• Hector Beltran-Alacreu, Ibai Lopez-de-Uralde-Villanueva, and Roy La Touche.
• Department of Physiotherapy, Faculty of Health Science, The Center for Advanced Studies University La Salle, Autonomous University of Madrid, Madrid, Spain ; Research Group on Movement and Behavioural Science and Study of Pain, The Center for Advanced Studies University La Salle, Autonomous University of Madrid, Madrid, Spain ; Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain.
• Anesth Pain Med. 2015 Dec 1; 5 (6): e32697.

IntroductionTension-type headache (TTH) is the most common primary headache affecting the general population, which is characterized by bilateral headache and mild to moderate pain. This disorder causes high levels of disability and recent scientific evidence suggests that manual therapy (MT) and therapeutic exercise are effective in reducing medication intake and decreasing the frequency and intensity of headaches in patients with TTH.Case PresentationA 34-year-old woman was known to have chronic TTH. Initially, the patient presented moderate headaches 5 days per week, mechanical neck pain and no positive response to analgesics. A battery of self-reports was given to the patient to assess disability (using the Spanish versions of the Headache Impact Test-6 and the neck disability index), pain (visual analogue scale) and psychosocial issues (Spanish version of the pain catastrophizing scale) involved in the headaches. All measurements were taken four times during 161 days. Eleven sessions of treatment including MT, motor control therapeutic exercise (MCTE) and therapeutic patient education (TPE) were applied.ConclusionsThis biobehavioral-based multimodal physical rehabilitation treatment combining MT, TPE and MCTE produced a substantial reduction in pain intensity, pain catastrophizing, disability and the impact of headaches on patient's life.

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