The effectiveness of physical therapy in the treatment of chronic daily headaches

We investigated the adjunctive use of physical therapy, with the more standard modalities of medication and/or biofeedback-enhanced neuromuscular re-education, in patients with chronic daily headaches who had palpable muscle spasm in the neck and shoulder regions. Patients in group one received medication detoxification (when necessary), amitriptyline and (in some cases), biofeedback. Patients in group two received detoxification (when necessary), amitriptyline (in some cases) and physical therapy, including TENS (transcutaneous electrical nerve stimulation). Patients in group three received detoxification (when necessary), amitriptyline in (some cases), and TENS without other modalities of physical therapy. Patients in groups two and three, as judged by changes in Headache Index, showed a significantly faster and greater decline in headaches than patients in group one, and maintained this excellent relief through the six month follow-up period. From a biochemical perspective, this improvement may be related to the demonstrable increase in serotonin levels that attends TENS. From a behavioural perspective, improvement may be related to the change in "locus of control" from the headache to the patient that attends the more "active" modalities of TENS and physical therapy, as opposed to the more "passive" modality of medication alone.