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)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Epidemiology of tension-type headache.Curr Pain Headache Rep. 2010; 14: 449-454
- Epidemiology and comorbidity of headache.Lancet Neurol. 2008; 7: 354-361
- Primary Headache Disorders-Part 2: Tension-type headache and medication overuse headache.Dis Mon. 2017; 63: 342-367
- Peripheral and central mechanisms in tension-type headache: an update.Cephalalgia. 2003; 23: 49-52
- Muscles and their role in episodic tension-type headache: implications for treatment.Eur J Pain. 2016; 20: 166-175
- Trigger points and myofascial pain: toward understanding how they affect headaches.Cephalalgia. 1998; 18: 436-448
- Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache.Headache. 2006; 46: 1264-1272
- Active myofascial trigger points in head and neck muscles of patients with chronic tension-type headache in two primary health care units in Tshwane.S Afr Fam Pract. 2016; 58: 131-135
- Travell & Simons' myofascial pain and dysfunction: upper half of body. Vol 1.Lippincott Williams & Wilkins, Baltimore1999
- An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle.J Appl Physiol. 2005; 99: 1977-1984
- Myofascial trigger points: peripheral or central phenomenon?.Curr Rheumatol Rep. 2014; 16: 395
- Heat pain thresholds and cerebral event-related potentials following painful CO2 laser stimulation in chronic tension-type headache.Pain. 2003; 104: 111-119
- Mechanisms of spontaneous tension-type headaches: an analysis of tenderness, pain thresholds and EMG.Pain. 1996; 64: 251-256
- Habituation and sensitization in primary headaches.J Headache Pain. 2013; 14: 65
- ATP-sensitive muscle afferents activate spinal trigeminal neurons with meningeal afferent input in rat–pathophysiological implications for tension-type headache.J Headache Pain. 2016; 17: 75
- Assessment of mechanisms in localized and widespread musculoskeletal pain.Nat Rev Rheumatol. 2010; 6: 599
- Treatment of central sensitization in patients with ‘unexplained’chronic pain: what options do we have?.Expert Opin Pharmacother. 2011; 12: 1087-1098
- Positional release therapy: assessment & treatment of musculoskeletal dysfunction.Mosby, St. Louis1997
- The effect of trigger point management by positional release therapy on tension type headache.NeuroRehabilitation. 2012; 30: 333-339
- Cingulate metabolites during pain and morphine treatment as assessed by magnetic resonance spectroscopy.J Pain Res. 2014; 7: 269
- Acute metabolic changes associated with analgesic drugs: an MR spectroscopy study.J Neuroimaging. 2016; 26: 545-551
- Investigation of central nervous system dysfunction in chronic pelvic pain using magnetic resonance spectroscopy and noninvasive brain stimulation.Pain Pract. 2015; 15: 423-432
- Proton magnetic resonance spectroscopy assessment of metabolite status of the anterior cingulate cortex in chronic pain patients and healthy controls.J Pain Res. 2017; 10: 287
- Applying the intention-to-treat principle in practice: Guidance on handling randomisation errors.Clin Trials. 2015; 12: 418-423
- Reliability, validity, and sensitivity measures of expanded and revised version of the Short-Form McGill Pain Questionnaire (SF-MPQ-2) in Iranian patients with neuropathic and non-neuropathic pain.Pain Med. 2012; 13: 1631-1636
- The McGill pain questionnaire.Anesthesiology. 2005; 103: 199-202
- Reliability and validity of a pressure algometer.J Strength Cond Res. 2009; 23: 312-314
- Recognition of central sensitization in patients with musculoskeletal pain: application of pain neurophysiology in manual therapy practice.Man Ther. 2010; 15: 135-141
- Generalized hyperalgesia in patients with chronic tension-type headache.Cephalalgia. 2006; 26: 940-948
- Can neuroimaging studies identify pain endophenotypes in humans?.Nat Rev Neurol. 2011; 7: 173
- 1H MR spectroscopy of the brain: absolute quantification of metabolites.Radiology. 2006; 240: 318-332
- Electroacupuncture analgesia is associated with increased serum brain-derived neurotrophic factor in chronic tension-type headache: a randomized, sham controlled, crossover trial.BMC Complement Altern Med. 2015; 15: 144
- 1H-MR spectroscopic detection of metabolic changes in pain processing brain regions in the presence of non-specific chronic low back pain.Neuroimage. 2011; 54: 1315-1323
- Magnetic resonance spectroscopy to assess neuroinflammation and neuropathic pain.J Neuroimmune Pharmacol. 2013; 8: 576-593
- Magnetic resonance spectroscopy in pediatric neuroradiology: clinical and research applications.Pediatric Radiol. 2010; 40: 3
- Metabolic abnormalities in pain-processing regions of patients with fibromyalgia: a 3T MR spectroscopy study.AJNR Am J Neuroradiol. 2011; 32: 1585-1590
- Proton magnetic resonance spectroscopy of the thalamus in patients with chronic neuropathic pain after spinal cord injury.AJNR Am J Neuroradiol. 2002; 23: 901-905
- Localized 1 H-NMR spectroscopy in patients with fibromyalgia: a controlled study of changes in cerebral glutamate/glutamine, inositol, choline, and N-acetylaspartate.Arthritis Res Ther. 2010; 12: R134
- In vivo detection of acute pain-induced changes of GABA+ and Glx in the human brain by using functional 1H MEGA-PRESS MR spectroscopy.Neuroimage. 2015; 105: 67-75
- In vivo NMR studies of the glutamate neurotransmitter flux and neuroenergetics: implications for brain function.Ann Rev Physiol. 2003; 65: 401-427
- Glutamate and glutamine: a review of in vivo MRS in the human brain.NMR Biomed. 2013; 26: 1630-1646
- Dynamic levels of glutamate within the insula are associated with improvements in multiple pain domains in fibromyalgia.Arthritis Rheum. 2008; 58: 903-907
- Principles of neural science. Vol 1. 4th ed.McGraw-Hill, New York2000
- Sustained neuronal activation raises oxidative metabolism to a new steady-state level: evidence from 1H NMR spectroscopy in the human visual cortex.J Cereb Blood Flow Metab. 2007; 27: 1055-1063
- Abnormal modulatory influence of diffuse noxious inhibitory controls in migraine and chronic tension-type headache patients.Cephalalgia. 2006; 26: 782-789
- Central sensitization in tension-type headache—possible pathophysiological mechanisms.Cephalalgia. 2000; 20: 486-508
Article info
Publication history
Published online: July 12, 2020
Footnotes
Supported by Shiraz University of Medical Sciences (contract no. 94-01-06-10162).
Disclosures: none.
Clinical Trial Registration No.: IRCT2016071726674N2.
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
