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Efficacy of physiotherapy including a craniocervical training programme for tension-type headache; a randomized clinical trial


J. W. van Ettekoven MSc, University of Amsterdam, Department of Clinical Epidemiology and Biostatistics, PO Box 22660, 1100 DD Amsterdam, the Netherlands. Tel. + 31 2 0641 4543, + 31 6 2053 0847, fax + 31 2 0640 6388, e-mail


We conducted a multicentre, randomized controlled trial with blinded outcome assessment. The treatment period was 6 weeks with follow-up assessment immediately thereafter and after 6 months. The objective was to determine the effectiveness of a craniocervical training programme combined with physiotherapy for tension-type headache. Eighty-one participants meeting the diagnostic criteria for tension-type headache were randomly assigned to an exercise group (physiotherapy and an additional craniocervical training programme) and a control group (physiotherapy alone). The primary outcome measure was headache frequency. Secondary outcomes included headache intensity and duration, Quality of Life (SF-36) and the Multidimensional Headache Locus of Control scale (MHLC). At 6 months’ follow-up, the craniocervical training group showed significantly reduced headache frequency, intensity and duration (P < 0.001 for all). Effect sizes were large and clinically relevant. Loss to follow-up amounted to 3.7%. Physiotherapy including craniocervical training reduces symptoms of tension-type headache significantly over a prolonged time frame.