Treatment of tension headache

More than 40% of adult Danes suffer from tension headaches and worldwide, it seems that tension headaches are the most common form of headache. Approx. 5% of chiropractic patients turn up because of headaches. Along with acupuncture and massage, chiropractic treatment is one of the forms of treatment that headache patients most often request, while other commonly used approaches are treatment with medication (NSAIDs and tricyclic antidepressants), relaxation, and cognitive therapy.

A number of systematic reviews have previously examined the effect of manual therapy, e.g. manipulation and dry-needling. The results have not been convincing, mostly because it has been difficult to compare the original studies. Researchers have also studied other types of treatment and found a modest effect of tricyclic antidepressants, Botulinum toxin A and acupuncture. As a result, the European Federation of Neurological Societies makes a cautious recommendation that physical (manual) treatment methods should be considered in addition to medication in the management of patients with tension headaches.

In a systematic literature review and meta-analysis, a group of Spanish researchers summarizes the evidence for the use of manual therapy in combination with exercises and compares with the use of medication (NSAIDs and tricyclic antidepressants) in patients with tension headaches. The conclusions are based on five randomized studies with sufficiently high methodological quality.

The Spanish researchers find that manual therapy in combination with exercise is more effective in the treatment of tension headaches measured immediately after the end of the course of treatment (typically after 4-6 weeks) measured by frequency of episodes, pain intensity and duration. On the other hand, there is no difference between manual treatment and medication measured over a longer period of time (4-6 months). The researchers explain the difference between the results by saying that it is possible that the patients in the medication group have continued to take the medication, the effect of which is increasing over time, while the manual treatment has been discontinued after the intervention course.

Clinical implications
Based on the results, the researchers recommend that manual therapy in combination with exercise can be recommended for patients with tension headaches. The treatment should consist of a combination of manipulation/mobilization of the neck and back, soft tissue treatment, as well as stabilizing exercises and counseling aimed at posture. The courses of treatment studied have stretched over 4-6 weeks and consisted of 5-12 sessions. Previous studies have shown that the individual modalities in isolation do not have a great effect, so the positive results found in this literature study are attributed to the fact that the treatment modalities are used in combination. The Spanish study has not assessed the potential costs and side effects of the two treatment regimens.

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