Introduction:

Although headaches can be due to a wide variety of causes, such as drug reactions, temporomandibular joint dysfunction, tightness in the neck muscles, low blood sugar, high blood pressure, stress and fatigue, the majority of recurrent headaches, known as primary headaches are of two types: tension headaches (cervicogenic headaches) and migraine headaches.

Discussion:

Headache disorders, especially migraine and tension-type headache, not only result in severe individual burden but also have serious socioeconomic impact. High costs for the health care system as well as reduced work capacity and impairments in social life indicate the relevance of these headache disorders.

Increasing headache frequency in migraine or tension-type headache leads to chronic headache, which is by definition, headache on more than 15 days per month.  Frequent headache increases the risk of frequent intake of analgesics, which may result in medication-overuse headache.

It has been postulated that tension-type headache related pain may originate, to some extent, from muscle trigger points (TrPs) located in head, neck and shoulder muscles.  Myofascial  TrPs are usually defined as the hypersensitive spots in a band of a skeletal muscle that elicit pain upon examination in areas distant to the area examined (referred pain).  In tension-type headache, active TrPs are those that reproduce pain symptoms similar to those the patient perceives during their headache attacks.  Different studies have demonstrated the relevance of active TrPs in adults with chronic tension-type headache.  In fact, a series of studies reported that the referred pain elicited by active TrPs in suboccipital muscles (muscles at the base of the skull), upper trapezius (nape of the neck), temporalis (above the ear surrounding the temple), and sternocleidomastoid (large muscle on the side of the neck) muscles reproduced the head pain pattern commonly seen in patients suffering from tension headaches.  This research supports the use of manual therapy techniques such as muscle and joint mobilization and manipulation in the treatment of the most common of all headache disorders.