DS4958

Conclusion

Recommendations

The findings in this study concur with the literature that CSM and dry needling as treatment modalities have a positive effect on the course of ETTH. The combination treatment group was superior to the other treatments in improving participants headache disability in the short term, however in terms of the other readings it was comparable to either treatment, indicating its effectiveness in the treatment of ETTH.

Future studies should:

?Utilise larger sample sizes as between group differences may be more apparent?Monitor participants use of headache medication, to determine if the use of

medication changed during the intervention period?A longer follow up period to determine the long term effect of the

treatments on the course of ETTH.

References1. Redwood, D. and Cleveland, C, S. 2003. Fundementals of Chiropractic. Mosby, Inc. 2. Lyngberg, A.C., Rasmussen, B.K., Jorgensen, T. and Jensen, R. 2005. Has the prevalence of migraine and tension-

type headache changed over a 12-year period? A Danish population survey. European Journal of Epidemiology,

20(3):243-249.3. Ashina, M., Bendtson, L., Jensen, R., Sakai, F. and Olesen, J. 1999. Muscle hardness in patients with chronic tension-

type headache: Relation to actual headache state. Pain, 79(2):201-205.4. Fernández-de-las-Peñas, C., Cuadrado, M.L. and Pareja, J.A. 2007. Myofascial trigger points, neck mobility and

forward head position in episodic tension-type headache. Headache, 47(5):662-672.5. Graff-Radford, S.B. and Newman, A.C. 2002. The role of temporomandibular disorders and cervical dysfunction in

tension-type headache. Current Pain and Headache Reports, 6(5):387-391.6. Gatterman, M.I. 1990. Chiropractic Management of Spine related disorders. Baltimore: Williams and Wilkins.7. Karakurum, B., Karaalin, O. and Coskun, O. 2001. The 'Dry-needling technique': intramuscular stimulation in tension-

type headache. Cephalalgia, 21(8):813-817. 8. Gardner, S. and Mosby, J.S. 2000. Chiropractic secrets, Hanley & Belfus, Inc.9. Lenaerts, M.E. 2004. Alternative therapies for tension-type headache. Current Pain and Headache Reports, 8(6):484-

488.10. International Headache Society. 2004. Part One – The Primary Headaches. Cephalalgia, 24(1):23–136.11. Dvorak, J. 2007. Musculoskeletal Manual Medicine: Diagnosis and Treatment. Thieme.12. Travell, J., Simons, D.G. and Simons, L.S. 1999. Myofascial Pain and Dysfunction: The Trigger Point Manual. 2nd ed.

Baltimore: Williams & Wilkins.13. de Busser, N.L. 2001. The relative effectiveness of chiropractic manipulation in conjunction with soft tissue treatment

as compared with soft tissue treatment alone in the management of tension-type headaches in children. Masters

degree in Technology: Chiropractic dissertation, Technikon Natal, Durban, South Africa.14. Yeomans, S.G. 2000. The Clinical Application of Outcomes Assessment. Appleton & Lange.15. Youdas, J., Carey, J. and Garret, T. 1991. Reliability of measurement of cervical range of motion–a comparison of

three methods. Journal of physical therapy, 71(2):98-106.16. Potter, L., McCarthy, C. and Oldham, J. 2006. Algometer reliability in measuring pain pressure threshold over normal

spinal muscles to allow quantification of anti-nociceptive treatment effects. International Journal of Osteopathic

IntroductionEpisodic Tension–type headache (ETTH) is the most commonly

1,2 3,4experienced headache with myofascial trigger points (MFTP) and 5,6

cervical spine joint dysfunction being indicated in the aetiology. Dry 7 8,9

needling of MFTP's and cervical spine manipulation (CSM) are commonly used treatments for tension-type headaches. However the effectiveness of these modalities in combination was unknown. Therefore this study aimed to determine the effectiveness of CSM combined with dry needling in the treatment of ETTHs.

Methodology

Results

A quantitative single blinded clinical trial conducted at the Chiropractic Day Clinic, Durban University of Technology (DUT). Ethical clearance was received from DUT Faculty of Health Sciences Research

10Committee (No. 034/09). A total of 45 participants diagnosed with ETTH , between the ages of 18 and 50, 11were recruited through convenience sampling. The participants had to have cervical spinal dysfunction

12and active MFTP's . Written informed consent was obtained. Participants each were randomly allocated to one of three groups: A=CSM, B= dry needling and C=combined CSM and dry needling. Subjective

13 14 15 16(headache diary and disability ) and objective (cervical range of motion (CROM) and algometer ) data was collected.

The study duration was four weeks with six consultations. At consultation one all measurements were taken and the participant was instructed to use the headache diary for a week to obtain baseline data of headache duration, intensity and severity. Consultation two objective measurements were taken and the participant were instructed to continue with the headache diary for the duration of the study, first treatment was given according to group allocation. Three treatments were administered within 2 weeks. At consultation five the headache disability and objective data was collected. One week later the all subjective and objective data was collected to determine short term treatment efficacy. Objective data was collected by a research assistant to minimize bias. Repeated measures ANOVA was used to determine inter and intra group analysis with Bonferoni adjusted post hoc test for pair wise comparisons. Statistical significance was set at a p value of <0.05.

All groups were comparable at baseline in terms of demographics and subjective and objective measurements. Intragroup analysis showed that all groups had statistically significant improvements in terms of subjective and objective measurements with intergroup analysis showing no statistically significant differences between the three groups. Group C the comb group had statistically significantly (p=0.0351) greater improvements in disability from consultation five to six and group A the cervical spine manipulation showed statistically significant improvement in right lateral flexion at consultation 6 when compared to the other groups.

CROM: Right Lateral Flexion (p = 0.0812)

How effective is cervical spine manipulation and dry needling in the treatment of episodic tension–type headaches?

L. J. W. Trollope, MTech: Chiropractic, V. Boodhoo, MTech: Chiropractic, L. Wilson, MTech: Chiropractic,Chiropractic Programme, Department of Chiropractic and Somatology, Durban University of Technology, South Africa

Algometer Readings (p = 0.3978)

Kg

’s (

me

an

)

Headache disability (p = 0.738)

Consultation number

Sc

ore

Eligible: 51 participants

Randomised: 45 participants

Excluded: 6

Cervical spine

manipulation (n=15)

Dry needling (n=15)

Cervical spine

manipulation and

dry needling (n=15)

Consultation 1:

·

Signed informed consent

·

Case history, physical and regional exam

·

Issued headache diary

·

Collected subjective and objective data

Consultation 2: 1 week later

·

objective data collected by research assistant

·

administered treatment according to group allocation

+4

·

treatment administered

Consultation 3 and 4:

week 2 and 3

·

Administer treatment

Consultation 5: end of week 3

·

collected subjective and objective data

·

administered last treatment

·

encouraged

participant to continue filling in headache diary

Consultation 6: 4th week

·

collected all subjective and objective data