Effectiveness of manual therapy in patients with tension-type headache. A systematic review and meta-analysis

Abstract

Purpose

To systematically review the evidence about the effectiveness of manual therapy (MT) on pain intensity, frequency and impact of headache in individuals with tension-type headache (TTH).

Methods

Medline, Embase, Scopus, Web of Science, CENTRAL, and PEDro were searched in June 2020. Randomized controlled trials that applied MT not associated with other interventions for TTH were selected. The level of evidence was synthesized using GRADE, and Standardized Mean Differences (SMD) were calculated for meta-analysis.

Results

Fifteen studies were included with a total sample of 1131 individuals. High velocity and low amplitude techniques were not superior to no treatment on reducing pain intensity (SMD = 0.01, low evidence) and frequency (SMD = −0.27, moderate evidence). Soft tissue interventions were superior to no treatment on reducing pain intensity (SMD = −0.86, low evidence) and frequency of pain (SMD = −1.45, low evidence). Dry needling was superior to no treatment on reducing pain intensity (SMD = −5.16, moderate evidence) and frequency (SMD = −2.14, moderate evidence). Soft tissue interventions were not superior to no treatment and other treatments on the impact of headache.

Conclusion

Manual therapy may have positive effects on pain intensity and frequency, but more studies are necessary to strengthen the evidence of the effects of manual therapy on subjects with tension-type headache.

Implications for rehabilitation

• Soft tissue interventions and dry needling can be used to improve pain intensity and frequency in patients with tension type headache.

• High velocity and low amplitude thrust manipulations were not effective for improving pain intensity and frequency in patients with tension type headache.

• Manual therapy was not effective for improving the impact of headache in patients with tension type headache.

Keywords:

• Primary headache
• soft tissue
• thrust manipulation
• physical therapy
• rehabilitation
• dry needling

Acknowledgement

The authors received no financial support for the research, authorship, and/or publication of this article.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior and Fundação de Amparo à Pesquisa do Estado de São Paulo (grant 2019/07689-0).