Development of a Clinical Prediction Rule for Identifying Women With Tension‐Type Headache Who Are Likely to Achieve Short‐Term Success With Joint Mobilization and Muscle Trigger Point Therapy

( Headache 2011;51:246‐261) Objective.— To identify prognostic factors from the history and physical examination in women with tension‐type headache (TTH) who are likely to experience self‐perceived clinical improvement following a multimodal physical therapy session including joint mobilization and muscle trigger point (TrP) therapies. Background.— No definitive therapeutic intervention is available for TTH. It would be useful for clinicians to have a clinical prediction rule for selecting which TTH patients may experience improved outcomes following a multimodal physical therapy program. Methods.— Women diagnosed with pure TTH by 3 experienced neurologists according to the International Headache Society criteria from different neurology departments were included. They underwent a standardized examination (neck mobility, pressure pain thresholds, total tenderness score, presence of muscle TrPs, Medical Outcomes Study 36‐Item Short Form, the Neck Disability Index [NDI], the Beck Depression Inventory, and the Headache Disability Inventory) and then a multimodal physical therapy session including joint mobilization and TrP therapies. The treatment session included a 30‐second grade III or IV central posterior‐anterior nonthrust mobilization applied from T4 to T1 thoracic vertebrae, at C7‐T1 cervico‐thoracic junction and C1‐C2 vertebrae for an overall intervention time of 5 minutes Different TrP techniques, particularly soft tissue stroke, pressure release, or muscle energy were applied to head and neck–shoulder muscles (temporalis, suboccipital, upper trapezius, splenius capitis, semispinalis capitis, sternocleidomastoid) to inactivate active muscle TrPs. Participants were classified as having achieved a successful outcome 1 week after the session based on their self‐perceived recovery. Potential prognostic variables were entered into a stepwise logistic regression model to determine the most accurate set of variables for prediction of success. Results.— Data for 76 subjects were included in the analysis, of which 36 experienced a successful outcome (48%). Eight prognostic variables were retained in the regression model: mean age <44.5 years, presence of left sternocleidomastoid TrP, presence of suboccipital TrP, presence of left superior oblique muscle TrP, cervical rotation to the left > 69°, total tenderness score <20.5, NDI <18.5, referred pain area of right upper trapezius muscle TrP >42.23. Conclusions.— The current clinical prediction rule may allow clinicians to make an a priori identification of women with TTH who are likely to experience short‐term self‐report improvement with a multimodal session including joint mobilizations and TrP therapies. Future studies are necessary to validate these findings.