***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE The purpose of this preliminary study was to determine feasibility of a clinical trial to measure the effects of manual therapy on sternocleidomastoid active trigger points ( TrPs ) in patients with cervicogenic headache ( CeH ) . METHODS Twenty patients , 7 males and 13 females ( mean ± SD age , 39 ± 13 years ) , with a clinical diagnosis of CeH and active TrPs in the sternocleidomastoid muscle were r and omly divided into 2 groups . One group received TrP therapy ( manual pressure applied to taut b and s and passive stretching ) , and the other group received simulated TrP therapy ( after TrP localization no additional pressure was added , and inclusion of longitudinal stroking but no additional stretching ) . The primary outcome was headache intensity ( numeric pain scale ) based on the headaches experienced in the preceding week . Secondary outcomes included neck pain intensity , cervical range of motion ( CROM ) , pressure pain thresholds ( PPT ) over the upper cervical spine joints and deep cervical flexors motor performance . Outcomes were captured at baseline and 1 week after the treatment . RESULTS Patients receiving TrP therapy showed greater reduction in headache and neck pain intensity than those receiving the simulation ( P < .001 ) . Patients receiving the TrP therapy experienced greater improvements in motor performance of the deep cervical flexors , active CROM , and PPT ( all , P < .001 ) than those receiving the simulation . Between-groups effect sizes were large ( all , st and ardized mean difference , > 0.84 ) . CONCLUSION This study provides preliminary evidence that a trial of this nature is feasible . The preliminary findings show that manual therapy targeted to active TrPs in the sternocleidomastoid muscle may be effective for reducing headache and neck pain intensity and increasing motor performance of the deep cervical flexors , PPT , and active CROM in individuals with CeH showing active TrPs in this muscle . Studies including greater sample sizes and examining long-term effects are needed Objective As myofascial release therapy is currently under development , the objective of this study was to compare the effectiveness of myofascial release therapy with manual therapy for treating occupational mechanical neck pain . Design A r and omized , single-blind parallel group study was developed . The sample ( n = 59 ) was divided into GI , treated with manual therapy , and GII , treated with myofascial release therapy . Variables studied were intensity of neck pain , cervical disability , quality of life , craniovertebral angle , and ranges of cervical motion . Results At five sessions , clinical significance was observed in both groups for all the variables studied , except for flexion in GI . At this time point , an intergroup statistical difference was observed , which showed that GII had better craniovertebral angle ( P = 0.014 ) , flexion ( P = 0.021 ) , extension ( P = 0.003 ) , right side bending ( P = 0.001 ) , and right rotation ( P = 0.031 ) . A comparative analysis between therapies after intervention showed statistical differences indicating that GII had better craniovertebral angle ( P = 0.000 ) , right ( P = 0.000 ) and left ( P = 0.009 ) side bending , right ( P = 0.024 ) and left ( P = 0.046 ) rotations , and quality of life . Conclusions The treatment of occupational mechanical neck pain by myofascial release therapy seems to be more effective than manual therapy for correcting the advanced position of the head , recovering range of motion in side bending and rotation , and improving quality of life OBJECTIVE To evaluate the effects of a protocol involving soft tissue techniques and /or neural mobilization techniques in the management of patients with frequent episodic tension-type headache ( FETTH ) and those with chronic tension-type headache ( CTTH ) . DESIGN R and omized , double-blind , placebo-controlled before and after trial . SETTING Rehabilitation area of the local hospital and a private physiotherapy center . PARTICIPANTS Patients ( N=97 ; 78 women , 19 men ) diagnosed with FETTH or CTTH were r and omly assigned to groups A , B , C , or D. INTERVENTIONS ( A ) Placebo superficial massage ; ( B ) soft tissue techniques ; ( C ) neural mobilization techniques ; ( D ) a combination of soft tissue and neural mobilization techniques . MAIN OUTCOMES MEASURES The pressure pain threshold ( PPT ) in the temporal muscles ( points 1 and 2 ) and supraorbital region ( point 3 ) , the frequency and maximal intensity of pain crisis , and the score in the Headache Impact Test-6 ( HIT-6 ) were evaluated . All variables were assessed before the intervention , at the end of the intervention , and 15 and 30 days after the intervention . RESULTS Groups B , C , and D had an increase in PPT and a reduction in frequency , maximal intensity , and HIT-6 values in all time points after the intervention as compared with baseline and group A ( P<.001 for all cases ) . Group D had the highest PPT values and the lowest frequency and HIT-6 values after the intervention . CONCLUSIONS The application of soft tissue and neural mobilization techniques to patients with FETTH or CTTH induces significant changes in PPT , the characteristics of pain crisis , and its effect on activities of daily living as compared with the application of these techniques as isolated interventions This study research es the effectiveness of two manual therapy treatments focused on the suboccipital region for  tension-type headache .  