Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2010. / The 1 year overall prevalence of Episodic Tension-Type Headache (ETTH) is 38.3%; with lifetime prevalence at 46% for TTH. Little literature exists to support the effectiveness of spinal manipulation in the treatment of ETTH. Therefore aim of this study was to determine the relative effectiveness of cervical spine manipulation and a Nonsteroidal Anti-inflammatory drug (NSAID) (Ibuprofen®) in the treatment of ETTH. Method: This study was a prospective randomised clinical trial with two intervention groups (N=32, n1=16 and n2=16). The allocation of participants to the two groups was completed by means of simple randomization. Group one were treated using cervical spine manipulation. Group two were treated using Ibuprofen. Subjective measurements included the Numerical Rating Scale 101 Questionnaire (NRS-101), Short Form McGill Pain Questionnaire (SF-MPQ), CMCC Neck Disability Index (CMCC) and Headache Diary. A p value <0.05 was considered as statistically significant. Results: The subjective measurements of the NRS-101, SF-MPQ and CMCC showed a significant time effect in both treatment groups. Several of the subjective Headaches Diary outcomes followed this trend with significant time effect in both groups. There was a significant treatment effect for the NRS-101. Several subject outcomes from the Headache Diary showed a significant treatment effect in favour of manipulation, namely frequency and duration of headaches. Conclusion: The findings in this study have shown that cervical spine manipulation is more effective than Ibuprofen® for the treatment of ETTH in terms of several subjective outcomes namely: pain intensity (NRS-101), and the frequency and the duration of headache per day.

Dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Chiropractic, Durban University of Technology, 2009. / Headaches are one of the most common clinical conditions in medicine, and 80% of these are tension-type headaches (TTH). TTH has a greater socioeconomic impact than any other type of headache due to its prevalence. Within the TTH category, episodic TTH are more prevalent than chronic TTH. The mainstay in the treatment of TTH are simple analgesics and NSAIDs. Unless contraindicated, NSAIDs are often the most effective treatment for ETTH. However patients suffering with TTH tend to relate their headaches to increased muscle stiffness in the neck and shoulders and thus the non-pharmacological treatment of ETTH could be directed at the associated musculoskeletal components of ETTH. It is therefore proposed that the Kinesio Taping® Method may have an effect in the treatment of the muscular component of ETTH. Method: This study was a prospective randomised clinical trial with two intervention groups (n=16) aimed at determining the relative effectiveness of a NSAID and the Kinesio Taping® Method in the treatment of ETTHs. The patients were treated at 5 consultations over a 3 week period. Feedback was obtained using the: NRS – 101, the CMCC Neck Disability Index and a Headache Diary. Results: The Headache Diary showed a reduction in the presence and number, mean duration and pain intensity of ETTH in both groups. These treatment effects were sustained after the cessation of treatment with the exception of mean pain intensity in the Kinesio Taping® Method group. The mean NRS score decreased in both groups but at a slightly faster rate in the Kinesio Taping® Method group. The CMCC showed an improvement in the functional ability of the patients in both groups. Conclusion: There seems to be no significant difference in the relative effectiveness of the treatment modalities. We can thus state that the overall short-term reduction in symptomatology supports the use of NSAIDs or Kinesio Taping® Method in the treatment of ETTH.

