Neck-Shoulder Region Training for Chronic Headache in Women: A Randomized Controlled Trial

Clin Rehabil. 2023 Oct;37(10):1322-1331. doi: 10.1177/02692155231170687. Epub 2023 Apr 25.


Objectives: We investigated whether a specific exercise program for the neck-shoulder region reduces headache intensity, frequency, and duration, and how it influences neck disability among women with chronic headache compared to a control group.

Design: Two-center randomized controlled trial.

Subjects: 116 working-age women.

Intervention: The exercise group (n = 57) performed a home-based program with six progressive exercise modules, over 6 months. The control group (n = 59) underwent six placebo-dosed transcutaneous electrical nerve stimulation sessions. Both groups performed stretching exercises.

Main measures: The primary outcome was pain intensity of headache, assessed using the Numeric Pain Rating Scale. Secondary outcomes were frequency and duration of weekly headaches, and neck disability assessed using the Neck Disability Index. Generalized linear mixed models were used.

Results: Mean pain intensity at baseline was 4.7 (95% CI 4.4 to 5.0) in the exercise group and 4.8 (4.5 to 5.1) in the control group. After 6 months the decrease was slight with no between-group difference. Headache frequency decreased from 4.5 (3.9 to 5.1) to 2.4 (1.8 to 3.0) days/week in the exercise group, and from 4.4 (3.6 to 5.1) to 3.0 (2.4 to 3.6) in the control group (between-group p = 0.017). Headache duration decreased in both groups, with no between-group difference. Greater improvement in the Neck Disability Index was found in the exercise group (between-group change -1.6 [95% CI -3.1 to -0.2] points).

Conclusion: The progressive exercise program almost halved headache frequency. The exercise program could be recommended as one treatment option for women with chronic headache.

Keywords: exercise; headache; neck disability; randomized controlled trial; strength; training; women.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Chronic Pain* / therapy
  • Exercise Therapy
  • Female
  • Headache
  • Headache Disorders* / therapy
  • Humans
  • Neck Pain / therapy
  • Shoulder
  • Treatment Outcome