Effectiveness of manual therapy in patients with tension-type headache. A systematic review and meta-analysis

To systematically review the evidence about the effectiveness of manual therapy (MT) on pain intensity, frequency and impact of headache in individuals with tension-type headache (TTH). Medline, Embase, Scopus, Web of Science, CENTRAL, and PEDro were searched in June 2020. Randomized controlled trials that applied MT not associated with other interventions for TTH were selected. The level of evidence was synthesized using GRADE, and Standardized Mean Differences (SMD) were calculated for meta-analysis. Fifteen studies were included with a total sample of 1131 individuals. High velocity and low amplitude techniques were not superior to no treatment on reducing pain intensity (SMD = 0.01, low evidence) and frequency (SMD = −0.27, moderate evidence). Soft tissue interventions were superior to no treatment on reducing pain intensity (SMD = −0.86, low evidence) and frequency of pain (SMD = −1.45, low evidence). Dry needling was superior to no treatment on reducing pain intensity (SMD = −5.16, moderate evidence) and frequency (SMD = −2.14, moderate evidence). Soft tissue interventions were not superior to no treatment and other treatments on the impact of headache. Manual therapy may have positive effects on pain intensity and frequency, but more studies are necessary to strengthen the evidence of the effects of manual therapy on subjects with tension-type headache.Implications for rehabilitationSoft tissue interventions and dry needling can be used to improve pain intensity and frequency in patients with tension type headache.High velocity and low amplitude thrust manipulations were not effective for improving pain intensity and frequency in patients with tension type headache.Manual therapy was not effective for improving the impact of headache in patients with tension type headache. Soft tissue interventions and dry needling can be used to improve pain intensity and frequency in patients with tension type headache. High velocity and low amplitude thrust manipulations were not effective for improving pain intensity and frequency in patients with tension type headache. Manual therapy was not effective for improving the impact of headache in patients with tension type headache.

本研究旨在系统评价手法治疗（manual therapy, MT）对紧张型头痛（tension-type headache, TTH）患者疼痛强度、发作频率及头痛相关影响的改善效应。
2020年6月，研究团队检索了Medline、Embase、Scopus、Web of Science、CENTRAL及PEDro数据库。
筛选仅针对紧张型头痛采用手法治疗且未联合其他干预手段的随机对照试验，采用GRADE分级系统进行证据质量合成，并通过meta分析计算标准化均差（Standardized Mean Differences, SMD）。
最终纳入15项研究，总样本量达1131例受试者。
结果显示：高速低振幅技术在降低疼痛强度（SMD=0.01，低等级证据）及发作频率（SMD=-0.27，中等级证据）方面，并不优于空白对照；软组织干预措施在降低疼痛强度（SMD=-0.86，低等级证据）与疼痛发作频率（SMD=-1.45，低等级证据）方面，优于空白对照；干针疗法在降低疼痛强度（SMD=-5.16，中等级证据）及发作频率（SMD=-2.14，中等级证据）方面，优于空白对照；软组织干预措施在改善头痛影响方面，既不优于空白对照，也不优于其他治疗方案。
研究结论：手法治疗或可对紧张型头痛患者的疼痛强度与发作频率产生积极影响，但仍需开展更多研究以强化手法治疗对该类患者的疗效证据。
康复启示：
软组织干预措施与干针疗法可用于改善紧张型头痛患者的疼痛强度及发作频率。
高速低振幅推压手法对改善紧张型头痛患者的疼痛强度及发作频率无显著效果。
手法治疗对改善紧张型头痛患者的头痛影响无显著效果。
软组织干预措施与干针疗法可用于改善紧张型头痛患者的疼痛强度及发作频率。
高速低振幅推压手法对改善紧张型头痛患者的疼痛强度及发作频率无显著效果。
手法治疗对改善紧张型头痛患者的头痛影响无显著效果。