Effect of neuromuscular and Jones techniques on patients with bruxism and associated episodic and chronic tension headaches.

Intervention name: It is a non-drug intervention: „Effect of neuromuscular and Jones techniques in patients with bruxism and associated episodic and chronic tension headaches.“ Intervention Description: The study will include approximately 50 patients, which are going to be put by random allocation into two groups, the intervention group and control group. The control group will receive a sham treatment. Intervention applied to experimental group A: The researcher will identify the side that has the more sensitive temporal muscle to palpation and will deliver the interventions to that side. The neuromuscular technique, with the aim of inhibiting the spasms of the temporal muscles, is exercised with the patient in the supine position and the therapist seated at the head of the table. One hand of the therapist applies a pressure to the insertion of the temporal muscle. The other hand comes in contact with the belly of the temporal muscle with the tip of the thumb extended. Next a deep, slow massage is performed in longitudinal sliding the thumb along the temporal muscle. Three strokes are passed over the muscle. Once the neuromuscular technique is applied, the Jones technique is performed on the same temporal muscle. The Jones technique, with the objective of suppressing the gamma hyperactivity of the temporal muscle, is performed with the patient in the supine position and the therapist seated at the head of the table. For the left temporal muscle, for example, the left hand of the therapist locates with the index finger the trigger point of the left temporal muscle. The right hand is placed on the right side of the patient's face and grasps the chin with the fingers. To begin, the middle finger of the left hand will apply pressure on the sensitive point of the left temporal muscle, which in turn triggers pain. Secondly, the right hand holds on to the anterior aspect of the mandible, opens the mouth and creates a lateral stretch of the mandible to the right until the pain of the trigger point disappears. This position is maintained for 90 seconds. Then the jaw is brought slowly to the neutral position. For the right temporal muscle the procedure would be mirrored. Evaluation applied to experimental group A: - Location and signaling of the trigger point on the side of the more sensitive temporal muscle to palpation by the researcher - The blinded external evaluator takes the pre-intervention measures: o Craniocervical extension using the goniometer: The patient is sitting in an upright posture. The evaluator is standing next to the patient. The goniometer is placed at 90° with the axis on the external auditory canal. The fixed arm is aligned with the vertical midline of the head. The mobile arm is aligned with the nostrils. The patient is asked for a cervical extension. The measurement of the extension to be taken with fixed arm kept in place and mobile arm staying in line with the nostrils. o The opening of the mouth by the caliber: The measurement is taken with the patient in the supine position, the head in neutral position, the evaluator on the right side of the patient. The patient is asked to open his mouth to the fullest. The caliber is placed between the central and lower incisors to take the measurement. o The threshold of pain at the temporal area will be measured by the algometer: The patient is lying in the supine position and the assessor is seated at the head of the patient. The flat circular probe is pushed against the trigger point of the temporal muscle until the pain threshold is reached and measurement taken. All measurements are taken three times with the average of the three recorded. o The researcher will perform the neuromuscular technique on the affected muscle and the Jones technique for the affected temporal muscles as described above. o The blinded external evaluator will take the post-intervention measurements 1, immediately after performing the techniques: craniocervical extension, opening of the mouth and pain threshold to pressure o The blinded external evaluator will take the post-intervention measurements 2, three days after performing the technique: craniocervical extension, the opening of the mouth and the pain threshold to pressure Each patient will receive a single session of the intervention lasting approximately 5 minutes. The blinded external evaluator will enter the pre/post-intervention measurements in an excel spreadsheet. I, the researcher, will perform an audit of the results entered by the external evaluator.