De effectiviteit van craniocervicale training, vergeleken met myofascial release en vijf andere fysiotherapeutische interventies op de frequentie van tension type headache bij volwassenen
Background: tension type headache (TTH) has the highest prevalence of all headache subtypes worldwide. Even though, in physiotherapy, different methods are used in the treatment of TTH, there is no clear evidence proving or rejecting the efficacy of physiotherapy on TTH in adults. Objective: to assess the efficacy of Craniocervical training, compared to Myofascial release and five other physiotherapeutic interventions in the frequency of TTH in adults. Methods: systematic reviews and randomized controlled trials (RCT's) were searched in databases Pubmed, PEDro and Cochrane. The following keywords were used: "tension type headache" "trigger points" "physiotherapy" "effectiveness" and "efficacy" Only RCT's investigating physiotherapeutic interventions were selected. Results: one systematic review and five RCT's were included. The systematic review provides an overview of physiotherapy and manual therapy in TTH, along with recommendations for further research. The methodological quality of four of the included RCT's is good (PEDro score 6 or higher) and one is of fair methodological quality (PEDro score 4) The studies were conducted in five different countries, the interventions were different for each study (for both the intervention and the control groups) and the number of participants was different for each study. The studies took place over different time frames, varying from 16 to 36 weeks. In four out of five of these studies, different outcome measures were used, aside from headache frequency, such as headache intensity and quality of life. All interventions, except acupuncture, reduce the frequency of TTH. Craniocervical training and Myofascial release seem to be the most effective due to the high percentage of 'responders' (patients whose headache frequency reduced by 50% or more) The results of Myofascial release were only measured directly after the intervention period. In Craniocervical training, 48% of the intervention group showed a reduction of headache frequency of 80 100% at six months follow up. Conclusion: Myofascial release and Craniocervical training are the only two interventions that provide a clinically relevant reduction in headache frequency (more than 50% Myofascial release provides a clinically relevant reduction in short term, immediately after the intervention period. Craniocervical training offers a great long term perspective because of the results at six months follow up. Positional release therapy and analgetic treatment both reduce headache frequency significantly short term. Physical training en relaxation training both provide a reduction in headache frequency long term (six months) Physiotherapy as described in the article by Torelli, Jensen, Olesen (2006) provides a significant reduction in headache frequency after the intervention period. The conclusions on the clinically relevant results only have one study each to support them; further research on these interventions is recommended.