Author Names
Kroll, L et al
Reviewer Name
Laurel Hale, SPT ’24
Reviewer Affiliation(s)
Duke Doctor of Physical Therapy
Paper Abstract
Background: Tension-type headache (TTH) has been ranked the second most prevalent health condition worldwide. Non-pharmacological treatments for TTH are widely used as a supplement or an alternative to medical treatment. However, the evidence for their effects are limited. Therefore, the aim of this study was to review the evidence for manual joint mobilisation techniques, supervised physical activity, psychological treatment, acupuncture and patient education as treatments for TTH on the effect of headache frequency and quality of life. Methods: A systematic literature search was conducted from February to July 2020 for clinical guidelines, systematic reviews, and individual randomised controlled trials (RCT). The primary outcomes measured were days with headache and quality of life at the end of treatment along with a number of secondary outcomes. Meta-analyses were performed on eligible RCTs and pooled estimates of effects were calculated using the random-effect model. The overall certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach (GRADE). In addition, patient preferences were included in the evaluation. Results: In all, 13 RCTs were included. Acupuncture might have positive effects on both primary outcomes. Supervised physical activity might have a positive effect on pain intensity at the end of treatment and headache frequency at follow-up. Manual joint mobilisation techniques might have a positive effect on headache frequency and quality of life at follow-up. Psychological treatment might have a positive effect on stress symptoms at the end of treatment. No relevant RCTs were identified for patient education. The overall certainty of evidence was downgraded to low and very low. No serious adverse events were reported. A consensus recommendation was made for patient education and weak recommendations for the other interventions. Conclusion: Based on identified benefits, certainty of evidence, and patient preferences, manual joint mobilisation techniques, supervised physical activity, psychological treatment, acupuncture, and patient education can be considered as non-pharmacological treatment approaches for TTH. Some positive effects were shown on headache frequency, quality of life, pain intensity and stress symptoms. Few studies and low sample sizes posed a challenge in drawing solid conclusions. Therefore, high-quality RCTs are warranted. Keywords: Dry needling; Exercise; Headache; Manual therapy; Mindfulness; Non-pharmacological treatment.
NIH Risk of Bias Tool
- Is the review based on a focused question that is adequately formulated and described?
- Yes
- Were eligibility criteria for included and excluded studies predefined and specified?
- Cannot Determine, Not Reported, Not Applicable
- Did the literature search strategy use a comprehensive, systematic approach?
- Yes
- Were titles, abstracts, and full-text articles dually and independently reviewed for inclusion and exclusion to minimize bias?
- Yes
- Was the quality of each included study rated independently by two or more reviewers using a standard method to appraise its internal validity?
- Were the included studies listed along with important characteristics and results of each study?
- Yes
- Was publication bias assessed?
- Cannot Determine, Not Reported, Not Applicable
- Was heterogeneity assessed? (This question applies only to meta-analyses.)
- Yes
Key Finding #1
A weak recommendation is made for both manual therapy and supervised physical activity may lead to decreased headache frequency and increased quality of life.
Key Finding #2
Some studies lead to improvements in headache frequency, quality of life, pain intensity, and stress symptoms.
Key Finding #3
Patient education is recommended for patients with Tension Type Headaches (TTH).
Please provide your summary of the paper
While this study gave weak recommendations for manual therapy and supervised physical activity to treat TTH, further research could be beneficial on this topic due to the interferences of bias, inconsistency, and imprecision on the studies reviewed in this systemic review.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
With the high prevalence that TTH have in society, more research needs to be done on non-pharmacological interventions that can be done to give patients short- and long-term relief of symptoms. Further research comparing mobilization vs supervised physical activity with both groups receiving patient education could provide valuable information on the best treatment protocol for patients with TTH.
