The Somatic Connection  |   July 2012
Myofascial Trigger Point Massage Reduces Pain of Chronic Tension-Type Headache
Article Information
The Somatic Connection   |   July 2012
Myofascial Trigger Point Massage Reduces Pain of Chronic Tension-Type Headache
The Journal of the American Osteopathic Association, July 2012, Vol. 112, 410-411. doi:
The Journal of the American Osteopathic Association, July 2012, Vol. 112, 410-411. doi:
Berggreen S, Wiik E, Lund H. Treatment of myofascial trigger points in female patients with chronic tension-type headache—a randomized controlled trial. Adv Physiother. 2012;14:10-17.  
Danish physiotherapy researchers conducted a randomized controlled trial in which the intervention was trigger point massage. Patients were recruited from the public and examined by a general practitioner, who determined if the individual met the criteria for chronic tension-type headache (CTTH) established by the International Headache Society (ie, headaches occurring at least 15 days per month). 
Exclusion criteria were pregnancy, monthly migraine of more than 24 hours, head pain associated with dental and jaw disorders, use of morphine or large amounts of analgesics, chronic sinusitis, headaches beginning at the same time as another disease or accident, serious psychological disorder, very high blood pressure, and other physiotherapy. The authors state, “The prevalence of CTTH is higher among women, which together with the possibility of a gender difference was the reason for including only female participants.” 
Trigger point assessment followed Travell & Simons' Myofascial Pain and Dysfunction—The Trigger Point Manual, Volume 1, Upper Half of Body (Baltimore, MD: Williams & Wilkins; 1999). For each patient in the treatment group, trigger point locations were determined, and only active trigger points were documented and manipulated. The same physiotherapist performed all assessments and treatments. Because the number of trigger points varied among patients, the time-to-treat varied depending on the individual. Each patient was scheduled to receive 10 treatments. An intent-to-treat analysis was performed because a few patients did not complete all 10 treatments. 
There were 20 patients in the treatment group and 19 in the control (ie, no treatment) group. Individuals in the control group were offered the treatment at the completion of the study. The outcome measures were pain as rated on a 100-mm visual analog scale (VAS), number of trigger points, medicine consumption, and results on the McGill Pain Questionnaire and the Short Form (SF-36) Questionnaire. 
Treatment consisted of ischemic compression (held 30 to 60 seconds at a time for each tender point for a period of 2 to 5 minutes), followed by muscle stretching. Each patient was treated approximately once a week for 10 weeks. 
The results showed that patients in the treatment group had statistically significant lower VAS ratings in the early morning, as well as a statistically significant reduced number of trigger points. None of the other measures were significantly different between the treatment and control groups. The early morning VAS is considered the most reliable measure for pain, because it occurs after a night of sleep and presents a consistent measure. 
The Berggreen et al study was selected for review because of the high prevalence of tension headaches in the practices of osteopathic physicians, as in my clinical experience. Furthermore, the technique of ischemic compression and muscle stretching is commonly taught in osteopathic manipulative medicine courses. As an osteopathic physician, I have used the techniques described in this study. It is encouraging to see that there is an evidence base for these techniques that can be communicated to patients. However, suboptimal components of the ischemic compression technique are that it is time consuming and that it requires very strong fingers—requirements that can compromise the use of other applications of osteopathic manipulative treatment throughout a busy day of osteopathic medical practice.—H.H.K.