|dc.description.abstract||Recurrent benign headache is a common problem often treated with manual therapy. A clinical observation that headache symptoms could be reproduced and subsequently, reduced was tested. A case series design was used to observe the changes in symptoms in a group (n=8) of participants in whom this phenomenon could be demonstrated. A systematic review was carried out to determine the best available evidence for various physiotherapy interventions.
Methodology: Potential participants were referred from general practitioners, and then, subsequently screened to ensure they all met the study entry criteria, headache with associated neck pain; long term benign recurring headache greater than six months; reproduction of headache and, reduction of their headache symptoms on examination of the upper cervical spine. Ethical approval was given by the Lower South Regional Ethics Committee, Otago, New Zealand and all patients provided written informed consent prior to entering the study. Each participant completed the Headache impact Test (HIT-6™) before recording headache frequency (number of headaches per day), duration (hours), medication use (pills per day) and peak intensity (visual analogue scale 0-10mm (VAS) in a headache diary for a 2 week period prior to undergoing manual therapy treatment. Treatment consisted of small end range sustained pressure in the normal physiological plane of cervical spine movement. The average number of treatment sessions for each participant was 15. On completion of treatment, a second headache diary and HIT-6™ was completed by each participant and again, at six months after the completion of treatment. A repeated measures ANOVA was performed to examine for differences in the outcome variables between the pre-treatment, post-treatment and 6 month follow-up periods. A Bonferroni correction was applied to correct for multiple comparisons. All tests of significance were set at p≤0 .05.
Results: Eight participants, four males (mean age 40.8 [±17] years, range, 26-59 years) and four females (37.75 [±12.4] years, range, 21-47 years) entered into the study. Collectively the participants reported a mean headache history of 8 (± 9.4) years (range 1-25 years).
The ANOVA showed a significant difference for the group mean HIT-6™ score between the pre-treatment and the six month follow-up (P≤0.01). Significant differences were also found for the VAS- peak intensity (P≤0.03) between the pre-treatment and the six month follow-up measurements. No significant difference in headache frequency (p<0.11) duration (p<0.71) or medication use p<0.64,) was found at either the post-treatment or 6 month-follow-up when compared with the base-line measures.
Conclusion: In this study the symptomatic improvement in the HIT-6™ and VAS outcome measure at the six month follow-up period serves to potentially endorse the utilisation of sustained pressure as a cervical spine manual therapy technique in those patients seeking relief from headache symptoms. The reservation is made that these results are only applicable to those individuals in whom the phenomenon of headache reproducibility upon their manual therapy examination can be demonstrated.
Recommendations: This study provides preliminary evidence that examination involving the reproduction and subsequent reduction of a patient’s headache symptom has an effect on their long term symptoms. A study of a larger sample size and with a comparison sample of participants that do not respond in this manner may help confirm these results.||