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Moraska AF1, Stenerson L, Butryn N, Krutsch JP, Schmiege SJ, Mann JD. (Oct, 2014). Myofascial Trigger Point-focused Head and Neck Massage for Recurrent Tension-type Headache: A Randomized, Placebo-Controlled Clinical Trial. Clin J Pain. 2014 Oct 17..

Abstract: OBJECTIVE:: Myofascial trigger points (MTrPs) are focal disruptions in skeletal muscle that can refer pain to the head and reproduce the pain patterns of tension-type headache (TTH). The present study applied massage focused on MTrPs of subjects with TTH in a placebo-controlled, clinical trial to assess efficacy on reducing headache pain. METHODS:: Fifty-six subjects with TTH were randomized to receive 12 massage or placebo (detuned ultrasound) sessions over six weeks, or to wait-list. Trigger point release (TPR) massage focused on MTrPs in cervical musculature. Headache pain (frequency, intensity and duration) was recorded in a daily headache diary. Additional outcome measures included self-report of perceived clinical change in headache pain and pressure-pain threshold (PPT) at MTrPs in the upper trapezius and sub-occipital muscles. RESULTS:: From diary recordings, group differences across time were detected in headache frequency (P=0.026), but not for intensity or duration. Post hoc analysis indicated headache frequency decreased from baseline for both massage (P<0.0003) and placebo (P=0.013), but no difference was detected between massage and placebo. Subject report of perceived clinical change was a greater reduction in headache pain for massage than placebo or wait-list groups (P=0.002). PPT improved in all muscles tested for massage only (all P's<0.002). DISCUSSION:: Two findings from this study are apparent: (1) MTrPs are important components in the treatment of TTH, and (2) TTH, like other chronic conditions, is responsive to placebo. Clinical trials on headache that do not include a placebo group are at risk for overestimating the specific contribution from the active intervention.