Effects Of Cervical Muscle Strengthening Exercises On Neck Muscle Function, Tenderness, Headache Intensity, And Disability In Patients With Chronic Tension-Type Headache: A Randomized Controlled Trial
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Background: Chronic tension-type headache is frequently associated with cervical muscle dysfunction, increased muscle tenderness, restricted cervical mobility, and headache-related disability. Although physiotherapy is commonly used in conservative headache management, the added value of structured cervical strengthening-centered rehabilitation requires further clarification. Objective: To determine the effects of cervical muscle strengthening exercises on neck muscle function, muscle tenderness, headache intensity, headache frequency, cervical range of motion, and headache-related disability in adults with chronic tension-type headache. Methods: This two-arm randomized controlled trial included 60 participants with chronic tension-type headache who were allocated to an experimental group receiving a structured cervical strengthening-centered rehabilitation program or a control group receiving conventional physiotherapy. Both interventions were delivered three times weekly for eight weeks. Outcomes included cervical flexor and extensor strength, pressure pain threshold, Visual Analogue Scale score, monthly headache frequency, cervical range of motion, and Headache Impact Test-6 score. Data were analyzed using mixed-design repeated-measures ANOVA. Results: The experimental group demonstrated greater improvements than the control group across all outcomes. Cervical flexor strength increased by 5.6 kg, cervical extensor strength by 5.9 kg, pressure pain threshold by 1.6 kg/cm², cervical range of motion by 38.5°, while headache intensity decreased by 4.2 points, headache frequency by 10.2 days/month, and HIT-6 score by 12.8 points. All group × time interaction effects were statistically significant. Conclusion: Structured cervical strengthening-centered rehabilitation produced greater short-term improvements than conventional physiotherapy in muscle function, tenderness, headache symptoms, cervical mobility, and disability among adults with chronic tension-type headache.
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1. Olesen J. The international classification of headache disorders: history and future perspectives. Cephalalgia. 2024;44(1):03331024231214731.
2. Lee HJ, Cho SJ, Seo JG, Schytz HW. Update on tension-type headache. Headache Pain Res. 2024;26(1):38-47.
3. Wang C, Liao C, Liu Y, Chen P, Xie Y, Tian L. Global burden trends of tension-type headache, 1990-2021: socio-demographic patterns, age-period-cohort effects, and frontier analysis from the GBD 2021 study. Front Neurol. 2025;16:1629025.
4. Khalil S, Saleem KK, Ishfaq N, Wahid E, Ahmad S. Prevalence of neck pain and its association with smartphone usage among Doctor of Physical Therapy students in Peshawar: a cross-sectional study.
5. Stovner LJ, Nichols E, Steiner TJ, Abd-Allah F, Abdelalim A, Al-Raddadi RM, et al. Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018;17(11):954-76.
6. Bendtsen L, Fernández-de-la-Peñas C. The role of muscles in tension-type headache. Curr Pain Headache Rep. 2011;15(6):451-8.
7. Repiso-Guardeño Á, Moreno-Morales N, Labajos-Manzanares MT, Rodríguez-Martínez MC, Armenta-Peinado JA. Does tension headache have a central or peripheral origin? Current state of affairs. Curr Pain Headache Rep. 2023;27(11):801-10.
8. Hong Y, Kang MK, Chu MK, Cho SJ, Im HJ. Cluster headache characteristics and the severity of obstructive sleep apnea: insights from polysomnography analysis. Headache Pain Res. 2024;25(1):63-71.
9. Fernández-de-Las-Peñas C, Cuadrado ML. Physical therapy for headaches. Cephalalgia. 2016;36(12):1134-42.
10. Ahmed A, Baig N, Zain-ul-Abedin UKS. Effects of physical therapy-based management approaches for tension type headache. Pak J Rehabil. 2024;13(1):6-16.
11. Onan D, Arıkan H, Ekizoğlu E, Taşdelen B, Özge A, Martelletti P. The efficacy of physiotherapy approaches in chronic tension-type headache: a systematic review and meta-analysis. J Oral Facial Pain Headache. 2025;39(1):34.
12. Quilghini C, Lefflot J, Buchholtz K. The effectiveness of physiotherapy for chronic headaches in patients with temporomandibular disorders: a systematic review. Front Rehabil Sci. 2025;6:1647927.
13. Madsen BK, Søgaard K, Andersen LL, Tornøe B, Jensen RH. Efficacy of strength training on tension-type headache: a randomised controlled study. Cephalalgia. 2018;38(6):1071-80.
14. Saeterbakken AH, Nordengen S, Andersen V, Fimland MS. Nordic walking and specific strength training for neck and shoulder pain in office workers: a pilot study. Eur J Phys Rehabil Med. 2017;53(6):928-35.
15. Padrós-Augé J, Schytz HW, Søgaard K, Donat-Roca R, Espí-López GV, Madsen BK. Strength training and posture correction of the neck and shoulder for patients with chronic primary headache: a prospective single-arm pilot study. J Clin Med. 2025;14(15):5359.
16. Padrós-Augé J, Espí-López GV, Schytz HW, Søgaard K, Donat-Roca R, Olsen HB, et al. Effects of strength training on neck muscle function and tenderness in patients with chronic headache: a secondary analysis of a clinical trial. J Clin Med. 2025;14(20):7364.