Trigger Point Manual Treatments May Be Effective in Tension-Type Headache

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Trigger point interventions examined consisted of compression, muscle energy, myofascial, soft tissues, and positional release techniques, as well as acupressure.
Trigger point interventions examined consisted of compression, muscle energy, myofascial, soft tissues, and positional release techniques, as well as acupressure.

Manual trigger point treatments of head and neck muscles may be associated with reductions in the duration, frequency, and intensity of tension-type headache and migraine headache attacks, according to a systematic analysis published in Frontiers in Neurology, although the evidence reviewed was deemed to be of low quality.

Investigators analyzed 7 randomized controlled trials that investigated the effects of trigger point vs placebo interventions in a total of 316 adults with tension-type headache, migraine headache, or chronic headache.

Trigger point interventions examined consisted of compression, muscle energy, myofascial, soft tissue, and positional release techniques, as well as acupressure.

The primary outcomes were the frequency, intensity (assessed with the 0 to 100 mm numeric pain intensity scale), and duration of attacks. 

The pooled analysis of 6 trials (3 at high and 3 at low risk for bias) indicated a greater reduction in the monthly frequency (mean difference [MD] −3.05; 95% CI, −4.11 to −2.00; P <.01), intensity (MD, −12.93; 95% CI, −18.70 to −7.16; P <.001), and duration (3 trials; mean reduction of 1.69 hour/attack; MD, −1.69; 95% CI, −2.93 to −0.46; P <.01) of tension-type headache and migraine headache attacks after trigger point intervention compared with control/no treatment.

Manual trigger point treatments also reduced the frequency (mean reduction of 3.50 attacks/month; MD, −3.50; 95% CI, −4.91 to −2.09; P <.001), intensity (MD, −12.83; 95% CI, −19.49 to −6.17; P <.001), and duration (mean reduction, 0.51 hour/attack; MD, −0.51; 95% CI, −0.97 to −0.04; P =.03) of tension-type headache attacks compared with control interventions. Trigger point vs control treatments also led to a reduction in the frequency (1.92 attack/month; MD, −1.92; 95% CI, −3.03 to −0.80; P <.001), intensity (MD, −13.60; 95% CI, −19.54 to −7.66; P <.001), and duration (mean reduction, 10.68 hours/attacks; MD, −10.68; 95% CI, −14.41 to −6.95; P <.001) of migraine headaches.

The studies reviewed examined a number of different treatments and did not allow determination of the most effective technique.

“Our findings must be interpreted with caution for the weakness of the level of the evidence mainly due to the high [risk for bias] within studies and imprecision in results. Moreover, as the majority of the included studies had short-term follow-up, the long-term effect of trigger point manual treatment still needs to be established,” concluded the study authors.

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Reference

Falsiroli Maistrello L, Geri T, Gianola S, Zaninetti M, Testa M. Effectiveness of trigger point manual treatment on the frequency, intensity, and duration of attacks in primary headaches: a systematic review and meta-analysis of randomized controlled trials. Front Neurol. 2018;9:254.

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