DISCUSSION
The objective of this study was to preliminarily examine the effects of the court-type traditional Thai massage on CTTH patients. The results indicated a significantly decrease in the intensity of headaches after the massage sessions. This finding is in agreement with Kruapanich et al. [18]. They tested the effectiveness of traditional Thai massage as compared to rest (sleep) in the treatment of headaches, discovering that the former could reduce the intensity of headaches by 1.84 while the latter did not lead to any recognizable degree of intensity alleviation. However, it should be noted that the degree to which traditional Thai massage in Kruapanich et al. [18] that can bring down headache intensity is lower in comparison with the court-type traditional Thai massage in this research. This is probably because of the differences in the massage sites on the body and position of the patients being massaged between the two types of massage therapy. The present findings also lend credence to Wattakeecharoen [19], Udompittayason [20], and Meechana [21].
Although the mechanism of pain reduction in CTTH that resulted from Court-type Traditional Thai Massage has not been well understood, he results of previous study suggested that the patients with cervical spondylosis who were treated with Court-type Traditional Thai Massage has decreased headache frequency and increase the CROM, reduce pain intensity, increase pain threshold and also has been well linked to improving blood circulation, consistent across the studies of Eungpinichpong [22, 23]. In addition, it is possible that Court-type Traditional Thai Massage may reduce headache as a result of releasing muscle tension of the neck and shoulder girdle that produce referred pain to the head. Since the patients in this were chronic type of TTH, they could have myofascial trigger points that may produce referred pain to the head and neck. The Court-type Traditional Thai Massage that applied for the patients may deactivate those trigger points resulting in pain reduction [24].
As regards the CROM, the court-type traditional Thai massage could enhance flexion, extension, left-lateral flexion, and right-lateral flexion at statistically significant degrees, a finding in line with that of Kruapanich et al. [18], Sooktho [24], and Puusjarvi [25]. The improvement in the CROM is likely to result from the effectiveness of this kind of therapy in alleviating fascia and promote muscle flexibility [22]. The high pressure of court-type traditional Thai massage directly on the target muscles and trigger points stimulate peripheral receptors resulting in the decreasing of alleviating fascia and improving muscle flexibility [26]. Therefore, the CROM outcomes, before and after treatment, were totally different as shown in Table 2.
It can be concluded from the results of the present study that the court-type traditional Thai massage can be effective in treating CTTH patients. Further research should be conducted on a larger sample with a control. Additionally, follow-ups should be carried out in order to monitor the effects of this therapy in the long-run. Finally, it is advisable to conduct research along this line that examines other dependent variables than headache intensity and the CROM.