Tension headache is the result of a stress process leading to excessive tension of the muscles around the skull with consequent pain and difficulty during daily life activities, this pain can be described as a pain in heaviness, tightness, or pressure. Among the different therapeutic approaches in tension headaches, manual therapy is easy to apply and has great acceptance by patients.

To analyze the effect of a manual therapy protocol on the pain of a subject with tension headache.

It is characterized as a longitudinal, descriptive, and exploratory case report. The subject, male, 34 years old, was evaluated using the following instruments: digital algometer (JTech Commander Algometer®, USA) which tested the pain points of the muscles: upper trapezius, levator scapula, sternocleidomastoid, splenius head and neck bilaterally. In sequence, the Visual Analog Pain Scale (VAS) and the Headache Impact Test (HIT-6) were applied. The evaluation took place before and after 8 treatment visits using the positional inhibition technique. The treatment was carried out for 4 weeks, 2x a week, lasting 45 to 60 minutes each session.

There was an improvement in the individual's ability in their functional activities evidenced through the HIT-6, in which before the consultations it was 23 points, and it increased to 13 points after 8 consultations; reduction in pain by VAS from 7 to 4 after 8 consultations. Through the measurement with the algometer, it was possible to observe that there was a reduction in the pain threshold in practically all the muscles evaluated when compared before and after the 8 treatments, with a greater emphasis on the right upper trapezius muscle (from 1,691 to 3,283) and left (from 2,223 to 3,398) increasing the pain threshold by practically 100%; In the levator scapulae muscle, a significant improvement was observed mainly on the right side (from 2,277 to 3,292), while on the left side (from 2,502 to 2,819); In the splenius muscle of the neck, the values on the right side (from 1475 to 2019) and on the left side (from 1657 to 1854); In the splenius capitis muscle it was possible to see that on the right side (from 1,991 to 3,730) while on the left side there was a reduction in the pain threshold (from 2,923 to 2,520); in relation to the right sternocleidomastoid muscle it increased (from 1,537 to 1,116) and on the left side (from 1,291 to 1,423).

It was found that the manual therapy technique after 8 weeks promoted a reduction in the pain of patients with tension headaches and improved the individual's ability in their functional activities.

The manual therapy technique seems to have been beneficial in the present case study, however further studies are needed to verify the effect of the duration of the technique, and its effectiveness in a larger sample.