***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*** 
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    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 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 The objective of the present study was to investigate the influence of headache-related disability on the recognition and management of migraine by French general practitioners ( GPs ) . Forty-nine teaching GPs at the Faculty of Medicine in the Nice-Sophia-Antipolis University were involved in this study . On one day , each patient who presented during the surgery hours of these GPs was invited to complete a question naire aim ed at identifying if he/she was a headache sufferer and , if so , whether the headache corresponded to migraine and had an impact on his/her functional ability . Functional disability was measured by the short-form of the Headache Impact Test ( HIT-6 ) . Being blind to the patients ' responses , the GPs completed a question naire for each patient aim ed at identifying if he/she considered the patient to suffer from migraine and , if so , whether he/she managed the patient for migraine . A total of 696 patients were included in this study and 289 ( 41.52 % ) of them had episodic headache . According to the new International Headache Society ( IHS ) criteria , 113 ( 16.24 % ) patients suffered from headache without migrainous features and 176 ( 25.29 % ) patients were migraine sufferers ( migraine according to IHS categories 1.1 and 1.2.1 : 11.21 % , and probable migraine according to IHS categories 1.6.1 and 1.6.2 : 14.08 % ) . The mean HIT score of these migraine sufferers was 59.1 + 8.8 and 50 % of them presented with a very severe impact score ( HIT score > 60 ) . Among the 176 migraine sufferers , 105 ( 59.7 % ) were not recognized as having migraine , 21 ( 11.9 % ) were recognized as having migraine but without migraine management and 50 ( 28.4 % ) were recognized as having migraine with migraine management . Recognition of migraine by GPs was statistically associated with the HIT score ( OR = 1.105 , 95 % CI : 1.056 - 1.157 , P < 0.001 ) and with the 1.1 and 1.2.1 IHS diagnostic categories ( OR = 2.942 , 95 % CI : 1.286 - 5.025 , P = 0.0107 ) whereas management of patients recognized as having migraine was only associated with the patient 's age ( OR = 1.051 , 95 % CI : 1.000 - 1.104 , P = 0.0486 ) . These results indicate that the continuing medical education of GPs should focus on the diagnosis of migraine and its impact on the lifestyle of the patient Background Migraine , tension-type headache ( TTH ) and medication-overuse headache ( MOH ) are disabling lifelong illnesses . The Eurolight project , a partnership activity within the Global Campaign against Headache , assessed the impact of headache disorders in ten countries in Europe using a structured question naire coupled with various sampling methods . Here we present the findings from the Italian population . Methods Question naires were distributed to a stratified sample ( N = 3500 ) of the adult ( 18–65 years ) inhabitants of Pavia province ( 1.05 % of the general population ) , r and omly selected in cooperation with the local health service . Questions included demographic and diagnostic enquries , and assessment of various aspects of impact and health-care utilisation . Results Altogether 500 question naires were returned of which 487 were adequately completed for analysis ( 58 % female , 42 % male ) . Among these , gender-adjusted lifetime prevalence of headache was 82.5 % , higher in females than in males ( 91.2 % vs 72.4 % ; p < 0.0001 ) . Gender-adjusted 1-year prevalence was 74.2 % ( females 87.7 % , males 61.1 % ; p < 0.0001 ) . The most prevalent headache type was migraine ( gender-adjusted 1-year prevalence 42.9 % ; females 54.6 % , males 32.5 % ; p < 0.0001 ) , followed by TTH ( 28.6 % ; no gender-related difference ) ; all causes of headache on ≥15 days/month were reported by 7.0 % of participants ( females 10.6 % , males 2.0 % ; p = 0.0002 ) , of whom 2.1 % , , all female ( p = 0.0064 ) concomitantly overused acute medications ( therefore probable MOH ) . Only 16.6 % of responders reporting headache had received a diagnosis from a doctor , and very few ( 2.4 % ) were taking preventative medications . Headache had negative impacts on different aspects of life : education , career and earnings , family and social life . Each person with headache had lost , on average , 2.3 days from paid work and 2.4 days from household work , and missed social occasions on 1.2 days , in the preceding 3 months . An increasing gradient for impact was observed from episodic to chronic forms of headache . Conclusions Our study reveals that in Italy , as in other countries , migraine , TTH and MOH are highly prevalent and are associated with significant personal impact . These findings have important implication s for health policy in Italy BACKGROUND Tension-type headache ( TTH ) is the most common type of primary headache however there is no clear evidence as to which specific treatment is most effective or whether combined treatment is more effective than individual treatments . AIM To assess the effectiveness of manual therapy techniques , applied to the suboccipital region , on aspects of disability in a sample of patients with tension-type headache . DESIGN R and omized Controlled Trial . SETTING Specialized centre for headache treatment . POPULATION Seventy-six ( 62 women ) patients ( age : 39.9 ± 10.9 years ) with episodic chronic TTH . METHODS Patients were r and omly divided into four treatment groups : 1 ) suboccipital soft tissue inhibition ; 2 ) occiput-atlas-axis manipulation ; 3 ) combined treatment of both techniques ; 4 ) control . Four sessions were applied over 4 weeks and disability was assessed before and after treatment using the Headache Disability Inventory ( HDI ) . Headache frequency , severity and the functional and emotional subscales of the question naire were assessed . Photophobia , phonophobia and pericranial tenderness were also monitored . RESULTS Headache frequency was significantly reduced with the manipulative and combined treatment ( P<0.05 ) , and the severity and functional subscale of the HDI changed in all three treatment groups ( P<0.05 ) . Manipulation treatment also reduced the score on the emotional subscale of the HDI ( P<0.05 ) . The combined intervention showed a greater effect at reducing the overall HDI score compared to the group that received suboccipital soft tissue inhibition and to the control group ( both P<0.05 ) . In addition , photophobia , phonophobia and pericranial tenderness only improved in the group receiving combined therapy ( P<0.05 ) . CONCLUSION When given individually , suboccipital soft tissue inhibition and occiput-atlas-axis manipulation result ed in changes in different parameters related to the disability caused by TTH . However , when the two treatments were combined , effectiveness was noted for all aspects of disability and other symptoms including photophobia , phonophobia and pericranial tenderness . CLINICAL REHABILITATION IMPACT Although individual manual therapy treatments showed a positive change in headache features , measures of photophobia , photophobia and pericranial tenderness only improved in the group that received the combined treatment suggesting that combined treatment is the most appropriate for symptomatic relief of TTH Objective : Myofascial trigger points ( MTrPs ) are focal disruptions in the skeletal muscle that can refer pain to the head and reproduce the pain patterns of tension-type HA ( TTH ) . The present study applied massage focused on MTrPs of patients with TTH in a placebo-controlled , clinical trial to assess efficacy on reducing headache ( HA ) pain . Methods : Fifty-six patients with TTH were r and omized to receive 12 massage or placebo ( detuned ultrasound ) sessions over 6 weeks , or to wait-list . Trigger point release massage focused on MTrPs in cervical musculature . HA pain ( frequency , intensity , and duration ) was recorded in a daily HA diary . Additional outcome measures included self-report of perceived clinical change in HA pain and pressure-pain threshold at MTrPs in the upper trapezius 
    Output:
    
Summary Manual therapy should be considered as an effective approach in improving the quality of life in patients with TTH and MH , while in patients with CGH , the results were inconsistent .