The efficacy of physiotherapy approaches in chronic tension-type headache: a systematic review and meta-analysis

Background: Although pharmacologic therapies are considered the first choice for the treatment of chronic tension-type headache (CTTH), physiotherapy and rehabilitation approaches are also used in the management of patients with CTTH. This study aimed to investigate the efficacy of physiotherapy approaches in CTTH through a systematic review and meta-analysis. Methods: The following electronic databases were searched, PubMed and Web of Science databases. Common primary outcomes from randomized controlled trials (RCTs) were changes in the intensity and duration of headaches, headache frequency, disability and headache impact. The methodologic quality (completeness of reporting and risk of bias) of trial reports included in systematic reviews was assessed using the Physiotherapy Evidence Database scale ratings. We also performed data synthesis and quantitative analysis of the eligible data. Results: Nine RCTs were included in the review. Seven studies related to intensity of headache (IH), three on headache frequency (HF), three on headache duration (HD), and two on headache impact were eligible for quantitative analysis. Analysis of the data showed that neck-shoulder strength exercises, electroacupuncture, and approaches targeting muscle relaxation improved the IH (−1.17 (−1.86, −0.49) p < 0.01) and reduced the HD (−0.71 (−1.31, −0.12), p = 0.02); the approaches targeting muscle relaxation and neck-shoulder strength exercises induced a significant decrease in the HF (−1.36 (−2.47, −0.26), p = 0.02) in patients with CTTH in comparison with the control groups. Conclusions: Neck-shoulder strength exercises and muscle relaxation are effective in reducing the intensity, duration, and frequency of headaches and electroacupuncture causes significant improvement in the duration and intensity of headaches in patients with CTTH. The PROSPERO Registration: PROSPERO number is CRD42023457085.

Chronic tension-type headache; Physiotherapy; Acupuncture; Exercise; Muscle relaxation; Meta-analysis; GRADE

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