Bakgrund: Migrän och huvudvärk av spänningstyp (HST) är två vanligt förekommande hälsoproblem. Traditionellt behandlas dessa åkommor farmakologiskt men på senare tid har fysioterapeutisk behandling blivit allt vanligare. Aerob träning är en av många fysioterapeutiska behandlingsmetoder som kan verka smärtlindrande för dessa patienter. Syfte: Att undersöka effekten av aerob träning på upplevd smärtnivå för personer med migrän och/eller HST. Metod: Studiens design var litteraturstudie. Systematiska sökningar genomfördes i databaserna PubMed och PEDro. Sökresultatet granskades utefter urvalskriterierna. Inkluderade artiklars risk för snedvridning bedömdes utifrån PEDro granskningsmall och det sammanvägda resultatets tillförlitlighet utvärderades med hjälp av GRADEstud. Resultat: Efter urvalsprocessen inkluderades åtta randomiserade kontrollerade studier. En av artiklarna bedömdes ha hög kvalitet och resterande hade måttlig kvalitet. Inkluderade artiklars olikheter gällande intervention och population ledde till subgruppering av resultaten. Antal dagar med migrän per månad minskade inom samtliga grupper som hade aerob träning som intervention men mellangruppsjämförelserna var ej statistiskt signifikanta. Samma minskning gick inte att se gällande HST. Den sammanvägda tillförlitligheten utifrån GRADEstud bedömdes som låg eller mycket låg gällande alla subgrupper. Konklusion: Baserat på artiklarnas resultat, låga kvalitet och det sammanvägda resultatets låga tillförlitlighet kan inga säkra slutsatser dras gällande effekten av aerob träning på upplevd smärtnivå för personer med migrän och HST. Fler studier behövs. / Background: Migraine and tension-type headache (TTH) are two common health problems. These health problems are traditionally treated pharmacologically but physical therapy has lately gained popularity as a treatment option. Aerobic exercise is one of many physiotherapeutic treatments that can reduce pain for these patients. Purpose: To examine the effect of aerobic exercise on perceived pain level for individuals with migraine and/or TTH. Method: The study design was literature review. Systematic searches were performed in the databases PubMed and PEDro. The search result was reviewed according to the selection criteria. The risk of bias in the included articles was assessed using PEDro scale and the certainty in evidence of the articles summarized outcomes was assessed using GRADEstud.  Results: Eight randomized controlled studies were included after the selection process. One article was considered to have high quality and the remaining seven to have fair quality. The results were sub-grouped due to differences in the included articles regarding intervention and population. Number of days with migraine per month decreased within all groups with training as intervention but the between group comparisons were not statically significant. The same reduction could not be found regarding TTH. The certainty in evidence of the articles summarized outcomes was considered to be low or very low in all subgroups. Conclusion: No certain conclusion could be drawn regarding the effect of aerobic exercise on perceived pain level in individuals with migraine and TTH based on the articles results, low quality, and low certainty in evidence. More studies are needed.

No description available.

Bakgrund: Spänningshuvudvärk är den vanligaste formen av huvudvärk och förekommer hos ungefär 40 % av världens vuxna befolkning. Fysioterapeuten kan bidra med flera olika smärtlindrande metoder där muskelstärkande fysisk aktivitet kan vara ett alternativ. I dagsläget saknas en systematisk översikt som sammanställt forskning inom området. Syfte: Sammanställa det nuvarande vetenskapliga underlaget gällande effekterna av muskelstärkande fysisk aktivitet i nacke och axlar på huvudvärkens frekvens, duration och intensitet samt jämföra det med ingen behandling eller med annan behandling som ges till vuxna individer med spänningshuvudvärk. Metod: En systematisk översikt. Systematiska sökningar genomfördes i databasen PubMed och granskades utifrån urvalskriterierna. De inkluderade artiklarna bedömdes för risk för snedvridning utifrån granskningsmallen PEDro och den sammanvägda tillförlitligheten utvärderades med hjälp av en modifierad version av GRADE. Resultat: 7 randomiserade kontrollerade studier inkluderades efter urvalsprocessen. Samtliga artiklar bedömdes ha hög kvalitet och därmed låg risk för snedvridning. 