Tension-type headache is one of the types of headache that occurs in clinical practice and the most common primary headache type.
The symptoms include suppressive holocranial pain, which can become chronic if it is not treated in good time. Manual therapy is one of the treatments, but it is not clear how effective it is or which techniques are best to use.
Do you know the difference between headache types?
The aim of a new systematic review article published in Neurologia aims to evaluate the effectiveness of non-invasive manual therapy in the treatment of patients with tension headache.
Methods
This systematic review was not pre-registered on PROSPERO, but adhered to the PRISMA guidelines and used the guidelines to assess the quality of the articles included in the review.
Articles had to be RCTs that included participants 18-65 years of age and diagnosed with tension headache according to the International Headache Criteria to be included. Articles were excluded if:
TTH was associated with a mechanical disorder such as neck or shoulder pain
Patients with other types of headache were included
The study evaluated invasive physical therapy techniques and medications
The full search strategy is not fully available, but it took place from September to November 2016 and included articles published between 2000 and 2016 at the time.
This string was used to search the journals Brain, PubMed, web of Science, PEDro, Scopus, CINAHL, and Science Direct.
“Tension-type headache”; & # 39; & # 39; manual therapy & # 39; & # 39 ;; and "tension-type headache" AND "manual therapy".
The methodological quality of the study was assessed using the CASP guidelines for studies and the Oxford scale for level of evidence and level of recommendation. It is unclear who carried out the assessment or which process took place.
Results
Brief summary of manual therapy for tension-type headache
Manual therapy for TTH is most useful in improving ROM than any other outcome measure
Combined manual therapy is probably more effective in relieving pain and improving range of motion than individual interventions
4-6 weeks of individual sessions of 20 minutes duration appear to be effective
There are questions about the methodological quality of this systematic review due to the short methodological report
The quality of the articles was average with the risk of reporting errors and misleading statistical analysis
A total of ten articles were included in the final review and there was a wide variety of techniques that have been used to treat TTH. Five studies compared suboccipital soft tissue inhibition with manual therapy of the C spine and a combination of the two techniques and then a control group with a total of 240 participants. All five articles dealt with 4 sessions lasting 20 minutes.
All other intervention combinations and variants were only included in individual studies and largely compared two interventions with a control and a combination of the two interventions against individual and control groups.
The other interventions were as follows:
superficial massage and soft tissue techniques
Mobilizations from Cyriax and Maitland
Simple resistance training and posture training
Retraining of the back and lumbar-pelvic posture
The entire duration of the intervention was between 4-6 weeks and the session between 10-30 minutes, the most common of which was 20 minutes. The most frequently used outcome measure was the pain intensity and the pain frequency.
In every study, physiotherapy had a positive effect on all outcome parameters, but above all on the range of motion and pain intensity and if combinations of manual therapy were used. There does not appear to be any type of manual therapy that is more effective than the others used in this review. As a rule, however, the combination of soft tissue and structural techniques seems to be the most effective.
There are reservations about the clinical application of this evidence as the quality of the studies included in this review is of average quality and most of them do not indicate fluctuation rates and have small sample sizes. In addition, only one study gives confidence intervals to determine the precision of the effects of the interventions. Two studies also do not clearly describe the groups of participants.
