to Stuidy the Effect of Cognitive Behavior Threapy CBT on Smartphone Addiction Patients With Tension Type Headache

Official title

Effect of Cognitive Behaviour Approach on Subjects With Smartphone Addiction

Overview

The goal of this clinical trial is to learn if cognitive behavioral approach works to treat tension type headache in smartphone addiction in adults. The main questions it aims to answer are: Is there an effect of adding cognitive behavior approach to physical therapy (manual therapy, corrective exercise therapy) on pain pressure threshold, forward head posture and headache intensity in smartphone addiction patients with tension-type headache? Researchers will compare adding cognitive behavior approach to physical therapy (manual therapy, corrective exercise therapy) to see if cognitive behavior approach works to treat tension type headache in smartphone addiction than physical therapy alone. Participants will: All participants will receive twelve treatment sessions (twice per week) in a 6 weeks period with a rest period of 48 to 72 hour between them.

Interventions

• Behavioral cognitive behavioral therapy
  The therapeutic patient education (TPE) program was based on a biobehavioral approach and was divided into the following three parts: cognitive, operant, and respondent. The purpose of the TPE program was to modify erroneous beliefs about pain and disability, as well as to provide coping strategies and improve patient self-efficacy through a graded activity.
• Other sub-occipital inhibitory pressure
  The suboccipital musculature will be palpated until contact is made with the posterior arch of the atlas, and progressive and deep gliding pressure was applied, pushing the atlas anteriorly. The occiput will be rested on the hands of the therapist while the atlas is supported by the fingertips. Finger pressure will be maintained for 10 minutes to produce the proposed therapeutic effect of inhibiting the suboccipital soft tissues.
• Other deep friction massage
  Friction massage is performed with the fingertips placed on the trigger points. Pressure was applied and the fingertips move in a circular manner, while the pressure is gradually increased. This massage will be applied until the patient report a reduction in pain at the trigger point
• Other Spinal manipulation
  This technique is performed along an imaginary vertical line passing through the odontoid process of the axis. No flexion or extension and very little lateral flexion will be used. Application will be bilateral. First, cephalic decompression will be performed lightly, followed by small circumductions. Selective tension will be applied to take up tissue slack and create a firm joint barrier. Manipulation is then performed with rotation towards the manipulated side in a helicoidal cranial movement
• Other Exercises for forward head posture
  Scapular stabilization exercises: 1. In quadruped position, the patient lift¬ up his arms alternatively with shoulder abduction and 120 ° flexion. 2. In sitting position, with 90° knee flexion on a stool or bed without backrest, patient hold a pair of dumb¬bells (2 kg) in each hand and lift them up laterally while maintaining scapulae's height below 80°. The patient was instructed to hold each stage for 10 seconds and then re-turn to the starting position and three sets of 10 repetitions with 3

Primary outcome measures

• pressure algometer [Time frame: from enrollment to nthe end of treatment at 6 weeks]

Secondary outcome measures (3)

• measurement of forward head posture [Time frame: from enrollment to nthe end of treatment at 6 weeks]
• Headache impact test [Time frame: from enrollment to nthe end of treatment at 6 weeks]
• The smartphone addiction scale short version [Time frame: from enrollment to nthe end of treatment at 6 weeks]

Eligibility criteria

Inclusion criteria

• Subjects were those diagnosed with tension type headache by neurologists based on the criteria of the International Headache Society.
• age between 19-34.
• International Headache Society diagnostic criteria of tension type headaches:
• Frequent ETTH or CTTH diagnosed, in both cases more than three months.
• Episodes of pain from 30 minutes to 7 days Fulfil 2 or more of the following characteristics:
• Bilateral location of pain.
• Non-pulsatile pain pressure.
• Pain mild to moderate.
• The headache does not increase with physical activity.
• The headache may be associated with pericranial tenderness.
• Controlled pharmacologically.
• Myofascial TrPs were bilaterally explored in upper trapezius, splenius capitis, sternocleidomastoid, masseter, superior oblique, levator scapulae and suboccipital muscles, TrP diagnosis was conducted following the diagnostic criteria:
• presence of a palpable taut band within a skeletal muscle.
• presence of a hypersensitive tender spot in the taut band.
• local twitch response elicited by snapping palpation of the taut band reproduction of the typical referred pain pattern of the TrP in response to compression.
• TrPs were considered active if both the local and the referred pain evoked by manual palpation reproduced total or partial pattern of the headache.
• Patients with FHP who have craniovertebral angle less than 49 degrees were included. Forward head posture is measured by calculating the angle between the horizontal line passing through C7 and a line extending from the tragus of the ear to C7.
• patients with smartphone addiction who will score 31 for males and 33 for females on smartphone addiction scale - short version.

Exclusion criteria

• rheumatoid arthritis.
• suspected malignancy.
• pregnancy.
• if they had received manual therapy treatment in the 2 months before enrolment into the study.
• Patients with infrequent episodic tension type headache, or with probable frequent and infrequent forms of tension type headache or other concomitant headache.
• They can never have vomiting or headache episodes during the treatment.
• Episodic tension type headache patients may experience very occasionally photophobia or phonophobia during their episodes of headache.
• Chronic tension type headache patients may experience very occasionally photophobia, phonophobia or mild nausea during headache episodes.
• Pain aggravated by movement of the head.
• Metabolic or musculoskeletal problems with similar headache symptoms.
• Previous trauma to the cervical spine.
• Active vertigo history.
• Poorly controlled hypertension.
• Atherosclerosis.
• Advanced osteoarthritis.
• Patients undergoing pharmacological adaptation or changes in the prophylactic medication.
• Excessive emotional stress.
• Patients with heart devices.
• Joint instability.
• Neurological disorders.
• Laxity of cervical soft tissues.
• Radiographic abnormalities.
• Generalized hyperlaxity or hypermobility.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Double blind

Primary purpose

Treatment

Study locations

Egypt · 1 center

• the British University in Egypt — Cairo

Identifiers

NCT: NCT06631222 · P.T.REC/120/005099

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