Formation of myofаscial pain syndrome and its correction in patients with tension headache

Abstract

Background. Tension headache (TH) is recognized as the second most prevalent medical condition globally. Osteopathic manipulative treatment is a non-pharmacological, non-invasive manual medicine, considered by some to be alternative medicine, that includes a wide range of therapeutic manual techniques to improve physiological function and promote the restoration of homeostasis altered by any somatic dysfunction. Purpose – to improve the algorithm for diagnosing and treating tension-type headache, taking into account the condition of the muscles of the body and face and adding an osteopathic method of therapy. Materials and Methods. The study involved examination and treatment of 96 patients (86 women and 10 men) aged 43.0 ± 10.2 years (range 23 to 59 years). The diagnosis was established according to the diagnostic criteria of ICHD-3. The patients underwent osteopathic diagnostics. Osteopathic treatment was performed according to the authorʼs developed methodology, using gentle manual techniques and a holistic approach. Statistical analysis consisted of assessing the change in pain syndrome before and after osteopathic treatment. The analysis was performed using the McNemar criterion and the effect size according to Cohenʼs d. Results. Treatment was carried out once a week, from 3 to 5 sessions, lasting 40–50 minutes. One patient underwent 9 sessions. The complex was tailored individually, chosen based on identified somatic dysfunctions, muscle tension, and functional changes observed during the examination. Patients with severe pain syndrome were recommended to take painkillers (ibuprofen 400–600 mg per day). A week after completing the procedures, patients underwent a follow-up examination. The results indicated an improvement in their general condition, evidenced by a reduction in the frequency of myofascial pain syndromes in several muscles: upper bundles of the trapezius, suboccipital, sternocleidomastoid, scalene, paravertebral muscles of the neck and back, pectoralis minor, levator scapulae, rhomboid, quadratus lumborum, masticatory, and temporal muscles, as well as a decrease in the intensity of TH. The average level of pain according to VAS before treatment was (5.1 ± 1.8) points. After treatment, a significant decrease in headache was noted on average to (2.3 ± 1.8) points, the effectiveness of the proposed osteopathic treatment was confirmed by a high coefficient of Cohenʼs d = 1.55. Conclusions. When diagnosing TH, attention should be paid to the state of the musculoskeletal system, the presence of myofascial pain dysfunction. In the study, myofascial dysfunctions were most often detected in the trapezius, suboccipital and masticatory muscles. The developed protocol for individual osteopathic correction focuses on addressing somatic dysfunctions through various techniques. These include joint and scapula articulation, sacrum mobility restoration, deep fascia balancing in the neck, cervical spine adjustments, craniocervical junction corrections, skull and TMJ kinetic dysfunctions using longitudinal suture techniques, and myofascial release of muscles in the neck, chest, and face. This approach is effective for treating TH.

Keywords

• tension headache myofascial dysfunction pain intensity osteopathic diagnosis osteopathic treatment