A r and omized double-blind clinical trial was conducted over a period of four weeks with a follow-up at one month . Eighty-four patients with a mean age of 39.7 years ( SD 11.4 ) with tension-type headache were assigned to 4 groups which included the following manual therapy treatment : suboccipital soft tissue inhibition ; occiput-atlas-axis global manipulation ; combination of both techniques ; and a control group . The primary assessment consisted of collecting socio-demographic data and headache characteristics in a one-month base period , data such as age , gender , severity of pain , intensity and frequency of headache , among other . Outcome secondary assessment were : impact of headache , disability , ranges of motion of the craniocervical junction , frequency and intensity of headache , and pericranial tenderness . In the month prior to the study , average pain intensity , was rated at 6.49 ( SD 1.69 ) , and 66.7 % subjects suffered headaches of moderate intensity . After 8 weeks , statistically significant improvements were noted . OAA manipulative treatment and combined therapy treatments proved to be more effective than suboccipital soft tissue inhibition for tension-type headache . The treatment with suboccipital soft tissue inhibition , despite producing less significant results , also has positive effects on different aspects of headache Background Treatment of headache disorders is not always optimal . Patients are treated in multiple ways , and the lack of scientific arguments for referral and the insufficient implementation of guidelines result in unclear treatment strategies . The coexistence of headache and neck pain can lead to the referral to a musculoskeletal physiotherapist . This treatment can only be successful if an underlying cervical segmental dysfunction is present . In such cases a physical treatment can be a valuable option that should be considered . The aim of this study is to identify prognostic therapeutic patient characteristics and to increase the number of correct physiotherapy referrals . Methods / design This trial is design ed to identify patient characteristics which can influence the prognosis of the patient . Patients with recurrent headache and co-existent neck pain are recruited via a multicenter setup . After screening for eligibility , subjects are tested at baseline and r and omly allocated to one of two treatment groups . Testing includes the administering of question naires ( a  Headache Diagnosis Question naire ,  Headache Inventory List  and the Headache Impact Test ( HIT-6 ) ) and physical tests ( Thermal Stimuli , Manual Cervical Spine Examination and Pressure Algometry ) . Treatment groups are a usual care group ( UC ) administered by the General Practitioner ( GP ) and a usual care plus musculoskeletal physiotherapy treatment group ( UCMT ) . UC is based on the Dutch GP Guideline for Headache . UCMT consists of the UC plus a combination of exercises and spinal cervical mobilisations . Follow-up measurements consist of the completion of the Headache Inventory List , the HIT-6 and scoring of the global perceived effect ( GPE ) . The latter allowing the distinction between responders ( positive effect ) and non-responders ( no effect or worse ) . Logistic regression analysis will be used to identify the specific patient characteristics of the responders and the non-responders . The additional value of the musculoskeletal physiotherapy will be examined . Follow-up measurements up to 52 weeks are scheduled . Discussion This trial aims to identify prognostic patient characteristics , in order to supply a useful diagnostic tool for all health care workers , dealing with headache sufferers BACKGROUND  Tension-type headache ( TTH ) is a disease with a great incidence on quality of life and with a significant socioeconomic impact . OBJECTIVES The aim of this review is to determine the effectiveness of physical therapy by using manual therapy ( MT ) for the relief of TTH . DATA SOURCES A review was done identifying r and omized controlled trials through search es in MEDLINE , PEDro , Cochrane and CINAHL ( January 2002 - April 2012 ) . STUDY SELECTION English- language studies , with adult patients and number of subjects not under 11 , diagnosed with episodic tension-type headache ( ETTH ) and chronic tension-type headache ( CTTH ) were included . DATA EXTRACTION Initial search was undertaken with the words Effectiveness , Tension-type headache , and Manual therapy ( 39 studies ) . In addition , a search which included terms