Immediate effects of sub-occipital muscle release combined with sustained natural apophyseal glides on pain, blood pressure, and cervical range of motion in patients with chronic tension-type headache

Abstract Objective: This study aimed to determine the immediate effects of sub-occipital muscle release combined with and without ‎sustained natural apophyseal glides on pain, blood pressure, and cervical ROM in the ‎management of chronic tension-type headache. Study Design: A Randomized Controlled Trial was conducted. Place and duration of study: The study was conducted at Fauji Foundation Hospital, Rawalpindi. Material and Methods: A randomized controlled trial was conducted at Fauji Foundation Hospital, Rawalpindi, ‎comprising 48 patients randomized into two groups.  The control group received conventional ‎physical therapy with suboccipital muscle release, whereas the interventional group received ‎additional sustained natural apophyseal glides. Numeric Pain Rating Scale (NPRS), blood pressure ‎‎(mm Hg), and cervical range of motion (ROM) were used as outcome variables. All measurements ‎were taken before and immediately after the intervention.‎ Results: The overall mean age of participants was 34.9 ± 11.0 years. Significant differences (p<0.05) were ‎observed within the two groups at baseline and after treatment in all variables. Significant ‎differences (p<0.05) were observed between the two groups at baseline, except for the Diastolic ‎BP, and cervical right lateral flexion (p>0.05) in which no significant results were obtained. A ‎significant difference (p<0.05) was observed between the two groups after treatment (p<0.05), ‎except for right and left lateral rotation (p>0.05) in which no significant results were obtained. ‎ Conclusion: ‎ Both conventional physical therapy with suboccipital muscle release and conventional physical ‎therapy, along with suboccipital muscle release and sustained natural apophyseal glides, are ‎effective. However, the latter approach is superior for managing chronic tension-type headaches, as ‎it provides better results in terms of pain relief, blood pressure regulation, and cervical range of ‎motion. ‎ Keywords: Blood Pressure, Chronic Tension-Type Headache, Pain, Suboccipital Muscle release, Sustained ‎Natural Apophyseal glides.‎