Combination of Physiotherapy, Acupuncture Boosts Analgesia in Tension-Type Headache

doctor holding acupuncture needle
doctor holding acupuncture needle
Acupuncture with stretching was compared with acupuncture, stretching, and physiotherapy in individuals with tension-type headache.

Patients with tension-type headache (TTH) experience benefits from acupuncture and stretching, especially in combination with pressure pain threshold (PPT) physiotherapy hands-on techniques, according to a new study conducted in Athens, Greece.

The researchers undertook the study because, despite “weak to moderate evidence,” nonpharmacologic therapies for TTH and cervicogenic cephalalgia remain a treatment choice for many patients. Therefore, they sought to compare the effectiveness of the 2 alternative therapies. They compared an acupuncture/stretching protocol with an acupuncture/stretching plus physiotherapy technique in patients with TTH. The results of the study were published in Physiotherapy Research International.

The researchers studied 44 participants with headache who were randomly assigned to one of 2 treatment groups: the control group consisting of only acupuncture/stretching (n=20) and the experimental group, consisting of acupuncture/stretching plus physiotherapy (n=24). Participants completed 10 treatment sessions within 4 weeks, with measurements taking place before treatment, after the fifth treatment, and after the tenth treatment.

The main outcome measured was change in the mechanical PPT assessed using a mechanical algometer to measure 7 bilateral somatic points.

Acupuncture in both groups included 17 to 20 acupuncture points, while stretching was initially taught and subsequently self-administered (self-stretches) following a standardized set of movements of the cervical spine. Physiotherapy consisted of microwave diathermy and myofascial release with hands-on techniques.

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Improvements were observed in both groups for both treatments regarding the main outcome measure PPT, from the first to fifth and the tenth treatment, at all measuring sites and at all measurements (P <.001). When the 2 groups were compared, differences were noted after the tenth treatment (P <.05).

The researchers stated that the additive role of myofascial release and diathermy to acupuncture was further shown on PPT, both at the treating and the control sites, thereby identifying the central pain mechanisms of TTH.

“In clinical terms, a combination of myofascial release techniques/diathermy with acupuncture and stretching [is strongly suggested] to further improve the analgesic effect [both for PPT and clinical pain measures],” the authors concluded.


Georgoudis G, Felah B, Nikolaidis P, Damigos D. The effect of myofascial release and microwave diathermy combined with acupuncture versus acupuncture therapy in tension-type headache patients: a pragmatic randomized controlled trial [published online December 20, 2017]. Physiother Res Int. doi: 10.1002/pri.1700