In the masterclass presented by René Castien, a physiotherapist and manual therapist, the focus is on understanding, diagnosing, and treating tension-type headaches (TTH). Castien discusses the epidemiology, diagnostic criteria, and pathophysiological models of TTH, emphasizing the importance of differentiating between episodic and chronic types based on frequency and duration of headaches. He explains that while imaging or blood tests are not necessary for diagnosis, physical assessments, such as evaluating pericranial muscle tenderness, can be useful. The interplay between TTH and neck pain is highlighted, with many patients experiencing comorbid neck issues. Castien also explores the mechanisms behind TTH, including peripheral and central sensitization, and the role of myofascial and central mechanisms in clinical assessments and therapy.

The masterclass further delves into the physical treatment options for TTH, underscoring the effectiveness of multidisciplinary approaches that include manual therapy, exercise, and pain education. Castien emphasizes the importance of a tailored physical treatment plan, as opposed to a one-size-fits-all approach, which should be based on thorough pain assessments and musculoskeletal evaluations. He reviews various studies and systematic reviews that support the use of manual therapy combined with active exercises, showing long-term benefits in reducing headache frequency and intensity. The masterclass concludes with recommendations for incorporating active treatments, such as neck flexor endurance exercises and postural corrections, into patient care for both episodic and chronic TTH, along with an invitation to explore further learning opportunities through a full online course.

Dr. René Castien is a senior researcher at the Department general practice & elderly care medicine Amsterdam UMC, the Department of Human Movement Science, Vrije Universiteit, Amsterdam, and at the SOMT University, Amersfoort, the Netherlands. René completed his PhD research on manual therapy and chronic tension-type headache (2013). His research is published in international journals and has presented the results of his work on (inter)national conferences, workshops, and Masterclasses. Recent research is focused on the effectiveness and working mechanisms of manual therapy on headaches. Besides his academic activities, René works as a specialized manual therapist in a primary care Headache Centre.