OBJECTIVE: The purpose of this study was to investigate the effects of instrument-assisted soft tissue mobilization (IASTM) and lidocaine phonophoresis combined or separated on trigger points in patients with tension-type headache (TTH). METHODS: A double-blind randomized trial. A total of 60 participants with TTH were randomized into 4 equal groups. All groups received conventional treatment at the National Institute of Neuromotor System. Group A received conventional treatment only; group B received IASTM; group C received lidocaine phonophoresis; and group D received IASTM and phonophoresis. Visual analog scale (VAS), Arabic neck disability index (ANDI), headache frequency, and pressure pain threshold (PPT) were among the outcome measurements. All variables were measured before treatment and 4 weeks post-treatment. RESULTS: Within the group's analysis, multiple pairwise comparison tests revealed improvements at all measurement variables (p < 0.01) in all groups. Post-treatment, results showed a significant difference in groups D versus group A, groups B, and C with mean difference (MD) and 95% CI in VAS (3.18 (2.379 to 3.981), 1.133 (0.332 to 1.935), and 1.907 (1.105 to 2.708) respectively), ANDI (10.267 (8.382 to 12.151), 4.2 (2.316 to 6.084) 7 (5.116 to 8.884) respectively), headache frequency (1.9 (1.246 to 2.554), 0.8 (0.146 to 1.454), and 1.4 (0.764 to 2.054) respectively), and PPT. Additionally, there was a significant difference in all variables between group A and group B with MD in VAS, ANID, and headache frequency (2.047, 6.067, and 1.1 respectively) in favor of group B. Moreover, there was a statistically significant difference between group A and group C in VAS, ANDI, and PPT of left the suboccipital muscles on the side of group C. In group B versus group C, there was a statistically significant difference in ANDI and PPT of the left upper fibers of the trapezius muscles as p < 0.05 in favor of group B. CONCLUSION: Both conventional treatments, IASTM, lidocaine phonophoresis, and the combination of IASTM and phonophoresis had statistically significant effects in relieving pain, increasing neck functional ability, decreasing headache frequency, and improving PPT in participants with TTP. Adding IASTM and lidocaine phonophoresis to conventional treatment was more effective than the other treatments.
Reprinted from the Journal of Manipulative and Physiological Therapeutics with copyright permission from the National University of Health Sciences.

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