Toro-Velasco C;
Arroyo-Morales M; Fernández-de-Las-Peñas C;
Cleland JA; Barrero-Hernández FJ
Department of Physical Therapy, Health Sciences School, Universidad Granada,
Spain.
OBJECTIVE: The purpose of this
study was to investigate the immediate effects of head-neck massage on heart
rate variability (HRV), mood states, and pressure pain thresholds (PPTs) in patients with chronic tension-type headache
(CTTH). METHODS: Eleven patients (8 females), between 20 and 68 years old, with
CTTH participated in this crossover study. Patients received either the
experimental treatment (massage protocol) or a placebo intervention (detuned
ultrasound). Holter electrocardiogram recordings (standard deviation of the
normal-to-normal interval, square root of mean squared differences of
successive NN intervals, index HRV, low-frequency component, and high-frequency
component), PPT over both temporalis muscles, and
Profile of Mood States questionnaire (tension-anxiety, depression-dejection,
anger-hostility, vigor, fatigue, confusion) were obtained preintervention,
immediately after intervention, and 24 hours postintervention.
Self-reported head pain was also collected preintervention
and 24 hours postintervention. Separate analyses of
covariance (ANCOVAs) were performed with each
dependent variable. The hypothesis of interest was group x time interaction.
RESULTS: The ANCOVA showed a significant group x time interaction for index HRV
(F = 4.5, P = .04), but not for standard deviation of the normal-to-normal
interval (F = 1.1, P = .3), square root of mean squared differences of
successive NN intervals (F = 0.9, P = .3), low-frequency component (F = 0.03, P
= .8), or high-frequency component (F = 0.4, P = .5) domains. Pairwise comparisons found that after the manual therapy
intervention, patients showed an increase in the index HRV (P = .01) domain,
whereas no changes were found after the placebo intervention (P = .7). The
ANCOVA also found a significant group x time interaction for tension-anxiety (F
= 5.3, P = .03) and anger-hostility (F = 4.6, P = .04) subscales. Pairwise comparisons found that after the manual therapy
intervention, patients showed a decrease in tension-anxiety (P = .002) and
anger-hostility (P = .04) subscales, whereas no changes were found after the
placebo intervention (P > .5 both subscales). No significant changes were
found in PPT levels (right F = 0.3, P = .6, left F = 0.4, P = .5). A
significant group x time interaction for pain (F = 4.8, P = .04) was
identified. No influence of sex was found (F = 1.5, P = .3). Pairwise comparisons showed that head pain (numerical pain
rating scale) decreased 24 hours after manual therapy (P < .05) but not
after the placebo intervention (P = .9). CONCLUSIONS: The application of a
single session of manual therapy program produces an immediate increase of
index HRV and a decrease in tension, anger status, and perceived pain in
patients with CTTH.