Original Article
Short-Term Effects of Manual Therapy on Heart Rate Variability, Mood State, and Pressure Pain Sensitivity in Patients With Chronic Tension-Type Headache: A Pilot Study

https://doi.org/10.1016/j.jmpt.2009.08.011Get rights and content

Abstract

Objective

The purpose of this study was to investigate the immediate effects of head-neck massage on heart rate variability (HRV), mood states, and pressure pain thresholds (PPTs) in patients with chronic tension-type headache (CTTH).

Methods

Eleven patients (8 females), between 20 and 68 years old, with CTTH participated in this crossover study. Patients received either the experimental treatment (massage protocol) or a placebo intervention (detuned ultrasound). Holter electrocardiogram recordings (standard deviation of the normal-to-normal interval, square root of mean squared differences of successive NN intervals, index HRV, low-frequency component, and high-frequency component), PPT over both temporalis muscles, and Profile of Mood States questionnaire (tension-anxiety, depression-dejection, anger-hostility, vigor, fatigue, confusion) were obtained preintervention, immediately after intervention, and 24 hours postintervention. Self-reported head pain was also collected preintervention and 24 hours postintervention. Separate analyses of covariance (ANCOVAs) were performed with each dependent variable. The hypothesis of interest was group × time interaction.

Results

The ANCOVA showed a significant group × time interaction for index HRV (F = 4.5, P = .04), but not for standard deviation of the normal-to-normal interval (F = 1.1, P = .3), square root of mean squared differences of successive NN intervals (F = 0.9, P = .3), low-frequency component (F = 0.03, P = .8), or high-frequency component (F = 0.4, P = .5) domains. Pairwise comparisons found that after the manual therapy intervention, patients showed an increase in the index HRV (P = .01) domain, whereas no changes were found after the placebo intervention (P = .7). The ANCOVA also found a significant group × time interaction for tension-anxiety (F = 5.3, P = .03) and anger-hostility (F = 4.6, P = .04) subscales. Pairwise comparisons found that after the manual therapy intervention, patients showed a decrease in tension-anxiety (P = .002) and anger-hostility (P = .04) subscales, whereas no changes were found after the placebo intervention (P > .5 both subscales). No significant changes were found in PPT levels (right F = 0.3, P = .6, left F = 0.4, P = .5). A significant group × time interaction for pain (F = 4.8, P = .04) was identified. No influence of sex was found (F = 1.5, P = .3). Pairwise comparisons showed that head pain (numerical pain rating scale) decreased 24 hours after manual therapy (P < .05) but not after the placebo intervention (P = .9).

Conclusions

The application of a single session of manual therapy program produces an immediate increase of index HRV and a decrease in tension, anger status, and perceived pain in patients with CTTH.

Section snippets

Methods

A placebo-controlled, repeated-measures, crossover, single-blind, randomized trial was used to investigate the effects of manual therapy in HRV parameters, psychologic disorders, pressure pain sensitivity, and pain intensity in patients with CTTH.

Results

All participants (n = 11) completed the protocol, and the results from all of them were used in the main analysis. Therefore, 3 males and 8 females (mean age, 51 ± 15 years old [95% CI, 41-60 years]; mean weight, 66.6 ± 7.5 kg [95% CI, 61-71 kg.]; and mean height, 160 ± 3 cm [95% CI, 155-164 cm.]) were included. Preintervention scores of each variable were not significantly different between each condition: SDNN (P = .4), RMSSD (P = .4), index HRV (P = .3), LF (P = .6), HF (P = .1),

Discussion

The results of our study showed that a single session of a manual therapy protocol aimed to inactivate muscle TrPs decreases the emotional tension and increases HRV, immediately after treatment, as compared with detuned ultrasound, in patients with CTTH. Nevertheless, we only found a transient effect of the treatment, which may have a limited clinical significance.

It has previously been identified that manual therapy associated with active aerobic recovery can restore balance to the ANS of an

Conclusions

The application of a single session of manual therapy program produces an immediate increase of index HRV and a decrease in tension, anger status, and perceived pain in patients with CTTH. Nevertheless, we only have found a transient effect of the treatment, which may have limited clinical significance. Future studies investigating the effects of numerous treatment sessions are needed to elucidate the clinical relevance of the current findings.

Practical Applications

  • •

    The application of a session of head-neck massage

Funding Sources and Potential Conflicts of Interest

No funding sources or conflicts of interest were reported for this study.

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