Efficiency of myofascial release in patients with tension-type headaches: integrative review

Silva, Marcela Galdina; Bento, Victor Augusto Alves; Castillo, Daisilene Baena

doi:10.5935/2595-0118.20210058

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REVIEW ARTICLE • BrJP 4 (4) • Oct-Dec 2021 • https://doi.org/10.5935/2595-0118.20210058 copy

Efficiency of myofascial release in patients with tension-type headaches: integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES:

Headaches are the most common neurological symptom and the most frequent medical complaint, with tension-type pain being one of the most reported forms, being considered a public health problem. Among the manual therapies indicated for the treatment of tension type headaches (TTH) is myofascial release (MRL), which consists of releasing muscle and fascia tension, through techniques that deactivate trigger points (TP). Thus, the objective of this integrative review is to determine the effectiveness of physical therapy using MRL in the treatment of TP-induced TTH.

The guiding question of the study was: “What is the effect of manual therapy using myofascial release as a treatment in patients with tension-type headaches”? Searches were performed in LILACS and Pubmed/Medline databases until August 2021. Sixteen studies published between 2003 and 2021 were included in this integrative review, including case reports and clinical trials, presenting a total of 481 patients.

CONCLUSION:

It was possible to conclude that the MRL technique showed positive results as a treatment for TTH through the reduction of pain, intensity and frequency.

