It has been suggested that not all patients with TTH would benefit from the same physical or manual therapy intervention. In fact, multiple studies have identified some prognostic variables to guide specific physical therapy interventions in patients with low back pain or neck pain.
Four studies have been conducted in a patient population with headache, 3 on cervicogenic headache and the last one in TTH. Niere found that a high frequency of attacks predicted a positive response of patients with cervicogenic headache to manipulative therapy. 18 Fleming
et al reported that age, provocation or relief of headache with movement, and being gainfully employed were all predictor factors that were found to be significantly related to improved outcomes in patients with cervicogenic headache 19 On the contrary, Jull et al tried to find those predictors which most likely to identify patients with cervicogenic headache who achieved a reduction of at least 50% on headache frequency, after a multimodal physical therapy program; however, the authors did not find a consistent pattern of variables. 20 The fourth one was a pilot study to try to identify patients with chronic TTH who experience a short-term success with after the application of a muscle trigger point (TrP) therapy treatment. 21 This study identified 4 variables for immediate short-term (headache duration < 8.5 hour/day, headache frequency < 5.5 days/week, bodily pain < 47, vitality < 47.5) and 2 variables for 1-month (headache
frequency < 5.5 days/week and bodily pain < 47) follow-up. 21 However, it should be considered that the application of solely TrP therapy may not be representative of usual clinical practice, as physical therapists usually apply a multimodal program for the management of patients with TTH.
Therefore, it would be of clinical utility to have guidance in selecting patients with TTH who may experience improved outcomes following a multimodal physical therapy program. Thus, the purpose of this study was to identify the prognostic factors for women with TTH likely to experience self-perceived clinical improvements following the application of a multimodal session of physical therapy including joint mobilization and muscle TrP therapies.