopathic Health Centre at the University of Johannesburg (UJ) Doornfontein campus, over a period of four weeks. A randomised sample of 34 male and female participants between the ages of 18 and 45 years who suffered from CTTHs were recruited by means of purposive sampling via advertisements placed on the UJ campus. At the initial consultation (day 0), prospective participants were requested to sign the Participant Information and Consent Form. The participants were then requested to complete the Screening Questionnaire to assess their eligibility for participating in the study. Participants’ meeting the diagnostic criteria for CTTHs, and those whose symptoms matched at least eight out of the twelve Lacticum acidum headache-related symptoms, were eligible to participate in the study. Participants’ were placed into matched pairs, according to gender and age. Participants in both groups received one 30 mL bottle of their respectively dispensed and labelled medication. On days 1-28 the participant was requested to complete the modified Headache Diary at the end of each day and to take 5 pillules of the medication in the morning and in the evening of each day. The first follow-up visit occurred on day 14; here participants completed the Headache Disability Inventory; the completed headache diaries were exchanged with new ones, a physical examination with vital signs was conducted and an additional bottle of medication was given. The second and final follow-up vi visit occurred on day 28, where the participant completed the Headache Disability Inventory, and a physical examination with vital signs was conducted. The average duration (time), intensity, frequency of headaches, and medication use was recorded on a daily basis and the level of perceived disability from CTTHs was measured weekly. This was conducted by completing the modified Headache Diary and the Headache Disability Inventory respectively. The data from the study was evaluated and analysed using frequencies and descriptive tests, cross tabulations, the Shapiro Wilk test, the Mann-Whitney test, and the Friedman and Wilcoxon signed ranks tests ...

Cervicogenic headache is a disorder that is gaining more recognition in the medical field annually. Although a lot of controversy surrounds cervicogenic headache due to its wide array of symptoms and overlap with pre-existing primary headaches, there are many etiologies and treatment procedures that currently exist. The aim of this study was to determine the most effective treatment protocol for cervicogenic headache by comparing three different research trials from the University of Johannesburg Chiropractic day clinic (former Technikon Witwatersrand Chiropractic day clinic) within a two-year period. The treatment protocols that were compared were cervical spinal manipulative therapy, a combination of cervical spinal manipulative therapy and cervical strengthening exercises, temporomandibular joint manipulative therapy and postural correction of the lumbar spine to decrease anterior head carriage. Seventy-eight participants from a possible 96 candidates were contacted telephonically and asked verbal consent to participate in the research trial. The participants were required to complete a telephonic questionnaire that was drawn up by the researcher involved with the aid of a statistical consultant. The questionnaire took 5 minutes to complete. The aim of the questionnaire was to assess the percentage of participants who were currently suffering from headache and the severity, duration and frequency of their headaches. Participants also needed to compare their current and previous headaches. The data was statistically analysed using cross tabulations and CHI squared tests. Statistical significance was calculated using Fischer’s exact test and Phi test for the two-by-two tables, while the Pearson test and Cramer’s V test was performed on tables larger than two-by-two. Statistical analysis revealed that the manipulation groups provided relief for up to three months, after which, symptoms recurred. The group that received the Easy Back Postural Correction Device showed the greatest improvement of symptoms in terms of headache free duration and decrease in current headache severity, duration and frequency. It can thus be concluded that postural correction of the lumbar spine, which in turn corrects anterior head translation, is the treatment of choice for cervicogenic headache. / Dr. M. Moodley Dr. R. van Zyl

