Multimodal manual therapy vs. pharmacological care for management of tension type headache: A meta-analysis of randomized trials.

BACKGROUND: Manual therapies are generally requested by patients with tension type headache. OBJECTIVE: To compare the efficacy of multimodal manual therapy vs. pharmacological care for the management of tension type headache pain by conducting a meta-analysis of randomized controlled trials. METHODS: PubMed, MEDLINE, EMBASE, AMED, CINAHL, EBSCO, Cochrane Database of Systematic Reviews, Cochrane Collaboration Trials Register, PEDro and SCOPUS were searched from their inception until June 2014. All randomized controlled trials comparing any manual therapy vs. medication care for treating tension type headache adults were included. Data were extracted and methodological quality assessed independently by two reviewers. We pooled headache frequency as the main outcome and also intensity and duration. The weighted mean difference between manual therapy and pharmacological care was used to determine effect sizes. RESULTS: Five randomized controlled trials met our inclusion criteria and were included in the meta-analysis. Pooled analyses found that manual therapies were more effective than pharmacological care in reducing frequency (weighted mean difference -0.8036, 95% confidence interval -1.66 to -0.44; three trials), intensity (weighted mean difference -0.5974, 95% confidence interval -0.8875 to -0.3073; five trials) and duration (weighted mean difference -0.5558, 95% confidence interval -0.9124 to -0.1992; three trials) of the headache immediately after treatment. No differences were found at longer follow-up for headache intensity (weighted mean difference -0.3498, 95% confidence interval -1.106 to 0.407; three trials). CONCLUSION: Manual therapies were associated with moderate effectiveness at short term, but similar effectiveness at longer follow-up for reducing headache frequency, intensity and duration in tension type headache than pharmacological medical drug care. However, due to the heterogeneity of the interventions, these results should be considered with caution at this stage.

Cadaveric validation of dry needle placement in the lateral pterygoid muscle.

OBJECTIVE: The aim of this anatomical study was to determine if a needle is able to reach the lateral pterygoid muscle during the application of dry needling technique. METHODS: A dry needling approach using 2 needles of 50 to 60 mm in length, one inserted over the zygomatic process posterior at the obituary arch (for the superior head) and other inserted below the zygomatic process between the mandibular condyle and the coronoid process (for the inferior head), was proposed. A progressive dissection into 3 stages was conducted into 2 heads of fresh male cadavers. First, dry needling of the lateral pterygoid muscle was applied on the cadaver. Second, a block dissection containing the lateral pterygoid was harvested. Finally, the ramus of the mandible was sectioned by osteotomy to visualize the lateral pterygoid muscle with the needle placements. RESULTS: With the needles inserted into the cadaver, the block dissection revealed that the superior needle reached the superior (sphenoid) head of the lateral pterygoid muscle and the inferior needle reached the inferior (pterygoid) head of the muscle. At the final stage of the dissection, when the ramus of the mandible was sectioned by osteotomy, it was revealed that the superior needle entered into the belly of the superior head of the lateral pterygoid muscle. CONCLUSIONS: This anatomical study supports that dry needling technique for the lateral pterygoid muscle can be properly conducted with the proposed approach.