4 av 7 studier påvisade en signifikant förbättring av muskelstärkande fysisk aktivitet på antingen frekvens, duration eller intensitet jämfört med annan behandling. Vid bedömning av artiklarnas sammanvägda tillförlitlighet delades artiklarna in i två undergrupper utefter intervention. Tre studier med styrketräning för nacke och axlar bedömdes ha låg tillförlitlighet och fyra studier med styrketräning för djupa nackmuskler ansågs ha mycket låg tillförlitlighet. Konklusion: Det går inte att dra några slutsatser om effekterna av muskelstärkande fysisk aktivitet vid spänningshuvudvärk. Det behövs flera randomiserade kontrollerade studier inom området för att säkerställa evidens kring muskelstärkande fysisk aktivitet vid spänningshuvudvärk. / Background: Tension type headache is the most common type of headache and occurs in approximately 40 % of the world's adult population. The physiotherapist can contribute with several pain-relieving methods where muscle-strengthening physical activity can be an alternative. As of today, there is no systematic review that has compiled research in this field. Aim: To compile the current scientific evidence regarding muscle-strengthening physical activity in the neck and shoulders on the frequency, duration and intensity of headaches and compare it with other treatments given to adults with tension-type headaches. Method: A systematic review. A systematic search was carried out in the database PubMed and reviewed according to the selection criteria. The included articles were assessed for risk of bias based on the PEDro review template and the overall reliability was evaluated using a modified version of GRADE. Results: 7 randomized controlled trials were included after the selection process. All articles were judged to be of high quality and thus have a low risk of bias. 4 of 7 studies showed a significant improvement in muscle-strengthening physical activity on either frequency, duration or intensity compared to other treatments. When assessing the overall reliability of the articles, the articles were divided into two subgroups according to intervention. Three studies with strength training for the neck and shoulders were considered to be of low quality, and four studies with strength training of deep neck muscles were considered to be of very low quality. Conclusion: It is not possible to draw any conclusions about the effects of muscle-strengthening physical activity on tension type headache. Several randomized controlled trials are needed in the field to ensure evidence of muscle-strengthening physical activity in tension type headache.

<p>Headache is the most frequently reported pain in children and is associated with missed schooldays, anxiety, depressive symptoms and various physical symptoms. A secular trend of increasing headache prevalence has been suggested. Few studies have focused on tension-type headache among children from the general population. </p><p>The aims of this thesis were to describe the prevalence, incidence and prognosis of tension-type headache, migraine and overall headache in schoolchildren, to identify medical, psychological and social factors associated with these headache types, and to determine whether the prevalence of headache has increased over the last decades.</p><p>In 1997, 1850 schoolchildren aged 7-15 years from the city of Uppsala participated in a questionnaire study and 1371 (74.1%) responded. Out of these, a randomly selected, stratified sample of 131 children and their parents were interviewed. Three years later, 122 children from the interview sample replied to an identical headache questionnaire.</p><p>Compared with a similar study in 1955, a significantly lower proportion of schoolchildren reported no headache. The prevalence of tension-type headache increased with age and was significantly higher in girls than boys after the age of twelve. Similar age and gender differences were obtained for migraine. A higher proportion of girls reported frequent headache than boys. Children with headache, especially those with migraine, as well as their first-degree relatives suffered from other pains and physical symptoms more frequently than headache-free children and their first-degree relatives. Although the likelihood of experiencing the same headache diagnosis and symptoms at follow-up was high, about one fifth of children with migraine developed tension-type headache and vice versa. Female gender was a predictor of migraine and frequent headache a predictor of overall headache at follow-up. The estimated annual incidence for tension-type headache, migraine and overall headache was 81, 65 and 131 per 1000 children, respectively. </p><p>In conclusion, the results indicate that headache has become increasingly common among schoolchildren over the last decades. Prevention and treatment of headache is particularly important for girls since they have high prevalence of headache, frequent headache episodes and a poor outcome. In children with headache, diagnoses and treatment should be reassessed regularly and other pains should be asked about and treated as well. </p>