related to treatments such as physiotherapy , physical therapy , spinal manipulation was performed ( 25 studies ) . RESULTS From the two search es 9 studies met the inclusion criteria and were analysed finding statistically significant results : 1 ) myofascial release , cervical traction , neck muscles trigger points in cervical thoracic muscles and stretching ; 2 ) Superficial heat and massage , connective tissue manipulation and vertebral Cyriax mobilization ; 3 ) cervical or thoracic spinal manipulation and cervical chin-occipital manual traction ; 4 ) massage , progressive relaxation and gentle stretching , program of active exercises of shoulder , neck and pericranial muscles ; 5 ) massage , passive rhythmic mobilization techniques , cervical , thoracic and lumbopelvic postural correction and cranio-cervical exercises ; 6 ) progressive muscular relaxation combined with joint mobilization , functional , muscle energy , and strain/counterstrain techniques , and cranial osteopathic treatment ; 7 ) massage focused on relieving myofascial trigger point activity ; 8) pressure release and muscle energy in suboccipital muscles ; 9 ) combination of mobilizations of the cervical and thoracic spine , exercises and postural correction . All studies used a combination of different techniques and none analyzed treatments separately , also all the studies have assessed aspects related to TTH beyond frequency and intensity of pain . CONCLUSIONS The findings from these studies showed evidence that physiotherapy with articulatory MT , combined with cervical muscle stretching and massage are effective for this disease in different aspects related with TTH . No evidence was found of the effectiveness of the techniques applied separately Background Headache is a highly prevalent disorder . Irrespective of the headache diagnosis it is often accompanied with neck pain and -stiffness . Due to this common combination of headache and neck pain , physical treatments of the cervical spine are often considered . The additional value of these treatments to st and ard medical care or usual care ( UC ) is insufficiently documented . We therefore wanted to compare the treatment effects of UC alone and in combination with manual therapy ( MT ) in patients with a combination of headache and neck pain .  UC consisted of a stepped treatment approach according to the Dutch General Practitioners Guideline for headache , the additional MT consisted of articular mobilisations and low load exercises . Due to insufficient enrolment the study was terminated prematurely . We aim to report not only our preliminary clinical findings but also to discuss the encountered difficulties and to formulate recommendations for future research . Methods A r and omised clinical trial was conducted . Thirty-seven patients were included and r and omly allocated to one of both treatment groups . The treatment period was 6 weeks , with follow-up measurements at weeks 7 , 12 and 26 . Primary outcome measures were global perceived effect ( GPE ) and the impact of the headache using the Headache Impact Test ( HIT-6 ) . Reduction in headache frequency , pain intensity , medication intake , absenteeism and the use of additional professional help were secondary outcome measures Results Significant improvements on primary and secondary outcome measures were recorded in both treatment groups . No significant differences between both treatment groups were found . The number of recruited patients remained low despite various strategies . Conclusion It appears that both treatment strategies can have equivalent positive influences on headache complaints . Additional studies with larger study population s are needed to draw firm conclusions . Recommendations to increase patient inflow in primary care trials , such as the use of an extended network of participating physicians and of clinical alert software applications , are discussed . Trial registration OBJECTIVE Clinical trials concerning cervical spine manipulation and mobilization in children and adolescents with cervicogenic headache are lacking . METHODS We performed a multicenter , prospect i ve , r and omized , placebo-controlled , and blinded trial in 52 children and adolescents ( 21 boys , 31 girls ) aged 7 - 15 . After prospect i ve baseline documentation for 2 months patients were either assigned to placebo or true manipulation with another 2-month follow-up . Main outcome measures were defined as : percentage of days with headache , total duration of headache , days with school absence due to headache , 
    Output:
    
According to these studies , manual therapy improves symptoms , increasing patients ' well-being and improving the outcome measures analysed .
Manual therapy has positive effects on pain intensity , pain frequency , disability , overall impact , quality of life , and craniocervical range of motion in adults with tension-type headache .
None of the techniques was found to be superior to the others ; combining different techniques seems to be the most effective approach