Deodato Manuela, Guolo Franco, Monticco Antonella, Fornari Mauro, Manganotti Paolo, Granato Antonio
J Am Osteopath Assoc. 2019 Aug 12. doi: 10.7556/jaoa.2019.093.
Nonpharmacologic treatment, such as osteopathic manipulative therapy (OMTh; manipulative care provided by foreign-trained osteopaths) may be a beneficial complementary treatment for tension-type headache. However, to the authors' knowledge, the benefit of OMTh in the management of tension-type headache has not been explored, especially chronic tension-type headache (CTTH).
To investigate the effectiveness of OMTh compared with traditional treatment in reducing pain intensity, frequency, and duration of CTTH, and to evaluate the objective postural measurement of the forward head posture (FHP) as an integral parameter in the assessment of the effects of OMTh and traditional management of CTTH.
Patients with CTTH were registered at the Headache Centre of Trieste in Italy. At the time of the study, none of the patients had been taking any headache prophylaxis in the past 3 months. A 3-month baseline period was recorded by all patients with an ad hoc diary. Patients were randomly placed in the test or control group using a simple randomization program in Excel (Microsoft). Patients in the OMTh group underwent a 3-month period of OMTh, and patients in the control group were treated with amitriptyline. Pain intensity, frequency, and duration of headaches, as well as FHP were analyzed.
The study enrolled 10 patients (mean [SD] age, 42.6 [15.2] years) in the OMTh group and 10 patients (51.4 [17.3] years) in the control group. The final assessment of OMTh patients showed statistically significant changes in all headache parameters: pain intensity decreased from a mean (SD) score of 4.9 (1.4) to 3.1 (1.1) (P=.002); frequency decreased from 19.8 (6) to 8.3 (6.2) days per month (P=.002); and the duration of headaches decreased from 10 (4.2) to 6 (3) hours (P=.01). Significant improvement of all parameters was found in the control group as well: pain intensity decreased from a mean (SD) score of 5.9 (0.7) to 4.2 (1.75) (P=.03); frequency decreased from 23.4 (7.2) to 7.4 (8.7) days per month (P=.003); and duration decreased from 7.8 (2.9) to 3.6 (2.1) hours (P=.002). Forward head posture significantly improved in OMTh patients (P=.003).
Our data suggested that OMTh may be an effective treatment to improve headaches in patients with CTTH. Our results also suggest that OMTh may reduce FHP.
非药物治疗，如整骨手法治疗（OMTh；由海外培训的整骨医生提供的手法治疗）可能是紧张型头痛的一种有益补充治疗方法。然而，据作者所知，尚未探讨OMTh在紧张型头痛管理中的益处，尤其是慢性紧张型头痛（CTTH）。
研究与传统治疗相比，OMTh在降低CTTH患者疼痛强度、频率和持续时间方面的有效性，并评估头前倾姿势（FHP）的客观姿势测量作为评估OMTh和CTTH传统管理效果的一个整体参数。
CTTH患者在意大利的里雅斯特头痛中心登记。在研究时，所有患者在过去3个月内均未服用任何头痛预防药物。所有患者通过特制日记记录3个月的基线期。使用Excel（微软）中的简单随机化程序将患者随机分为试验组或对照组。OMTh组患者接受为期3个月的OMTh治疗，对照组患者接受阿米替林治疗。分析头痛的疼痛强度、频率和持续时间以及FHP。
该研究纳入了OMTh组10名患者（平均[标准差]年龄，42.6[15.2]岁）和对照组10名患者（51.4[17.3]岁）。对OMTh患者的最终评估显示，所有头痛参数均有统计学显著变化：疼痛强度从平均（标准差）评分4.9（1.4）降至3.1（1.1）（P = 0.002）；频率从每月19.8（6）天降至8.3（6.2）天（P = 0.002）；头痛持续时间从10（4.2）小时降至6（3）小时（P = 0.01）。对照组所有参数也有显著改善：疼痛强度从平均（标准差）评分5.9（0.7）降至4.2（1.75）（P = 0.03）；频率从每月23.4（7.2）天降至7.4（8.7）天（P = 0.003）；持续时间从7.8（2.9）小时降至3.6（2.1）小时（P = 0.002）。OMTh患者头前倾姿势有显著改善（P = 0.003）。
我们的数据表明，OMTh可能是改善CTTH患者头痛的有效治疗方法。我们的结果还表明，OMTh可能会降低FHP。