Headache is the most frequently reported pain in children and is associated with missed schooldays, anxiety, depressive symptoms and various physical symptoms. A secular trend of increasing headache prevalence has been suggested. Few studies have focused on tension-type headache among children from the general population. The aims of this thesis were to describe the prevalence, incidence and prognosis of tension-type headache, migraine and overall headache in schoolchildren, to identify medical, psychological and social factors associated with these headache types, and to determine whether the prevalence of headache has increased over the last decades. In 1997, 1850 schoolchildren aged 7-15 years from the city of Uppsala participated in a questionnaire study and 1371 (74.1%) responded. Out of these, a randomly selected, stratified sample of 131 children and their parents were interviewed. Three years later, 122 children from the interview sample replied to an identical headache questionnaire. Compared with a similar study in 1955, a significantly lower proportion of schoolchildren reported no headache. The prevalence of tension-type headache increased with age and was significantly higher in girls than boys after the age of twelve. Similar age and gender differences were obtained for migraine. A higher proportion of girls reported frequent headache than boys. Children with headache, especially those with migraine, as well as their first-degree relatives suffered from other pains and physical symptoms more frequently than headache-free children and their first-degree relatives. Although the likelihood of experiencing the same headache diagnosis and symptoms at follow-up was high, about one fifth of children with migraine developed tension-type headache and vice versa. Female gender was a predictor of migraine and frequent headache a predictor of overall headache at follow-up. The estimated annual incidence for tension-type headache, migraine and overall headache was 81, 65 and 131 per 1000 children, respectively. In conclusion, the results indicate that headache has become increasingly common among schoolchildren over the last decades. Prevention and treatment of headache is particularly important for girls since they have high prevalence of headache, frequent headache episodes and a poor outcome. In children with headache, diagnoses and treatment should be reassessed regularly and other pains should be asked about and treated as well.

La cefalea tensional tiene una elevada prevalencia, con repercusión en el ámbito laboral y social de los sujetos que la padecen. Considerando estudios previos, el objetivo de esta investigación es evaluar la eficacia de dos tratamientos con terapia manual en pacientes con cefalea tensional.Se ha llevado a cabo un estudio a doble ciego, aleatorio, con 84 pacientes (81% mujeres) diagnosticados de cefalea tensional, con edad media de 39,76 años (DT=11,38), distribuidos en 4 grupos (tres de tratamiento y un grupo de control placebo). Los tratamientos incluyen terapia manual con: 1) inhibición del tejido blando suboccipital; 2) articulatoria occipucio-atlas-axis; 3) la combinación de ambas. Se aplicaron 4 sesiones, con periodicidad semanal, y seguimiento a los 15 y a los 30 días. La evaluación antes y después el tratamiento y en los seguimientos abarcó: valoración de la movilidad cervical (goniómetro cervical CROM), ansiedad (STAI-E/R), depresión (Inventario de Beck), calidad de vida (SF-12), impacto del dolor (HIT-6), percepción del dolor (Cuestionario del dolor McGill), discapacidad por el dolor (HDI) e intensidad del dolor (EVA). La frecuencia del dolor, ingesta de fármacos sintomáticos, horas de sueño y factores asociados, se evaluaron mediante un autorregistro. Los resultados han mostrado que el tratamiento con inhibición ha mejorado significativamente en depresión, impacto, discapacidad y percepción por dolor (p=0,001 a p=0,01), y en la flexión suboccipital y cervical (p=0,02 y p=0,03). Tanto el tratamiento articulatorio como el combinado, han mejorado en ansiedad, depresión, e impacto discapacidad, percepción e intensidad