The Somatic Connection  |   May 2014
Manual Therapy Shown to Be Effective for Tension-Type Headache
Author Affiliations
  • Hollis H. King, DO, PhD
    University of Wisconsin School of Medicine and Public Health, Madison
Article Information
The Somatic Connection   |   May 2014
Manual Therapy Shown to Be Effective for Tension-Type Headache
The Journal of the American Osteopathic Association, May 2014, Vol. 114, 403-404. doi:
The Journal of the American Osteopathic Association, May 2014, Vol. 114, 403-404. doi:
Espí-López GV, Gómez-Conesa A, Gómez AA, Martínez JB, Pascual-Vaca ÁO, Blanco CR. Treatment of tension-type headache with articulatory and suboccipital soft tissue therapy: a double-blind, randomized, placebo-controlled clinical trial [published online January 27, 2014]. J Bodyw Mov Ther. 2014. doi:10.1016/j.jbmt.2014.01.001.  
Tension-type headache is commonly encountered in primary health care settings. The application of osteopathic manipulative treatment (OMT) in the care of patients with head pain has been discussed1,2 but, to my knowledge, no randomized controlled trials have been conducted on the use of OMT for these patients. A recent study by Spanish physiotherapists Espí-López et al assessed the effectiveness of manual techniques in the treatment of patients with tension-type headache. This study was selected for review because it was well designed and used manual techniques similar to those taught and used by osteopathic physicians. 
Eighty-four patients diagnosed with tension-type headache were randomly assigned to 1 of 4 groups: (1) suboccipital soft tissue inhibition (SI), (2) occiput-atlas-axis (OAA), (3) combined SI and OAA, or (4) placebo. For the SI therapy, a physiotherapist placed his or her hands in contact with the patient's suboccipital muscles in the area of the posterior arch of the atlas and applied steady pressure to release muscle spasm. For the OAA therapy, a physiotherapist administered global manipulation bilaterally, first performing cephalic decompression and then small circumductions on a vertical axis through the odontoid process of the axis. Patients in the placebo group received no treatment and rested in the supine position for 10 minutes. Patients in all groups participated in 4 weekly intervention sessions. Before each session, all patients underwent the vertebral artery challenge test. 
The outcome measures were based on results of the Headache Impact Test-6; the Headache Disability Inventory; headache pain intensity, which was rated daily by patients on a 0- to 10-point visual analog scale; and craniocervical range of motion, which was measured with a standardized physiotherapy device. All outcome measures were collected at baseline, at the conclusion of the 4 weekly intervention sessions, and at an 8-week follow-up visit. 
At the end of the 4 intervention sessions, statistically significant results were found for the SI, OAA, and combined intervention groups compared with the placebo group on almost all of the outcome measures. Improvements were maintained at the 8-week follow-up evaluation. The authors hypothesized that the combined SI and OAA intervention would be more effective than each intervention separately. However, the OAA intervention was as effective as the combined intervention and more effective than SI alone. 
In my opinion, this study needs to be replicated by osteopathic physicians. Such a study would contribute substantially to the evidence base of cervical spine OMT efficacy and safety. 
   “The Somatic Connection” highlights and summarizes important contributions to the growing body of literature on the musculoskeletal system's role in health and disease. This section of The Journal of the American Osteopathic Association (JAOA) strives to chronicle the significant increase in published research on manipulative methods and treatments in the United States and the renewed interest in manual medicine internationally, especially in Europe.
   To submit scientific reports for possible inclusion in “The Somatic Connection,” readers are encouraged to contact JAOA Associate Editor Michael A. Seffinger, DO (, or JAOA Editorial Advisory Board Member Hollis H. King, DO, PhD (
Biondi DM. Cervicogenic headache: a review of diagnostic and treatment strategies. J Am Osteopath Assoc. 2005;105(4 suppl 2):S16-S22.
Keays AC, Neher JO, Safranek S, Webb CW. Clinical inquiries: is osteopathic manipulation effective for headaches? J Fam Practice. 2008;57(3):190-191.