Therapeutic Massage for Management of Pain & Disability in Tension-Type Headache

描述(申请人提供)：慢性或间歇性紧张型头痛(TTH)影响到很大比例的人口，不仅影响个人生活，而且还造成严重的社会经济负担，造成工作日损失和工人生产率下降。尽管TTH是最常见的头痛疾病，但对具体治疗方法的研究还不够充分，而且落后于所有其他主要的头痛分类。国际头痛协会指出，肌肉受累与某些形式的紧张型头痛有关。肌肉受累在研究文献中得到证实，因为TTH患者经常报告肌肉压痛、肌筋膜触发点(MTrP‘s)升高以及颈部和颅肌的生理异常。因此，一种针对骨骼肌肉系统的治疗方法可能是TTH治疗的重要组成部分。治疗紧张型头痛的补充和替代医学方法，如按摩，在患者中越来越受欢迎，但支持其有效性的证据有限。TTH患者肌肉组织与健康对照人群有显著差异，为手法治疗TTH提供了理论依据。例如，肌肉内的MTrP可以引起局部疼痛(穴位压痛)和模拟患者头痛主诉的远处部位(牵涉疼痛)，这使其成为头痛患者和按摩治疗师特别感兴趣的部位。我们最近在一系列病例中报道，在紧张型头痛患者中，以MTrP疗法为重点的按摩疗法显著减少了头痛的频率和持续时间。然而，在对照临床试验中，按摩作为临床资源的潜力受到其有效性验证的限制。本提案的目的是在一项安慰剂对照的随机临床试验中评估推拿治疗紧张型头痛的有效性。具体地说，这项建议的目标是确定结构化按摩治疗计划的影响，重点是肌肉筋膜触发点治疗，对TTH参与者的疼痛和残疾测量。60名TTH患者将被随机分为推拿组、安慰剂组或等待名单对照组。训练有素的治疗师将遵循一个明确的方案，在六周的时间里进行12次按摩治疗或12次假治疗。受试者将在日常日记中记录头痛参数，并完成评估，以评估由于TTH造成的残疾。因此，第一个具体目标是在一项随机、安慰剂对照试验中证实和推广我们最近的发现，即按摩疗法将减少TTH患者头痛的频率、强度和持续时间。由于TTH还可以影响日常生活质量，因此，第二个具体目标是确定推拿疗法对TTH患者与头痛相关的残疾的效果。 与公共卫生相关：紧张型头痛是一种痛苦的疾病，可以影响一个人的生活质量和生产力多年，但几乎没有治疗选择。在随机对照试验设计中验证推拿疗法治疗紧张型头痛将为患有这种疾病的患者创造新的治疗选择。

DESCRIPTION (provided by applicant): Chronic or episodic forms of tension-type headache (TTH) affect a high percentage of the population and not only impact personal life, but also pose a significant socio-economic burden in terms of lost workdays and decreased worker productivity. Although TTH is the most prevalent of the headache disorders, research into specific treatments is inadequate and lags all other major headache classifications. The International Headache Society indicates that a muscular involvement is associated with some forms of tension-type headache. A muscular involvement is confirmed in the research literature, as elevation in muscle tenderness, myofascial trigger point's (MTrP's), and physical abnormalities in cervical and cranial muscles are often reported by patients with TTH. Thus, a treatment approach that addresses the skeletal musculature may be an important component in the management of TTH. Complementary and alternative medicine approaches, such as massage, to the treatment of tension-type headache are increasingly popular among patients, but evidence supporting their efficacy is limited. Muscle tissues of patients with TTH have noteworthy differences from a healthy control population, which provide a theoretical basis for manual therapy as a treatment for TTH. For example, a MTrP within a muscle can elicit pain locally (point tenderness) and at distant sites (referred pain) that mimic the patient headache pain complaint, which makes it a site of particular interest by both the headache patient and massage therapist. We recently reported, in a case series, that massage therapy with a focus on MTrP therapy significantly reduced frequency and duration of headache in those with tension-type headache. However, the potential for massage to be used as a clinical resource is limited by verification of its effectiveness in a controlled clinical trial. The intent in this proposal is to assess the effectiveness of therapeutic massage for tension-type headache in a placebo-controlled, randomized clinical trial. Specifically, the objective of this proposal is to determine the impact of a structured massage therapy program, with a focus on myofascial trigger point therapy, on pain and disability measures in participants with TTH. Sixty subjects with TTH will be randomized into massage therapy, placebo or wait-list control groups. Trained therapists will follow a defined protocol to administer 12 massage therapy sessions or 12 sham treatments over a six-week period. Subjects will record headache parameters in a daily diary and complete evaluations to assess disability due to TTH. Thus, Specific Aim #1 is to confirm and extend our recent findings that massage therapy will reduce the frequency, intensity and duration of headache in patients with TTH in a randomized, placebo-controlled trial. Since TTH can also affect the quality of daily living, Specific Aim #2 is to determine the effect of massage therapy on disability associated with headache in patients with TTH. PUBLIC HEALTH RELEVANCE: Tension-type headache is a painful condition that can affect ones quality of life and productivity for many years, but has few treatment options. Verification of massage therapy for the treatment of tension-type headache in a randomized, controlled trial design will create new treatment options for patients with this condition.