Neck Exercises Versus Myofascial Release for Chronic Tension-Type Headache and Posture: A Randomized Controlled Trial Protocol

Introduction: Tension-type headache (TTH) is the most common type of headache worldwide, causing significant psychological, physical, financial, and societal consequences. One of the activating factors of chronic TTH (CTTH) is cervical dysfunction, such as forward head posture (FHP), leading to suboccipital muscle tenderness and deep neck flexor (DNF) muscle weakness. Physiotherapy affects these patients through two mechanisms: Top-down (e.g. DNF exercises) and bottom-up (e.g. suboccipital myofascial release [MFR]), but their relative effectiveness in reducing headache-related parameters remains unclear. Materials and Methods: This randomized, parallel-group, assessor-blind, double-dummy clinical trial included 44 participants divided into two groups: One receiving MFR with sham exercise and the other receiving DNF exercises with sham MFR. Interventions were performed over four weeks, followed by a six-week follow-up. The primary outcomes were headache intensity and craniovertebral angle (CVA), while the secondary outcomes were headache frequency, duration, pressure pain threshold (PPT), disability and quality of life. Results: After the trial's completion, all collected data will undergo statistical analysis and subsequently be published in international, high-impact factor, related journals. In addition, the findings will be presented at neurology or physiotherapy conferences. Conclusion: This study compares the effectiveness of a top-down versus a bottom-up physiotherapy approach in CTTH patients with FHP. If a significant difference is found, the study will identify the superior approach for short- and medium-term outcomes, providing valuable insights for clinicians and healthcare managers.