ORIGINAL ARTICLE Efficacy of manual therapy on anxiety and depression in patients with tension-type headache. A randomized controlled clinical trial Gemma Victoria Espı ´-Lo ´pez a, *, Laura Lo ´pez-Bueno a , M.Teo´filaVicente-Herrero b , Francisco M. Martinez-Arnau a , Lucas Monzani c a Physiotherapy Department, University of Valencia, Spain b Occupational Health Service, Correos Group of Valencia, Spain c Richard Ivey Business School at Western Ontario University, Ontario, N6G 0N1, Canada Received 16 June 2015; revised 23 May 2016; accepted 31 May 2016 KEYWORDS Efficacy; Manual therapy; Tension-type head- ache; Depression; Anxiety; Spinal manipulation Abstract Introduction: Tension-type headache (TTH) is a highly prevalent disor- der with a significant socio-economic impact. The purpose of this study was to test the efficacy of three manual therapy treatments for reducing TTH-related anxiety and depression. Subjects and methods: A clinical trial was conducted on 84 participants diag- nosed with tension-type headache forming 4 groups: the first group received sub- occipital soft tissue treatment (ST); the second group was treated with articulatory techniques (AT); the third group underwent a combination of both techniques (ST and AT), while the fourth group was the control group. Treatment sessions were administered over four weeks, with post-treatment assessment, and follow-up at one month. We conducted repeated measures analysis of covariance (RM-MANCOVA) to evaluate the effect of treatment on between and within-subject conditions and their interaction on reported depression and anxiety. * Corresponding author. Physiotherapy Department, University of Valencia, C/ Gasco ´ Oliag 5, 46010 Valencia, Spain. Tel.: þ34 963983853; fax: þ34 963983852. E-mail addresses: gemma.espi@uv.es (G.V. Espı ´-Lo ´pez), laura.lopez@uv.es (L. Lo ´pez-Bueno), MTVH@ono.com (M.T. Vicente- Herrero), francisco.m.martinez@uv.es (F.M. Martinez-Arnau), lmonzani@ivey.uwo.ca (L. Monzani). http://dx.doi.org/10.1016/j.ijosm.2016.05.003 1746-0689/ª 2016 Elsevier Ltd. All rights reserved. International Journal of Osteopathic Medicine (2016) xxx, xxxexxx www.elsevier.com/ijos Please cite this article in press as: Espı ´-Lo ´pez GV, et al., Efficacy of manual therapy on anxiety and depression in patients with tension-type headache. A randomized controlled clinical trial, International Journal of Osteopathic Medicine (2016), http:// dx.doi.org/10.1016/j.ijosm.2016.05.003