Cognitive behavioral therapy plus physical therapy for adults with smartphone-related tension-type headaches

Effect of Cognitive Behaviour Approach on Subjects With Smartphone Addiction

This tests whether adding cognitive behavioral therapy to manual and corrective-exercise physical therapy helps adults with smartphone addiction reduce tension-type headache pain, improve posture, and raise pain pressure thresholds.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 40 (estimated)
• Ages: 19 Years to 34 Years
• Sex: All
• Sponsor: Badr University (Academic / other)
• Locations: 1 site (Cairo, Cairo Governorate)
• Trial ID: NCT06631222 on ClinicalTrials.gov

What this trial studies

This interventional comparison assigns adults with smartphone addiction and tension-type headache to receive twelve treatment sessions over six weeks of either physical therapy alone (manual therapy, sub‑occipital inhibitory pressure, deep friction massage, spinal manipulation, and corrective exercises) or the same physical therapy plus cognitive behavioral therapy. Outcomes include headache intensity, forward head posture measurements, and pressure pain threshold assessed before and after the intervention. Sessions occur twice weekly with 48–72 hours rest between them. The trial enrolls participants aged 19–34 diagnosed with tension-type headache per International Headache Society criteria and with identifiable myofascial trigger points.

Who should consider this trial

Good fit: Adults 19–34 years old with International Headache Society–diagnosed frequent episodic or chronic tension-type headache, smartphone addiction, and detectable myofascial trigger points are the intended participants.

Not a fit: People outside the 19–34 age range, those with other primary headache disorders (such as migraine), individuals with uncontrolled medical conditions, or those unable to attend twice-weekly in-person sessions are unlikely to benefit from this protocol.

Why it matters

Potential benefit: If successful, patients might experience fewer or less intense headaches, improved neck posture, and reduced muscle pain sensitivity.

How similar studies have performed: Cognitive behavioral therapy has demonstrated benefit for chronic headache management and behavioral overuse in other studies, but combining CBT with targeted manual therapy for smartphone-related tension-type headache is relatively novel.

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.

Where this trial is running

Cairo, Cairo Governorate

• the British University in Egypt — Cairo, Cairo Governorate, Egypt (Recruiting)

Study contacts

• Study coordinator: abeer abdelrahman, professor

Conditions Tension Type Headache; Smartphone Addiction