Keywords:
Musculoskeletal manipulations; Tension-type headache; Trigger points

Databases	Studies found	Studies selected
LILACS	99	3
Pubmed	231	13
Total	330	16

Authors	n	Type of study	Treatments	Conclusion
Mignelli, Tollefson and Stefanowicz ²⁸28. Mignelli J, Tollefson LJ, Stefanowicz E. Conservative management of neck and thoracic pain in an adult with neurofibromatosis-1. J Can Chiropr Assoc. 2021;65(1):121-6.	1	Case report	MRL of masseter and temporalis muscles	Manual therapy in the form of cervical flexion-distraction with MRL was effective in reducing neck and chest pain and reducing headache frequency.
Corum et al.²⁹29. Corum M, Aydin T, Medin Ceylan C, Kesiktas FN. The comparative effects of spinal manipulation, myofascial release and exercise in tension-type headache patients with neck pain: a randomized controlled trial. Complement Ther Clin Pract. 2021;43:101319.	15	RCT	MRL and suboccipital inhibition	Manipulative exercise was shown to be more effective than MRL.
Pérez-Llanes et al.³⁰30. Pérez-Llanes R, Ruiz-Cárdenas JD, Meroño-Gallut AJ, Fernández-Calero MI, Ríos-Díaz J. Effectiveness of suboccipital muscle inhibition combined with interferential current in patients with chronic tension-type headache: a randomised controlled clinical trial. Neurologia. 2020;25:S0213-4853(20)30042-6.	12	Clinical trial	MRL and suboccipital inhibition	MRL reduced disability and impact of headache on daily life by 4 weeks.
Shields and Smith³¹31. Shields G, Smith JM. Remedial massage therapy interventions including and excluding sternocleidomastoid, scalene, temporalis, and masseter muscles for chronic tension type headaches: a case series. Int J Ther Massage Bodywork. 2020;13(1):22-31.	4	Clinical trial	Release of myofascial TP in anterior neck, mandible and skull region, and neuromuscular therapy	Applied therapy reduced the frequency of headaches, and may be an effective method for treating TTH.
Georgoudis et al.³²32. Georgoudis G, Felah B, Nikolaidis P, Damigos D. The effect of myofascial release and microwave diathermy combined with acupuncture versus acupuncture therapy in tension-type headache patients: A pragmatic randomized controlled trial. Physiother Res Int. 2018;23(2):e1700.	24	RCT	MRL and stretching	The combination of physical therapy in the form of MRL, acupuncture and stretching to improve analgesic effect is strongly recommended
Moraska et al.³³33. Moraska AF, Schmiege SJ, Mann JD, Butryn N, Krutsch JP. Responsiveness of myofascial trigger points to single and multiple trigger point release massages: a randomized, placebo-controlled trial. Am J Phys Med Rehabil. 2017;96(9):639-45.	62	RCT	MRL in trapezius and suboccipital muscles	The proposed therapy may show complete resolution of headache after several treatment sessions.
Antunes et al.³⁴34. Antunes MD, Favoreto AB, Nacano MS, Morales RC, Nascimento Júnior JR, Oliveira DV, et al. Análise comparativa dos efeitos da massoterapia e pompagem cervical na dor e qualidade de vida em mulheres. ConScientiae Saúde, 2017;16(1):109-15.	20	Clinical trial	MRL associated with pompage	Both massage therapy and pompage promoted an improvement in pain and quality of life, with massage therapy having a better result in the pain condition and pompage in quality of life.
Ferragut-Garcías et al.³⁵35. Ferragut-Garcías A, Plaza-Manzano G, Rodríguez-Blanco C, Velasco-Roldán O, Pecos-Martín D, Oliva-Pascual-Vaca J, et al. Effectiveness of a treatment involving soft tissue techniques and/or neural mobilization techniques in the management of tension-type headache: a randomized controlled trial. Arch Phys Med Rehabil. 2017;98(2):211-9.e2.	97	Clinical trial	MRL and neural mobilization	MRL with neural mobilization techniques is more effective in the management of patients with chronic headache.
Sousa et al.³⁶36. Sousa RC, Silva LFBP, Barradas LPF, Silvia CC, Matos LKBL. Efeitos da liberação miofascial na qualidade e frequência da dor em mulheres com cefaleia do tipo induzida por pontos-gatilho tensional. Fisioterapia Brasil. 2015;16(3):231-5.	9	Clinical trial	MRL	Presented a significant result in the reduction of overall subjective pain intensity, relief of sensory and affective components and decrease in pain frequency in women.
Bastos et al.³⁷37. Bastos AFC, Melo LG, Rezende AAB, Herrera SDSC, Ueda TK. Intervenção fisioterapêutica na melhoria da qualidade de vida de paciente portador de cefaleia do tipo tensional crônica. Rev Amazônia. 2013;1(1):25-31.	1	Case report	MRL and Stretching	Manual therapy improved quality of life of patients with chronic tension headache.
Rodríguez-Fernández et al.³⁸38. Rodríguez-Fernández AL, Garrido-Santofimia V, Güeita-Rodríguez J, Fernández-de-Las-Peñas C. Effects of burst-type transcutaneous electrical nerve stimulation on cervical range of motion and latent myofascial trigger point pain sensitivity. Arch Phys Med Rehabil. 2011;92(9):1353-8.	76	Clinical trial	MRL	Participants were classified as having achieved a successful outcome one week after the session based on perceived recovery. Data from 76 individuals were included in the analysis, of which 36 had a successful outcome (48%).
Hoffmann et al.³⁹39. Hoffmann CF, Rezende MAA, Clemente C, Araujo AGS. Uso da técnica de energia muscular em mulheres com cervicalgia. Fisioterapia Brasil. 2011;12(4):255-60.	22	Clinical trial	MRL	Improvement in pain, discomfort and quality of life, but there are limitations due to the small number of patients treated.
Macedo et al.⁴⁰40. Macedo CSG, Cardoso JR, Prado FM L, Carvalho PG. Eficácia da terapia manual craniana em mulheres com cefaleia. Fisioter Pesq. 2007;14(2):14-20.	37	Clinical trial	MRL and Stretching	Manual therapies with cranial and cervical maneuvers are effective and should be used for the treatment of women with chronic headache.
Morelli and Rebelatto⁴¹41. Morelli JGS, Rebelatto JR. A eficácia da terapia manual em cefaleicos portadores e não-portadores de degeneração cervical: análise de seis casos. Rev Bras Fisioter. 2007;11(4):325-9.	6	Clinical trial	MRL	Regarding intensity, the treatment showed greater difficulty in improving symptoms in the group of individuals who don’t have vertebral alterations, but in relation to the threshold of pain by pressure, the individuals with associated vertebral alterations showed marked improvement.
Morelli and Rebelatto⁴²42. Morelli JGS, Rebelatto JR. A efetividade de um protocolo fisioterapêutico de terapia manual para o alívio dos pacientes com cefaleia tensional e mudanças da coluna cervical. Fisioter Bras 2006;7(4):313-6.	24	Clinical trial	MRL	Effectiveness in headache relief and increasing pain threshold was observed.
Hoffmann and Teodoroski⁴³43. Hoffmann J, Teodoroski RCC. A eficácia da pompagem, na coluna cervical, no tratamento da cefaléia do tipo intensional. Rev Ter Man. 2003;2(2):56-60.	1	Case report	MRL associated with pompage	The pompage technique on the posterior and lateral muscles of the cervical spine showed effectiveness in the treatment of TTH.

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[1] Correspondence to: Departamento de Materiais Odontológicos e Prótese Faculdade de Odontologia de Araçatuba Universidade Estadual Paulista Júlio de Mesquita Filho Rua José Bonifácio, 1193 16015-050 Araçatuba, SP, Brasil. E-mail: vtrbento97@gmail.com

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Efficiency of myofascial release in patients with tension-type headaches: integrative review

ABSTRACT

BACKGROUND AND OBJECTIVES:

CONTENTS:

CONCLUSION: