Predictor variables for identifying patients with chronic tension-type headache who are likely to achieve short-term success with muscle trigger point therapy

Authors

  • C Fernández-de-las-Peñas,

    Corresponding author
    1. Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation of Universidad Rey Juan Carlos,
    2. Aesthesiology Laboratory of Universidad Rey Juan Carlos and
    Search for more papers by this author
  • JA Cleland,

    1. Department of Physical Therapy, Franklin Pierce College and
    2. Research Coordinator, Rehabilitation Services, Concord Hospital,Concord, NH, and
    3. Faculty, Manual Therapy Fellowship Program, Regis University, Denver, CO, USA
    Search for more papers by this author
  • ML Cuadrado,

    1. Aesthesiology Laboratory of Universidad Rey Juan Carlos and
    2. Departments of Neurology of Fundación Hospital Alcorcón and Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain,
    Search for more papers by this author
  • JA Pareja

    1. Aesthesiology Laboratory of Universidad Rey Juan Carlos and
    2. Departments of Neurology of Fundación Hospital Alcorcón and Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain,
    Search for more papers by this author

César Fernández-de-las-Peñas, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain. Tel. + 34 91 488 8884, fax + 34 91 488 8957, e-mail cesar.fernandez@urjc.es

Abstract

To date, no studies have investigated the predictive validity of variables from the initial examination to identify patients with tension-type headache pain who are likely to benefit from muscle trigger point (TrP) therapy. The purpose of this study was to develop a preliminary clinical prediction rule (CPR) to identify chronic tension-type headache (CTTH) patients who are likely to experience a successful response from TrP therapy. Consecutive patients with CTTH underwent a standardized examination and then received six sessions of TrP therapy over 3 weeks (two sessions per week). They were classified as having experienced a successful outcome at short-term (1 week after discharge) and 1-month follow-up based on a 50% reduction on at least one headache parameter (intensity, frequency or duration) and self-report perceived recovery. Potential predictor variables were entered into a stepwise logistic regression model to determine the most accurate set of variables for identifying treatment success. Data from 35 patients were included, of which 19 (55%) experienced a successful outcome. A CPR with four variables for short-term (headache duration < 8.5 h/day, headache frequency < 5.5 days/week, bodily pain < 47 and vitality < 47.5) and a CPR with two variables for 1-month (headache frequency < 5.5 days/week and bodily pain < 47) follow-up were identified. At short-term follow-up, if three of four variables [positive likelihood ratio (LR) 3.4] were present, the chance of experiencing a successful outcome improved from 54% to 80%, and if all the variables (positive LR 5.9) were present, the probability of success was 87.4%. At 1-month follow-up, if one of two variables (positive LR 2.2) was present, the probability of success increased from 54% to 72%, and if both variables (positive LR 4.6) were present, the probability of success was 84.4%. The present CPR provides the potential to identify CTTH patients who are likely to experience short-term and 1-month follow-up success with a muscle TrP therapy approach. Future studies are necessary to validate the CPR.

Ancillary