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

描述（由申请人提供）：慢性或发作性紧张性头痛（TTH）影响很大比例的人口，不仅影响个人生活，而且在工作日损失和工人生产力降低方面造成重大的社会经济负担。虽然TTH是最普遍的头痛疾病，但对具体治疗的研究不足，并且落后于所有其他主要头痛分类。国际头痛协会指出，肌肉受累与某些形式的紧张性头痛有关。研究文献证实了肌肉受损伤，因为TTH患者经常报告肌肉压痛、肌筋膜触发点（MTrP）升高以及颈部和颅肌的生理异常。因此，针对骨骼肌的治疗方法可能是TTH治疗的重要组成部分。治疗紧张性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，但支持其疗效的证据有限。TTH患者肌肉组织与健康对照人群存在显著差异，为手工疗法治疗TTH提供了理论依据。例如，肌肉内的MTrP可以引起局部疼痛（点压痛）和远处疼痛（参考疼痛），模仿患者的头痛主诉，这使它成为头痛患者和按摩治疗师特别感兴趣的部位。我们最近在一个病例系列中报道，以MTrP疗法为重点的按摩疗法显著减少了紧张性头痛患者头痛的频率和持续时间。然而，按摩作为一种临床资源的潜力受到临床对照试验有效性验证的限制。本研究的目的是通过一项安慰剂对照的随机临床试验来评估按摩治疗紧张性头痛的有效性。具体而言，本提案的目的是确定结构化按摩治疗方案的影响，重点是肌筋膜触发点治疗，对TTH患者疼痛和残疾措施的影响。60名TTH患者将被随机分为按摩组、安慰剂组或等候组。训练有素的治疗师将按照规定的方案，在六周的时间内进行12次按摩治疗或12次假治疗。受试者将在每日日记中记录头痛参数并完成评估，以评估TTH所致的残疾。因此，具体目标#1是确认和扩展我们最近的发现，按摩疗法将减少TTH患者头痛的频率、强度和持续时间，这是一项随机、安慰剂对照试验。由于TTH也会影响日常生活质量，具体目标#2是确定按摩治疗对TTH患者头痛相关残疾的影响。

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.