Added Value of Diaphragmatic Myofascial Release in the Management of Chronic Tension-Type Headache

INTERVENTION: Intervention 1: Intervention group: diaphragm release and suboccipital release: To release the diaphragm, the patient is positioned in the supine position. The therapist stands at the head of the patient. The therapist makes manual contact bilaterally under the costal cartilages of the lower ribs (7th to 10th ) with hypothenar regions of the hands and last three fingers. During the patient’s inspiration, the therapist is gently pulling the points of hands contacts toward the head and slightly laterally, while elevating the ribs simultaneously. During exhalation, the therapist deepens hand contacts towards the inner costal margins. The release technique is performed thrice a week for two weeks; each technique lasts for 5 to 7 minutes. All release techniques will be done by the same physiotherapist. For suboccipital release technique, the patient is asked to lie down in a relaxed supine position on the treatment table while the therapist sits on a chair at the head of the patient. The therapist's elbows are supported by the table, and their forearms are positioned in supination. The patient is then instructed to rest their head on the therapist's palms. Next, the therapist places the pads of four fingers of both hands on either side of the C2 vertebra, just below the occipital region, and applies pressure until a melting sensation is felt. The intervention lasts four minutes. During this technique, the patient is asked to close both eyes to prevent eye movements, which could affect the tone of the sub occipital muscles. This technique is performed three times a week for two weeks for each patient in this group. Intervention 2: Intervention group: For suboccipital release technique, the patient is asked to lie down in a relaxed supine position on the treatment table whil CONDITION: G44.2 tension‐type headache. ; Tension‐type headache PRIMARY OUTCOME: Headache frequency. Timepoint: 4 weeks before intervention, 1 week after intervention period. Method of measurement: interview and headache records. Pain intensity. Timepoint: before intervention, after intervention period. Method of measurement: numerical pain rating scale. Quality of life. Timepoint: before intervention, 1 week after intervention. Method of measurement: headache disability index. INCLUSION CRITERIA: Age range: 18 to 40 years Headache lasting from 30 min to 7 days. 3. At least two of the following pain characteristics:1. Bilateral location2. Pressing or tightening (non‐pulsating) quality 3. Mild or moderate intensity 4. Not aggravated by routine physical activity, such as walking or climbing stairs People with CTTH who had headache for at least 3 days in a week for the past four Consecutive weeks No nausea, vomiting (anorexia can occur) No more than one of photophobia or phonophobia not attributed to another disorder