Tension type headache (TTH) is the most common type of primary headache, affecting ~50% of adults at some point during their lifetime. Symptoms of TTH include bilateral head pain that is non-pulsating, has a pressing or tightening quality, and is of mild to moderate intensity. The pain is not typically aggravated by physical activity (in fact, it is often relieved by exercise), nor is it associated with nausea and vomiting.
The cause of TTH is currently undetermined, although it is thought to be multifactorial. Following are some of the likely contributing factors of TTH: 1) Activation of hyperexcitable peripheral afferent neurons from the muscles of the head and neck; 2) muscle tension and tenderness due to psychological stress; 3) abnormalities in central pain processing and generalized increased pain sensitivity; and 4) genetic factors.
Non-pharmacologic treatments for patients with TTH have been recommended, including acupuncture and dry needling, cognitive-behavioral therapy, biofeedback training, relaxation training, manual therapy (including spinal manipulation) and physical modalities. The effectiveness of manual therapy interventions for the treatment of TTH have previously been investigated in systematic reviews, although the findings of these reviews are somewhat conflicting. We talk about this in detail in our new E-Seminar “Chiropractic Checkup from the Neck Up” - details here.
The current authors thought there was a need to conduct another systematic review because of limitations with the previous reviews. Mainly, studies were included in the previous systematic reviews in which manual therapy interventions were combined with other interventions. When interventions are combined in a study, the ability to identify the effectiveness of individual manual therapy methods is limited. Another reason for conducting another review is that more studies have been published on this topic since the last review was conducted.
Therefore, the purpose of this review was to summarize and analyze the current evidence regarding the use of manual therapy interventions alone (i.e., not including other modalities) to improve pain intensity, headache frequency and impact of headache in individuals with TTH.
THIS WEEK'S RESEARCH REVIEW: “Effectiveness of Manual Therapy for Tension-Type Headache”
This paper was published in Disability and Rehabilitation (2020) and this Review is posted in Recent Reviews, Headache - Tension and the 2020 Archive.
Tension headache