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Can the Positional Release Technique Affect Central Sensitization in Patients With Chronic Tension-Type Headache? A Randomized Clinical Trial

      Abstract

      Objectives

      To investigate whether the positional release technique (PRT) affects central sensitization in patients with chronic tension-type headache (TTH).

      Design

      Randomized controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis.

      Setting

      Two university neurology clinics.

      Participants

      Patients (N=32) with TTH and myofascial trigger points (MTrP) in their cervical muscles.

      Interventions

      Patients in the PRT group received 10 treatment sessions for each of their MTrPs over the course of 5 weeks. All participants could use ibuprofen 200 mg for their headaches during the study.

      Main Outcome Measures

      The primary outcome measure was brain metabolite profile. The secondary outcome measures were headache frequency and intensity, McGill score, and pressure pain threshold (PPT), which were evaluated in each participant during 5 weeks with proton magnetic resonance spectroscopy, patients’ self-reports, the McGill Pain Questionnaire, and a pressure algometer.

      Results

      Analysis of the data from 26 patients showed that headache frequency (P=.001), headache intensity (P=.002), McGill score (P=.003), and local PPT (P=.003) changed significantly after PRT. The myo-inositol/creatine concentration ratio in the somatosensory cortex (P=.041) decreased significantly in the control group. Furthermore, there were significant differences between groups in headache frequency (P<.001), headache intensity (P<.001), McGill score (P<.001), local PPT (P=.004), distal PPT (P=.041), and glutamate–glutamine/creatine concentration ratio in the thalamus (P=.014).

      Conclusions

      These findings indicate that PRT did not affect central sensitization in patients with TTH despite the improvement in clinical symptoms.

      Keywords

      List of abbreviations:

      1H-MRS (proton magnetic resonance spectroscopy), CNS (central nervous system), Cr (creatine), Glx (glutamate and glutamine), M-Ino (myo-inositol), MRI (magnetic resonance imaging), MRS (magnetic resonance spectroscopy), MTrP (myofascial trigger point), PRT (positional release technique), TTH (tension-type headache)
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