del dolor (p=0,000 a p=0,02); y en flexión y extensión suboccipital (p=0,003 a p=0,04). El tratamiento articulatorio mejora también en las rotaciones cervicales derecha (p=0,007) e izquierda (p=0,03).En conclusión, tanto el tratamiento articulatorio como el combinado son eficaces para los pacientes con cefaleas en la mayor parte de las evaluaciones realizadas. El tratamiento con inhibición, aunque con resultados inferiores, también ha sido positivo respecto a diferentes ámbitos de la cefalea. / The tension-type headache has a high prevalence, with impact on the working and social life of the subjects who suffer from this condition. Considering previous studies, the aim of the present research is to evaluate the effectiveness of two manual therapy techniques in patients suffering from tension-type headache.A randomised double-blind study has been carried out, with 84 patients (81% women) diagnosed with tension-type headache, mean age of 39,76 years (SD=11,38), divided into 4 groups (three treatment groups and one placebo control group). The treatments include manual therapy with: 1) suboccipital soft-tissue inhibition technique; 2) occiput-atlas-axis articulatory technique; 3) the combination of both. Four sessions were applied, with a weekly periodicity, plus two follow-up sessions 15 and 30 days after. The evaluation before and after the treatment and in the follow-up sessions included: measurement of cervical range of motion (cervical goniometer), assessment of anxiety (STAI-E/R), depression (Beck depression inventory), quality of life (SF-12), impact of pain (HIT-6), pain perception (McGill pain questionnaire), headache disability (HDI) and pain intensity (VAS). The frequency of pain, intake of symptomatic medication, hours of sleep and associated factors were evaluated by means of a self-assessment register. The results have showed that the treatment with soft-tissue inhibition resulted in a significant improvement in depression, impact, disability and pain perception (p=0,001 to p=0,01), and in suboccipital and cervical flexion (p=0,02 and p=0,03). Both the articulatory technique and the combined treatment showed significant improvement in anxiety, depression, impact, disability, pain perception and pain intensity (p=0,000 to p=0,02); and in suboccipital flexion and extension (p=0,003 to p=0,04). The articulatory technique also improves in cervical rotations to the right (p=0,007) and left (p=0,03).In conclusion, both the articulatory technique and the combined treatment are effective for patients with headache in the majority of the evaluations carried out. The treatment with soft-tissue inhibition, although having inferior results, has also proved to have positive effects on different spheres of headache.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-02-15T14:13:18Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) FINAL DISSERTAÇAO.pdf: 2799176 bytes, checksum: e0af1d6e674152ad70b985b0813cb374 (MD5) / Made available in DSpace on 2017-02-15T14:13:19Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) FINAL DISSERTAÇAO.pdf: 2799176 bytes, checksum: e0af1d6e674152ad70b985b0813cb374 (MD5) Previous issue date: 2015-07-29 / CAPES / Introdução: A avaliação da percepção dolorosa em seres humanos é fundamental para a compreensão dos mecanismos fisiopatológicos e desenvolvimento de métodos de controle e manejo da dor. As alterações hormonais ocorridas durante o ciclo menstrual podem afetar diretamente o processo doloroso crânio facial em pacientes com cefaleia e influenciar o processo de cronificação da doença. Objetivo: O presente estudo tem como objetivo analisar o limiar doloroso à pressão nas diferentes fases do ciclo menstrual e comparar os limiares entre as mulheres com cefaleia e o grupo controle. Métodos: Trata-se de uma série de casos. Foram incluídas no estudo 39 mulheres com idade entre 18 e 30 anos (22±2 anos), eutróficas. O algômetro (Wagner Force Dial) foi utilizado para graduar o limiar de dor à pressão nos pontos de acupuntura, no músculo trapézio, e nos ramos do nervo trigêmeo. Foram realizadas avaliações nas fases: menstrual (1° ao 3º dia), proliferativa (5º dia), ovulatória (14º dia) e lútea (22º dia) para todas as participantes do presente estudo. Resultados: Houve diferença entre as fases do ciclo menstrual apenas no grupo que não utiliza anticoncepcional, nos pontos VG20,no grupo CTT, entre fase menstrual e lútea (p=0,044) e menstrual e proliferativa (p=0,022); e no ponto IG4D, no grupo migrânea, entre as fases menstrual e lútea (p=0,018) e menstrual e