SHORT-WAVE DIATHERMY IN THE REHABILITATION MANAGEMENT OF TENSION-TYPE HEADACHE ASSOCIATED WITH NECK PAIN: A CASE CONTROL STUDY

A. Picelli¹, D. Lorenzoni Inama¹, C. Angeli¹, T. Malgrati¹, M. Cappellesso¹, M.C. Schiavariello¹, V. Schweiger², A. Martini², N. Smania¹, M. Filippetti¹ | ¹Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; ²Center for Anesthesiology, Intensive Care and Pain Therapy, Department of Surgery, University of Verona

INTRODUCTION
Tension-type headache is the most common neurological disorder worldwide and is often associated with neck pain. Cervical musculoskeletal dysfunctions are frequently observed in this patients, suggesting a potential role for physical rehabilitation. Short-wave diathermy (SWD) is a deep-heating technique known to raise pain thresholds, reduce muscle spasms, and improve soft tissue flexibility. This single-center retrospective case-control study aims to evaluate the effectiveness of SWD as an adjunct to conventional rehabilitation in adults with tension-type headache and neck pain.
MATERIALS AND METHODS
The study was conducted at the Neurorehabilitation Unit of the University of Verona. The study population consisted of 42 adults with persistent tension-type headache and neck pain. Participants were divided into two groups. SWD was administered using the ProNexibus Plus® device (focusMED srl, Montegrotto Terme, Italy). The case group received 20 minutes of short-wave diathermy and 20 minutes of myofascial release (pompage), while the control group underwent 20 minutes of pompage followed by 20 minutes of therapeutic neck exercises. Both groups completed a total of 10 rehabilitation sessions, each lasting 45 minutes, for 5 weeks. Inclusion criteria were: age ≥18 years; persistent headache associated with neck pain for more than 8 weeks at the time of inclusion; pain intensity ≥2 on the Numerical Pain Rating Scale (NPRS); and stable pharmacological treatment. Exclusion criteria included: participation in other clinical trials; diagnosed specific causes of headache or cervical pain (e.g., trauma, rheumatic or systemic disorders); presence of central or peripheral neurological signs; cognitive impairment; prior cervical spine surgery; and known or suspected disorders affecting sensory or vascular pathways (e.g., migraine, hypertension). Patients were evaluated at two time points: before treatment (T0) and one week after the completion of the intervention (T1). The primary outcome of the study was pain intensity, measured using the NPRS. Secondary outcomes included disability, assessed with the Neck Disability Index (NDI) and the Pressure Pain Threshold (PPT). Statistical analysis was performed by an independent statistician using the Statistical Package for the Social Sciences (SPSS) for Macintosh, version 27.0 (IBM Corp., Armonk, NY, USA). The level of statistical significance was set at P <0.05.
RESULTS
After treatment, the Case group showed significantly greater improvements compared to controls in neck pain (P=0.03) and disability (P=0.04). No significant between-group differences were observed in pressure pain threshold measurements at cervical sites.
CONCLUSIONS
Preliminary findings suggest that short-wave diathermy may serve as a useful adjunct when added to conventional rehabilitation programs of adults with tension-type headache associated with neck pain. Larger randomized controlled studies are needed to confirm these results.