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Hands-On Relief: A Pilot Study on the Use of Osteopathic Manipulative Treatment for Tension-Type Headaches

Journal: Journal of Osteopathic Medicine Date: 2025/12, 125(12):Pages: A698–699. doi: Subito , type of study: randomized controlled trial

Full text    (https://www.degruyterbrill.com/document/doi/10.1515/jom-2025-2000/html)

Keywords:

headache [161]
OMT [3780]
osteopathic manipulative treatment [3800]
pilot study [196]
randomized controlled trial [899]

Abstract:

Context: Tension-type headaches (TTH) are the most common form of primary headache, accounting for up to 78% of cases [1]. TTH can impair physical, social, and emotional functioning, contributing to reduced productivity and diminished quality of life. Pharmacologic therapies, such as over-the-counter analgesics, are limited by side effects and lack long-term efficacy [2]. The pathophysiology of TTH is multifactorial, involving both central and peripheral mechanisms. Somatic dysfunction–particularly in the cervical and upper thoracic musculature–is commonly observed in patients with TTH, contributing to muscle hypertonicity, tissue texture abnormalities, and nociceptive signaling [3]. Osteopathic manipulative treatment (OMT) addresses somatic dysfunction through a range of manual techniques and offers a promising non-pharmacologic alternative for TTH. However, few studies have assessed the clinical impact of OMT on TTH. Objective: To evaluate the immediate effectiveness of osteopathic manipulative treatment (OMT) in reducing headache severity in patients with tension-type headaches (TTH). Methods: This randomized, controlled pilot study was conducted from February 2023 to April 2025 and approved by the Institutional Review Board at Western University of Health Sciences (IRB Protocol #1880862). Participants were recruited based on diagnostic criteria outlined in the International Classification of Headache Disorders, 3rd edition (ICHD-3) [4], for TTH. Exclusion criteria included current headaches that were not TTH (e.g., migraine, cluster headache), recent head or neck trauma, or the use of prescription or over-the-counter medications for headache management on the day of the OMT session. Participants were randomly assigned to one of two groups: an immediate-treatment group or a delayed-treatment control group. All sessions were conducted in an osteopathic manipulative medicine (OMM) laboratory under the supervision of a board-certified physician in neuromusculoskeletal medicine and osteopathic manipulative medicine (NMM/OMM). The immediate-treatment group received a 20-minute OMT session targeting somatic dysfunctions in the cervical, thoracic, and rib regions. Treatment modalities included soft tissue, articulatory, myofascial release, muscle energy, Still techniques, and high-velocity, low-amplitude (HVLA). No medications or adjunct therapies were used. The delayed-treatment control group remained seated in a quiet setting for 20 minutes without therapeutic intervention, which served as the study’s control condition. Participants in this group then completed a post-wait survey before crossing over to receive the same OMT session as the immediate-treatment group. Headache severity was assessed using the 11-point numeric rating scale, ranging from 0 (no pain) to 10 (worst pain), immediately before and after each condition. Statistical analysis was performed using GraphPad Prism (version 10.5.0), with significance set at p<0.05. The Wilcoxon matched-pairs signed-rank test was used to assess within-group changes in headache severity. The Mann-Whitney U test was used to evaluate absolute changes in headache severity between the OMT and control conditions. Results: A total of 28 OMT sessions were conducted. All participants (ages 23-56; 89.3% female) exhibited palpable somatic dysfunction in the cervical and/or upper thoracic regions. In the immediate-treatment group (n=19), mean headache severity decreased from 3.63 ± 1.11 to 0.39 ± 0.66 following OMT (p<0.0001), with an average change of 3.24 ± 1.22. In the control group (n=9), mean headache severity changed from 4.44 ± 2.06 to 4.11 ± 1.76 after 20 minutes of sitting (p=0.50), with an average change of 0.33 ± 0.87. After OMT was provided to the control group, mean headache severity decreased to 1.06 ± 0.95 (p=0.0039), with an average change of 3.06 ± 1.13. Comparison of the absolute change in headache severity between groups revealed a statistically significant difference favoring OMT (p<0.0001). A subgroup analysis showed that participants with a history of migraines (n=8) responded similarly to those without (n=20), with an average pain reduction of 3.19 ± 1.00 in those with a history of migraines, compared to 3.18 ± 1.26 in those without. However, the difference between these subgroups was not significant (p<0.84). Notably, the average pain reduction following OMT exceeded the 2-point threshold on the numeric rating scale that is considered clinically meaningful in pain research [5]. No adverse events were reported, and all participants tolerated the intervention well. Conclusion: OMT was associated with a statistically and clinically significant immediate reduction in headache severity among patients with TTH. These findings support the potential of OMT as a safe, well-tolerated, and non-pharmacologic intervention for managing TTH. Although ambient lighting and noise levels in the treatment environment were not standardized, no significant impact on outcomes was observed. Future studies should control for environmental conditions, include a larger, more diverse sample, and assess long-term treatment effects.


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