ovulatória (p=0,014).Houve correlação negativa entre o limiar doloroso no ponto VG20 na fase lútea e a frequência das crises de cefaleia (p=0,012; r=0,396) e com o MIDAS (p=0,16; r=-0,383). O ponto IG4 direito na fase lútea está correlacionado à frequência das crises de cefaleia (p=0,002; r=-0,478) . O ponto IG4 direito na fase ovulatória está correlacionado a frequência das crises de cefaleia (p=0,013; r=-0,396). Conclusão: mulheres com cefaleia apresentaram menores médias de limiar de percepção dolorosa em comparação ao grupo saudável em todos os pontos avaliados. Foi identificada diferença significativa na variação do limiar de desconforto na migrânea no ponto IG4 direito e na CTT no ponto VG20 no grupo que não utiliza anticoncepcional, sendo a fase menstrual a menos sensível. O limiar de desconforto desses pontos está correlacionado positivamente com a frequência de crises de cefaleia. / Introduction: The assessment of pain perception in humans is important for the understanding of the pathophysiology and development of methods of control and pain management. The hormonal changes during the menstrual cycle can directly affect the process painful craniofacial in patients with headache and influence the chronicity of the disease process. Objective: This study aims to analyze the pain threshold to pressure during the different phases of the menstrual cycle and compare the thresholds among women with migraine and the control group. Methods: This is a series of cases. The study included 39 women aged between 18 and 30 years (22 ± 2 years), eutrophic. The algometer (Wagner Force Dial) was used to measure the pain threshold to pressure on acupuncture points in the trapezius muscle, and branches of the trigeminal nerve. Evaluations were carried out in phases: menstrual (1st to 3rd day), proliferative (5th day), ovulatory (14th day) and luteal (22th day) for all participants of this study. Results: There was difference between the phases of the menstrual cycle only in the group that does not use contraceptives, on the VG20 point in the CTT group, between menstrual phase and luteal (p = 0.044) and menstrual and proliferative (p = 0.022); and on IG4D point,in migraine groupbetween menstrual phases and luteal (p = 0.018) and menstrual and ovulation (p = 0.014). There was a negative correlation between pain threshold in VG20 point in the luteal phase and the frequency of headache attacks (p = 0.012, r = -0.396) and the MIDAS (p = 0.16; r = -0.383). The right IG4 point in the luteal phase is correlated to the frequency of headache attacks (p = 0.002, r = -0.478). The rightIG4point in the ovulatory phase is correlated the frequency of headache attacks (p = 0.013, r = 0.396). Conclusion: Women with migraine had lower mean pain perception threshold compared to the healthy group in all points assessed. There was a significant difference in the variation of discomfort thresholds in migraine on the right IG4 point in CTT and on the VG20 point in the group not using contraception, with the menstrual phase the least sensitive. The discomfort level of these points is positively correlated with the frequency of headache attacks.

The relationship between autonomic dysfunction and primary headache disorders has been established in the adult population. The aim of this retrospective study was to elucidate if there was a similar association in the pediatric primary headache population. Three groups were compared - migraine patients, tension-type headache patients and idiopathic scoliosis patients as a control group. Utilizing clinical data collected during patients' initial visits, prevalence of autonomic dysfunction symptoms were quantified. The headache groups also filled out the Functional Disability Index (FDI) as well as the Children's Depression Inventory (CDI) to help elucidate if there was a relationship between function disability, psychiatric state and primary headaches and/or autonomic dysfunction symptoms. It was found that the headache groups had significantly greater dysautonomia as compared to the control group. Only slight differences were found between the migraine and tension-type patients in regards to dysautonomia. No significant differences were found in total FDI or CDI scores. These results illuminate a relationship between autonomic nervous system dysfunction and primary headache disorders in the pediatric population studied. Prospective studies and the development of standardized dysautonomia questionnaires will allow a more detailed autonomic dysfunction profile to be built for this population.