Efficacy of manual therapy on anxiety and depression in patients with tension-type headache. A randomized controlled clinical trial

Introduction: Tension-type headache (TTH) is a highly prevalent disorder with a significant socio-economic impact. The purpose of this study was to test the efficacy of three manual therapy treatments for reducing TTH-related anxiety and depression. Subjects and methods: A clinical trial was conducted on 84 participants diagnosed with tension-type headache forming 4 groups: the first group received sub occipital soft tissue treatment (ST); the second group was treated with articulatory techniques (AT); the third group underwent a combination of both techniques (ST and AT), while the fourth group was the control group. Treatment sessions were administered over four weeks, with post-treatment assessment, and follow-up at one month. We conducted repeated measures analysis of covariance (RM-MANCOVA) to evaluate the effect of treatment on between and within-subject conditions and their interaction on reported depression and anxiety. Results: All treatments resulted in a 'moderate' reduction of psychological symptoms associated with TTH (Cohen's f =.31 for anxiety trait; f =.35 for anxiety state and f =.35 for depression). However, their efficacy varied across treatments, TTH types and the elapsed time between measurements. Conclusion: Treatments including an articulatory technique showed a greater efficacy than a soft tissue technique, or a combination of both, for the reduction of TTH-related anxiety and depression levels in these participants.