The possibility of using osteopathic correction in combination with psychotherapeutic techniques in the treatment of tension headaches

This article describes a case of successful combined treatment of chronic tension headache (CTH) in a 40-year-old female patient using osteopathic and psychotherapeutic correction. After experiencing a psychotraumatic situation (divorce), the patient first experienced episodes of headache that met the criteria for frequent episodic TTH according to the International Classification of Headache Disorders (ICHD-3). Over several months, there was a gradual increase in the frequency of attacks to 20 days per month with an intensity of 6–7 points on the VAS, which indicated the progression of the disease and allowed for the diagnosis of chronic TTH. An osteopathic examination revealed a number of somatic dysfunctions (SD), including global psychovisceral SD and regional SD in the head, neck, chest, pelvis, and dura mater. Given the incomplete relief of symptoms with pharmacotherapy and the pronounced affective background, non-drug treatment was performed, including osteopathic correction and cognitive-behavioral therapy. After two osteopathic and one psychotherapeutic sessions, significant improvement was noted: the frequency of headaches decreased to 1–2 episodes per month, global and regional SD regressed, the level of depression on the Beck scale decreased from 28 to 10 points, anxiety on the Spielberger scale decreased from 48 to 8 points for situational anxiety and from 46 to 10 points for personal anxiety. The results demonstrate the potential of a comprehensive non-pharmacological approach combining osteopathic correction and psychotherapy. The use of osteopathy as part of individualized therapy is consistent with the provisions of the current clinical guidelines for the treatment of tension headaches from the Russian Ministry of Health (2025), which emphasize the validity of including manual and psychotherapeutic methods in the presence of pronounced muscle-tonic and affective components characteristic of chronic tension headaches.

1. Ashina S., Mitsikostas D. D., Lee M. J. et al. Tension-type headache. Nat. Rev. Dis. Prim. 2021; 7 (1): 24. https://doi.org/10.1038/s41572-021-00257-2

2. GBD 2015 Neurological Disorders Collaborator Group. Global, regional, and national burden of neurological disorders during 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet Neurol. 2017; 16 (11): 877–897. https://doi.org/10.1016/S1474-4422(17)30299-5

3. Jensen R. H. Tension-type headache — the normal and most prevalent headache. Headache. 2018; 58 (2): 339–345. https://doi.org/10.1111/head.13067

4. Allena M., Steiner T. J., Sances G. et al. Impact of headache disorders in Italy and the public-health and policy implications: A population-based study within the Eurolight Project. J. Head. Pain. 2015; 16: 100. https://doi.org/10.1186/s10194-015-0584-7

5. Zebenholzer K., Andree C., Lechner A. et al. Prevalence, management and burden of episodic and chronic headaches: A cross-sectional multicentre study in eight Austrian headache centres. J. Head. Pain. 2015;16:531. https://doi.org/10.1186/s10194-015-0531-7

6. Osipova V. V. Tension-type headache in therapeutic practice. Spravochnik poliklinicheskogo vracha. 2012; 10: 70–73 (in russ.).

7. Lepekhina A. S., Pospelova M. L., Efimtsev A. Yu. et al. Tension-type headache: State of the problem, new aspects of etiopathogenesis, neuroimaging possibilities, non-drug treatment methods. Translyats. med. 2020; 7 (2): 6–11. https://doi.org/10.18705/2311-4495-2020-7-2-6-11 (in russ.).

8. Jensen R., Stovner L. J. Epidemiology and comorbidity of headache. Lancet Neurol. 2008; 7 (4): 354–361. https://doi.org/10.1016/S1474-4422(08)70062-0

9. Artemenko A. R., Osipova V. V., Filatova E. G. et al. Chronic primary headaches (diagnostics, clinical features, therapy): Methodological recommendations № 26. M.: Departament zdravookhraneniya g. Moskvy; 2014: 28 p. (in russ.).

10. Bendtsen L. Central and peripheral sensitization in tension-type headache. Curr. Pain Head. Reports. 2003; 7 (6): 460–465. https://doi.org/10.1007/s11916-003-0062-7

11. Osipova V. V. Pericranial muscle dysfunction in primary headache and its correction. Neurol., neyropsikhiat., psikhosom. 2011; 4: 29–35. https://doi.org/10.14412/2074-2711-2011-223 (in russ.).

12. Holroyd K. A., Martin P. R., Nash J. M. Psychological treatments of tension-type headache. The Headaches. (3rd ed.). Philadelphia: Lippincott Williams & Wilkins; 2005: 711–719. https://doi.org/10.1097/00004625-200511000-00001

13. Azimov Yu. E., Alferova V. V., Amelin A. V. et al. Tension-Type Headache: Clinical Guidelines. M.: Ministerstvo zdravookhraneniya RF; 2024: 56 p. (in russ.).

14. Jiang W., Li Z., Wei N. et al. Effectiveness of physical therapy on the suboccipital area of patients with tension-type headache: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2019; 98 (19): e15487. https://doi.org/10.1097/MD.0000000000015487

15. Falsiroli M. L., Geri T., Gianola S. et al. Effectiveness of trigger point manual treatment on the frequency, intensity, and duration of attacks in primary headaches: A systematic review and meta-analysis of randomized controlled trials. Front. Neurol. 2018; 9: 254. https://doi.org/10.3389/fneur.2018.00254

16. Cumplido-Trasmonte C., Fernández-González P., Alguacil-Diego I. M., Rodríguez-Antigüedad Z. A. Manual therapy in adults with tension-type headache: A systematic review. Neurología (Engl. Ed.). 2018; 33 (5): 297–306. https://doi.org/10.1016/j.nrleng.2018.01.006

17. Mokhov D. E., Belash V. O., Aptekar I. A., Nenashkina E. N., Potekhina Yu. P., Tregubova E. S., Belyaev A. F. Somatic dysfunction: Clinical guidelines. Russ. Osteopath. J. 2023; 2: 8–90. https://doi.org/10.32885/2220-0975-2023-2-8-90 (in russ.).

18. Spielberger C. D. Manual for the State-Trait Anxiety Inventory (STAI). Palo Alto: Consulting Psychologists Press; 1983.

19. Khanin Yu. L. Short guide to using spielberger′s state-trait anxiety inventory. L.: NII fiziologii; 1976 (in russ.).

20. Beck A. T., Ward C. H., Mendelson M. et al. An inventory for measuring depression. Arch. Gen. Psychiat. 1961; 4: 561–571. https://doi.org/10.1001/archpsyc.1961.01710120031004

21. Tarabrina N. V. Workshop on the psychology of post-traumatic stress. St. Petersburg: Piter; 2001: 224–229 (in russ.).

22. Yakhno N. N., Parfenov V. A., Danilov A. B. Headaches. M.: GEOTAR-Media; 2021: 145–150. https://doi.org/10.33029/9704-5544-5-GOL-2021-1-464 (in russ.).

23. Smirnov V. M., Frolov V. A. Osteopathy in the treatment of headache. M.: Meditsina; 2019: 78–82 (in russ.).