This study aimed to determine the effectiveness of the court-type traditional Thai massage (CTTM) in treating patients suffering from chronic tension-type headaches (CTTHs) in comparison with amitriptyline. Assessment was conducted at week 2, week 4, and week 6 follow-up for both the CTTM group and the control group. The outcome measures involved visual analog scale (VAS), tissue hardness, pressure pain threshold (PPT), and heart rate variability (HRV).
The headache pain intensity scores reduced from baseline at week 2, week 4, and week 6 follow-up for both the CTTM group and the control group. In terms of the VAS, a comparison between the two groups indicated statistically significant differences for all assessment time points. Such a decline in headache pain intensity may be explained in terms of physiological effects. Specifically, TTM involves stimulating blood and lymph circulation as well as the sympathetic nervous system through exerting pressure on the skin and muscles. As a result, the flow of nutrients to tissues is enhanced, and the discretion of toxins and residual substances inside the body improves, thereby reducing swelling and pain [11]. Another possible reason lies in the gate control theory. TTM essentially involves the exertion of pressure on the skin and muscles, thereby stimulating pressure receptors and inhibiting the transmission of pain receptors at the spinal cord or the “gate” [12–14]. Finally, TTM may relieve muscle tension by freeing the mind from stress and anxiety.
The results were consistent with Chatchawan and colleagues [20] on the effects of Thai traditional massage on pressure pain threshold and headache intensity in patients with chronic tension-type and migraine headaches. Seventy-two participants who had had a headache diagnosis for at least 3 months before the experiment were recruited and randomly allocated in either a massage group or a control group (medication). After the treatment, and at 3 and 9 weeks of follow-up, in both groups, headache intensity decreased significantly (). However, they found no significant differences between the groups (). Similar findings were also reported elsewhere. Kanji and colleagues [21] determined efficacy of regular sauna bathing for chronic tension-type headache and found headache intensity significantly differed between the sauna and control group by 1.27 ().
A comparison of the effectiveness in reducing tissue hardness within-group means for tissue hardness of the CTTM group and the control group at baseline, week 2, week 4, and week 6 follow-up indicated a significant decline for both the groups ().
When the CTTM group and the control group were compared at each assessment time point, it was found that the two groups differed significantly at week 4 () with the tissue hardness value for the former being lower than that of the latter. In addition, tissue hardness generally reduced for both the groups at all assessment time points. All this seems to point to the effectiveness of CTTM in improving tissue hardness and the superiority of CTTM over amitriptyline when a series of massage treatment is administered.
Similar findings are also reported elsewhere. Zheng et al. [22] evaluated the therapeutic effectiveness of lumbar tender point deep massage in treating chronic nonspecific low back pain. They found that the increase in muscle hardness after the treatment was statistically significant () [23].
A comparison of the effectiveness in increasing pressure pain threshold within-group means of the CTTM group and the control group assessed at baseline, week 2, week 4, and week 6 follow-up indicated a significant increase in PPT at all assessment time points for both the groups (). When the CTTM group and the control group were compared, it was found that the two groups differed significantly at all assessment time points () with the mean difference equaling 0.28, 0.35, 0.32, and 0.38, respectively. However, the figures did not exceed 1 (clinical significance set at 1 kg/cm2 or 2.2 lb/cm2) [24], demonstrating no clinically significant difference.
This research compares the effectiveness of CTTM and amitriptyline in treating CTTH patients. In terms of VAS the results showed a statistically significant decrease in headache pain intensity for the CTTM group at different assessment time points and a statistically significant difference between the CTTM group and the control group at each assessment time point. The superiority of CTTM over amitriptyline was also identified for other variables. As for tissue hardness, the value for the CTTM group was significantly lower than that of the control group at week 4, and the value for both the groups reduced at the other assessment time points, although not statistically significant. Additionally, the PPT of the CTTM group increased significantly and was significantly higher than that of the control group. Finally, the HRV of the CTTM group increased significantly in terms of