Manual joint mobilisation techniques, supervised physical activity, psychological treatment, acupuncture and patient education for patients with tension-type headache. A systematic review and meta-analysis

Lotte Skytte Krøll, Henriette Edemann Callesen, Louise Ninett Carlsen, Kirsten Birkefoss, Dagmar Beier, Henrik Wulff Christensen, Mette Jensen, Hanna Tómasdóttir, Hanne Würtzen, Christel Vesth Høst, Jakob Møller Hansen, Lotte Skytte Krøll, Henriette Edemann Callesen, Louise Ninett Carlsen, Kirsten Birkefoss, Dagmar Beier, Henrik Wulff Christensen, Mette Jensen, Hanna Tómasdóttir, Hanne Würtzen, Christel Vesth Høst, Jakob Møller Hansen

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.

Conflict of interest statement

DB is Advisory Board Member at: Novartis, Lilly, TEVA, conducted Clinical Trials for: Novartis, TEVA, Lilly, Lundbeck and received travel support from: Novartis, Allergan. HEC has reveived personal fees from Danish Knowledge Centre on Headache Disorders. HWC has reveived operating grants from Foundation for Chiropractic Research and Postgraduate Education. LNC has received grants from the Danish Health Authority. MJ is chairman of the board of the Danish Medical Acupuncture Society and owns an acupuncture clinic. LSK, KB, HW, HT, CVH and JMH declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Non-pharmacological treatments for tension-type headache. Meta-analyses of primary outcomes: headache frequency and quality of life at end of treatment of manual joint mobilisation techniques, supervised physical activity, psychological treatment, and acupuncture. No randomized controlled trials were found for patient education. SD: standard deviation. CI: confidence interval

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