Headache is a common complaint in society and is related to personal, biomechanical and socioeconomic circumstances. In current literature trigger-points (TrPs) in the majority of the muscles of the face and neck contributing to tension-type headache (TTH) have been evaluated, except the TrPs of the masseter muscles. The aim of this studyis to determine the association between myofascial (TrPs) in the masseter muscle group and episodic tension-type headache (ETTH). Fourteen subjects with ETTH were matched with same sex and same age subjects not suffering from headache acting as the control group. The diagnostic criteria as described by Simons and Travel (1999) were used in the objective tests to diagnose the TrPs in the masseter muscles. Subjective tests included a disability questionnaire, National stress awareness day stress questionnaire, (NSAD stress questionnaire), a precipitating and aggravating factors questionnaire. Active TrPs were found in 92.86% of ETTH group and 7.14% had latent TrPs. Within the control group 7.14% had active TrPs, 14.29% latent TrPs and 78.37% had no TrPs.Differences in the presence of masseter TrPs between the ETTH and control group were significant with p-value <0.001. All the questions asked in the headache disability questionnaire evaluating headache frequency, intensity and severity were significantwith p-value<0.005. The NSAD stress questionnaire revealed statistical significant values for questions pertaining to muscular aches and pains and subjectively subjects claimed that theyfelt tension at work. The precipitating questionnaire showed that physical activity, stress / tension and reading were significant precipitating factors for developing a tension-type headache. The aggravating questionnaire only showed light as an aggravating factor. Stress and tension had 100% “yes”answers in the ETTH group.Weather as an aggravating factor had 100% “no” answersfrom the control group.Physical activity, driving and noise had relative high percentages of “yes”answers from the ETTH group and higher probability scores for being an aggravating factor whencomparing the ETTH and control group, but were not found to be statistically significant. Myofascial TrPs in the masseter muscle group contribute to the origin and or maintenance of ETTH.

Headache pain impacts most of the population at some point in life, at an enormous cost to day-to-day functioning. Determination of the variables that are associated with prevalence and severity of headaches has been inconsistent. One area that deserves more attention is the relationship between headaches and sleep. For instance, several sleep parameters may precipitate or exacerbate headaches, but previous research often used inconsistent and limited assessments of both headaches and sleep, making results difficult to interpret and compare. The current study seeks to extend previous research by using more comprehensive and empirically validated assessment techniques to study the relationship between sleep and headaches in a healthy sample. Greater self-reported sleep quality is related to lower headache frequency and severity, and lower self-reported sleep quality is characteristic of individuals having migraine-type headaches. Greater sleep efficiency is related to lower headache severity and shorter headache duration. Greater sleep onset latency is related to longer headache duration and greater headache severity. Greater number of nighttime awakenings is related to greater headache severity and is characteristic of individuals having a diagnosable headache disorder (either tension-type or migraine-type). Stress appeared to be a partial mediator between self-reported sleep quality and headache severity. Further experimental studies may clarify causality between sleep and headache.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2007 / The purpose of this study was to determine the relationship between Myofascial Pain Syndrome (MPS) of the pericranial musculature and the clinical presentation of episodic tension-type headache (ETTH). It set out to determine the extent to which MPS is related to the nature of the ETTH. ETTH is a very prevalent disorder, common to individuals in their third decade, and particularly females. Current literature suggests a multi-factorial aetiology, combining psychological and neuromusculoskeletal mechanisms, to name a few. Due to the many facets of this disorder, it has, for a long time, provided a challenge to the practitioner with regard to patient treatment and management. MPS is a condition that may affect any number of muscles, resulting in motor, sensory and autonomic symptoms. MPS of the pericranial muscles, namely the upper Trapezius, Sternocleidomastoid, Temporalis and Suboccipital muscles, produces a referred pain pattern similar to the pain pattern experienced during an ETTH. The literature states that the pain produced by MPS has been somewhat overlooked and it was thus necessary to further investigate the myofascial component of ETTH. This study was a quantitative, pilot, non-intervention, clinical assessment study, which required forty participants residing in the province of Kwa-Zulu Natal suffering from ETTH. The clinical assessment included a case history and physical and cervical examinations. The participants were requested to complete a headache diary over a period of 14 days. Following this, they returned to the Chiropractic Day Clinic for a second consultation. Data was collected at both consultations and the participant was offered one free treatment. The headache diary and Numerical Pain Rating Scale provided the subjective measurements, while the algometer and Myofascial Diagnostic Scale were used to gather the objective measurements. / M