OBJECTIVE: This study aimed to assess the effects of single and multiple massage treatments on pressure-pain threshold (PPT) at myofascial trigger points (MTrPs) in people with myofascial pain syndrome expressed as tension-type headache. DESIGN: Individuals (n = 62) with episodic or chronic tension-type headache were randomized to receive 12 twice-weekly 45-min massage or sham ultrasound sessions or wait-list control. Massage focused on trigger point release (ischemic compression) of MTrPs in the bilateral upper trapezius and suboccipital muscles. PPT was measured at MTrPs with a pressure algometer pre and post the first and final (12th) treatments. RESULTS: PPT increased across the study timeframe in all four muscle sites tested for massage, but not sham ultrasound or wait-list groups (p < 0.0001 for suboccipital; p < 0.004 for upper trapezius). Post hoc analysis within the massage group showed (1) an initial, immediate increase in PPT (all p values < 0.05), (2) a cumulative and sustained increase in PPT over baseline (all p values < 0.05), and (3) an additional immediate increase in PPT at the final (12th) massage treatment (all p values < 0.05, except upper trapezius left, p = 0.17). CONCLUSIONS: Single and multiple massage applications increase PPT at MTrPs. The pain threshold of MTrPs have a great capacity to increase; even after multiple massage treatments additional gain in PPT was observed.

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