Author Names

Turkistani A, Shah A, Jose AM, et al.

Reviewer Name

Kyra Callens, SPT

Reviewer Affiliation(s)

Duke University School of Medicine, Doctor of Physical Therapy Division

 

Paper Abstract

Tension-type headache is one of the most prevalent types of headache. The common presentation is a mild-to-moderate dull aching pain around the temporal region, like a tight band around the forehead, neck, shoulder, and sometimes behind eyes. It can occur at any age but most commonly in the adult female population. The exact underlying mechanism is not clear but muscle tension is one of the main causes, which can be due to stress and anxiety. There are several non-pharmacologic treatment options suggested for tension-type headaches, such as cognitive behavioral therapy, relaxation, biofeedback, acupuncture, exercise, manual therapy, and even some home remedies. This systematic review was performed to evaluate the effectiveness of acupuncture and manual therapy in tension-type headaches. The literature search was primarily done on PubMed. Eight articles involving 3846 participants showed evidence that acupuncture and manual therapy can be valuable non-pharmacological treatment options for tension-type headaches. Acupuncture was compared to routine care or sham intervention. Acupuncture was not found to be superior to physiotherapy, exercise, and massage therapy. Randomized controlled trials done in various countries showed manual therapy also significantly decreased headache intensity. Manual therapy has an efficacy that equals prophylactic medication and tricyclic antidepressants in treating tension-type headaches. The available data suggests that both acupuncture and manual therapy have beneficial effects on treating symptoms of tension-type headache. However, further clinical trials looking at long-term benefits and risks are needed.

 

NIH Risk of Bias Tool

Quality Assessment of Systematic Reviews and Meta-Analyses

  1. Is the review based on a focused question that is adequately formulated and described?
  • Yes
  1. Were eligibility criteria for included and excluded studies predefined and specified?
  • Yes
  1. Did the literature search strategy use a comprehensive, systematic approach?
  • Yes
  1. Were titles, abstracts, and full-text articles dually and independently reviewed for inclusion and exclusion to minimize bias?
  • Yes
  1. Was the quality of each included study rated independently by two or more reviewers using a standard method to appraise its internal validity?
  1. Were the included studies listed along with important characteristics and results of each study?
  • Yes
  1. Was publication bias assessed?
  • No
  1. Was heterogeneity assessed? (This question applies only to meta-analyses.)
  • No

 

Key Finding #1

The implementation of acupuncture shows a 50% decrease in headache frequency in patients with tension type headaches.

Key Finding #2

Manual therapy appears to be the most common form of non-pharmacological treatment for tension type headaches and indicates a decrease in headache symptoms, frequency, and intensity.

 

Please provide your summary of the paper

Tension type headaches are the most common type of primary headaches, as well as the second most common chronic condition. This systematic review determines the effectiveness of manual therapy and acupuncture on tension type headaches. Majority of the articles used in this review came from PubMed and were screened by two independent authors. Two random control trials indicated that acupuncture shows a 50% decrease in headache frequency, however, short term effects can only be observed as participants were given this treatment for 3 months. Another study showed correlation between acupuncture treatment and improvement in overall quality of life. Manual therapy appears to be the most common form of non-pharmacological treatment for tension type headaches. The effects of manual therapies on the relief of headache symptoms ranged from 17.0% to 82.0%. Head and neck massage showed a reduction in headache intensity, and with the incorporation of relaxation and stretching twice a week, headache days were statistically significantly reduced. Mobilizations of cervical and thoracic spines along with exercise and postural correction indicated a significant reduction in headache frequency.

Please provide your clinical interpretation of this paper.  Include how this study may impact clinical practice and how the results can be implemented.

This systematic review indicated the effectiveness of acupuncture and manual therapy on the symptoms and frequency of tension type headaches, as well as overall quality of life. Therefore, these treatments may be beneficial for patients presenting with tension headaches. While common acupuncture points were presented, a standard effective prescription needs to be established in order to better determine the effectiveness of acupuncture. Accordingly, to determine the true short and long term benefits of manual therapy more research needs to be done implementing a standardized protocol.