The purpose of this pilot study was to determine the possible effect of chiropractic manipulation and combined chiropractic manipulation and manual traction in subjects with tension-type headache. The study was a randomized, comparative clinical trial, without placebo control, conducted at the Technikon Natal Chiropractic Day Clinic. Thirty patients presenting with tension-type headache were selected following a case history, relevant physical examination, and radiological examination (if deemed clinically necessary). The patients were randomly allocated to two groups of 15 each. Treatment in group A consisted of chiropractic manipulation only. Treatment in group B consisted of chiropractic manipulation combined with manual traction. Patients were treated a maximum of nine times within a 4-week treatment period. A follow-up examination was conducted 1 month after the treatment period. Subjective findings were recorded with the Short-Form McGill Pain Questionnaire, the CMCC Neck Disability Index, the Numerical Pain Rating Scale, and a Headache Diary. Objective findings consisted of the six cervical ranges of motion obtained by means of a cervical goniometer. Both group A and group B demonstrated a statistically significant decrease in measures for the Short-Form McGill Pain Questionnaire and the Numerical Pain Rating Scale. Furthermore, a statistically significant improvement was noted for all the Headache Diary measures for group A, but none for group B. The objective measures did not show any significant changes. Final treatment comparisons revealed that group A had significantly reduced headache intensity and frequency compared to group B, while other results showed no difference. The statistical results suggest that group A had some advantage over group B, but the final interpretation of the results proposes that both treatments have a positive and equal effect. Assessment of the clinical relevance, based on intragroup effect size, reveals that group A appeared to have had a greater clinical effect than group B. This suggests that the combined approach yields no better results than chiropractic manipulation alone.

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