Tension-type headache. Narrative review of physiotherapy treatment

Headache is a very common phenomenon with a high economic and psychosocial impact. Tension-type headache (TTH) is the most prevalent (40%), especially amongst adult western women. The aim was to evaluate the existing evidence on the effectiveness of physiotherapy techniques in treating TTH.Literature review of randomised clinical trials (RCT) and systematic reviews, published over the last five years, on the physiotherapy techniques most used in treating TTH: therapeutic exercise, suboccipital inhibition, cervical manip-ulation, massage, joint mobilisation and puncture.Twenty-six articles (seven reviews) met the criteria for inclusion. The reviews found evidence of the effectiveness of therapeutic exercise on the intensity, frequency and duration of pain. Improvement was also achieved by manual therapy in a similar way to medicines (although with contradictory long-term results), by the combination of dry puncture and physiotherapy on the VAS score, and by the combination of mobilisation techniques with stretching and muscular massage, but not separately. Amongst other results, the RCT showed that massage achieved less pain and frequency, as well as better quality of life, perceived clinical sensation and range of movement; pain improved with suboccipital inhibition and aerobic exercises; and the range of movement with cervical manipulation, massage of soft tissues and mobilisation.The published clinical evidence endorses physiotherapy as an effective treatment in managing patients with TTH, although additional studies with a better quality methodology are required.