The Somatic Connection  |   July 2014
Headaches Are a Pain in the Neck
Author Affiliations
  • Michael A. Seffinger, DO
    Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California
  • Anna Halbeisen, DO
    Presbyterian Intercommunity Hospital, Downey Campus in California
Article Information
The Somatic Connection   |   July 2014
Headaches Are a Pain in the Neck
The Journal of the American Osteopathic Association, July 2014, Vol. 114, 590-591. doi:
The Journal of the American Osteopathic Association, July 2014, Vol. 114, 590-591. doi:
Espí-López GV, Rodríguez-Blanco C, Oliva-Pascual-Vaca A, Benítez-Martínez JC, Lluch-Girbés E, Falla D. The effect of manual therapy techniques on headache disability in patients with tension-type headache [published online April 30, 2014]. Eur J of Phys Rehabil Med. Accessed May 30, 2014.  
Cervical manipulation has been found to be effective in reducing the frequency, duration, and intensity of pain in patients with tension-type headache.1 In addition, the application of soft tissue techniques has been shown to influence cervical muscle relaxation by decreasing the frequency and intensity of pain.2 Espí-López et al conducted a factorial, randomized controlled trial to establish the effectiveness of applying single and combined manual therapies on patients with episodic and chronic tension-type headaches. 
Seventy-six patients (62 women, 14 men; mean [standard deviation] age, 39.9 [10.9] years) with diagnosed episodic tension-type headache or chronic tension-type headache were recruited from different neurology clinics. Inclusion criteria were 3 or more months' history of headache episodes lasting 30 minutes to 7 days with 2 or more of the following: bilateral pain, pressing nonpulsatile pain, mild to moderate pain, or pain not aggravated by physical activity. Patients were allocated to a control group or 1 of 3 treatment groups using a computer-generated randomization sequence. The first treatment group received suboccipital soft tissue inhibition (SI), the second group received occiputatlas-axis (OAA) manipulation, and the third group received a combination of the SI and OAA techniques. All participants received 4 weekly sessions of their assigned intervention. 
Two therapists with more than 10 years of experience in manual therapy were trained to apply the techniques. Patients were in the supine position for all interventions. For the SI therapy, the therapist placed his or her hands under the suboccipital musculature in the region of the posterior arch of the atlas. Pressure was progressively and deeply applied and maintained for 10 minutes. The OAA manipulation was conducted bilaterally along a vertical axis in 2 stages: first, the therapist applied cephalic decompression and subsequent cephalic circumduction before engaging the joint barrier; second, the therapist initiated rotation with a helical movement toward the selected side. After manual therapy was applied, the patient was placed with his or her head and neck in a neutral position for 5 minutes. Participants in the control group rested in the supine position for 10 minutes and did not receive manual therapy. 
The investigators assessed patients' pre- and posttreatment pain severity and frequency, as well as functional and emotional subscale scores, using the Headache Disability Inventory. Among all patients, 40.8% had tension-type headache and 59.2% had episodic tension-type headache. Patients in the OAA and combined groups had statistically significant reductions in headache frequency (P<.05), and the SI, OAA, and combined groups had statistically significant reductions in headache severity (P<.05). No statistically significant changes were noted for pain severity or frequency in the control group. Combined treatment yielded the greatest effect size for improvement in the functional subscale score and for reductions in pericranial tenderness, photophobia, and phonophobia. 
Overall, combined manual therapy procedures with SI and OAA manipulation yielded the most benefit for patients with episodic and chronic tension-type headaches. Future studies of other techniques such as frontal and parietal lifts may further benefit patients with tension-type headaches. 
Castien RF, van der Windt D, Blankenstein AH, Heymans MW, Dekker J. Clinical variables associated with recovery in patients with chronic tension-type headache after treatment with manual therapy [published online February 18, 2012]. Pain. 2012;153(4):893-899. doi:10.1016/j.pain.2012.01.017. [CrossRef] [PubMed]
Moraska A, Chandler C. Changes in clinical parameters in patients with tension-type headache following massage: a pilot study. J Man Manip Ther. 2008;16(2):106-112. [CrossRef] [PubMed]