Effect of suboccipital release versus instrument-assisted soft tissue mobilization on tension-type headache: a randomized controlled trial

Authors

  • Nada Gamal Saad PhD Candidate, Basic Sciences Department, Faculty of Physical Therapy, Cairo University, Physical therapy specialist, National Institute of Neuromotor System Giza, Egypt.
  • Neveen Abdel Latif Abdel Raoof Professor of Physical Therapy, Basic Science Department, Vice Dean for Education and Student Affairs, Faculty of Physical Therapy, Cairo University, Giza, Egypt.
  • Amr Azzam Consultant of Orthopedic Surgery, Former Dean of the National Institute of Neuromotor System, Giza, Egypt. ORCID ID: 0000-0003-1293-8752.
  • Nouran A. Ibrahim Lecturer of Physical Therapy, Basic Science Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt.
  • Rania Reda Mohamed Assistant Professor of Physical Therapy, Basic Science Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt.

DOI:

https://doi.org/10.47197/retos.v78.119027

Keywords:

Tension-type headache, suboccipital release, instrument-assisted soft tissue mobilization, physiotherapy, manual therapy

Abstract

Background: Tension- type headache is the most common form of primary headache disorder associated with increased muscle tension. This study aimed to compare the effects of suboccipital release and instrument-assisted soft tissue mobilization (IASTM) on tension-type headache. Methods: Fifty-six females with tension-type headache aged 20 - 40 years, with a body mass index ranging from 18.5 to 24.9, were randomly assigned to three groups. Group A (control) (n=18) received conventional physical therapy, including hot pack and exercise program. Group B (experimental) (n=19) received suboccipital release in addition to conventional physical therapy and Group C (experimental) (n=19) received IASTM in addition to conventional physical therapy. Outcome measures included pain intensity assessed by the Numeric Rating Scale, pressure pain threshold measured using a pressure algometer, headache-related impact assessed by the Headache Impact Test, cervical functional disability assessed by the Neck Disability Index, and headache frequency measured as the number of headache days per week. Measurements were recorded at baseline and after four weeks of treatment.

Results: MANOVA showed that Groups B and C had significantly better outcomes than Group A across all measures (P <0.001). No significant differences were found between Groups B and C in pain intensity, pressure pain threshold, impact of headache, and headache frequency. However, Group C showed greater improvement in neck functional ability compared with Group B (p=0.001).

Conclusion: Both suboccipital release and IASTM were associated with improvements in pain intensity, pressure pain threshold, impact of headache, and headache frequency in women with tension-type headache. IASTM showed greater improvement in neck functional ability.

Author Biographies

  • Nada Gamal Saad, PhD Candidate, Basic Sciences Department, Faculty of Physical Therapy, Cairo University, Physical therapy specialist, National Institute of Neuromotor System Giza, Egypt.

    PhD Candidate, Basic Sciences Department, Faculty of Physical Therapy, Cairo University, Physical therapy specialist, National Institute of Neuromotor System Giza, Egypt.

  • Neveen Abdel Latif Abdel Raoof, Professor of Physical Therapy, Basic Science Department, Vice Dean for Education and Student Affairs, Faculty of Physical Therapy, Cairo University, Giza, Egypt.

    Professor of Physical Therapy, Basic Science Department, Vice Dean for Education and Student Affairs, Faculty of Physical Therapy, Cairo University, Giza, Egypt.

  • Amr Azzam, Consultant of Orthopedic Surgery, Former Dean of the National Institute of Neuromotor System, Giza, Egypt. ORCID ID: 0000-0003-1293-8752.

    Consultant of Orthopedic Surgery, Former Dean of the National Institute of Neuromotor System, Giza, Egypt. ORCID ID: 0000-0003-1293-8752. 

  • Nouran A. Ibrahim, Lecturer of Physical Therapy, Basic Science Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt.

    Lecturer of Physical Therapy, Basic Science Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt.

  • Rania Reda Mohamed, Assistant Professor of Physical Therapy, Basic Science Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt.

    Assistant Professor of Physical Therapy, Basic Science Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt.

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Published

01-05-2026

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Vol. 78 (2026)

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Original Research Article

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Copyright (c) 2026 Nada Gamal Saad, Neveen Abdel Latif Abdel Raoof, Amr Azzam, Nouran A. Ibrahim, Rania Reda Mohamed

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How to Cite

Saad, N. G., Abdel Raoof, N. A. L., Azzam, A., Ibrahim, N. A., & Mohamed, R. R. (2026). Effect of suboccipital release versus instrument-assisted soft tissue mobilization on tension-type headache: a randomized controlled trial. Retos, 78, 934-947. https://doi.org/10.47197/retos.v78.119027