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Myofascial Trigger Point-focused Head and Neck Massage for Recurrent Tension-type Headache: A Randomized, Placebo-controlled Clinical Trial

Moraska, Albert F. PhD*; Stenerson, Lea MS*; Butryn, Nathan RMT; Krutsch, Jason P. MD; Schmiege, Sarah J. PhD*; Mann, John D. MD§

doi: 10.1097/AJP.0000000000000091
Original Articles

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 randomized 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 and suboccipital muscles.

Results: From diary recordings, group differences across time were detected in HA frequency (P=0.026), but not for intensity or duration. Post hoc analysis indicated that HA frequency decreased from baseline for both massage (P<0.0003) and placebo (P=0.013), but no difference was detected between massage and placebo. Patient report of perceived clinical change was greater reduction in HA pain for massage than placebo or wait-list groups (P=0.002). Pressure-pain threshold improved in all muscles tested for massage only (all P’s<0.002).

Discussion: Two findings from this study are apparent: (1) MTrPs are important components in the treatment of TTH, and (2) TTH, like other chronic conditions, is responsive to placebo. Clinical trials on HA that do not include a placebo group are at risk for overestimating the specific contribution from the active intervention.

*College of Nursing, University of Colorado at Denver

Department of Anesthesiology, School of Medicine, University of Colorado at Denver, Aurora

Boulder College of Massage Therapy, Boulder, CO

§Department of Neurology, School of Medicine, University of North Carolina, Chapel Hill, NC

Supported by the NIH/NCCAM Grant number R21 AT004469 and by NIH/NCATS Colorado CTSI Grant number UL1 TR000154, Bethesda, MD. Contents are the authors’ sole responsibility and do not necessarily represent official NIH views. The authors declare no conflict of interest.

Reprints: Albert F. Moraska, PhD, College of Nursing, University of Colorado at Denver, 13120 E. 19th Ave., C288-19, Aurora 80045, CO (e-mail:

Received June 21, 2013

Received in revised form March 25, 2014

Accepted February 21, 2014

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