Multimodal manual therapy vs. pharmacological care for management of tension type headache: A meta-analysis of randomized trials

Primary tabs

SCIENCE
Multimodal manual therapy vs. pharmacological care for management of tension type headache: A meta-analysis of randomized trials
Key Take-Away: 

Medical interventions alone are not enough for management of tension-type headache. In comparison to medical interventions, the multimodal manual therapy has emerged safe and effective way to provide relief in patients of tension-type headache.

Manual therapies are generally requested by patients for the management of tension-type headache. The objective of this study is to compare the efficacy of multimodal manual therapy vs. pharmacological care for the management of tension type headache pain by conducting a meta-analysis of randomized controlled trials.

ABSTRACT: 
Background: 

Manual therapies are generally requested by patients for the management of tension-type headache.

The objective of this study is to compare the efficacy of multimodal manual therapy vs. pharmacological care for the management of tension-type headache pain by conducting a meta-analysis of randomized controlled trials.

Methods: 

The Pubmed, MEDLINE, EMBASE, AMED, CINAHL, EBSCO, Cochrane Database of Systematic Reviews, Cochrane Collaboration Trials Register, PEDro and SCOPUS were searched from their commencement until June 2014. 

In this study, all randomized controlled trials were included which comparing any manual therapy vs. medication cares for treating tension-type headache in adults. All data were extracted and methodological quality assessed independently by two reviewers.  The primary outcome was pooled headache frequency and also intensity and duration. The weighted mean difference between manual therapy and pharmacological care was determined effect sizes.

Results: 

Five randomized controlled trials met our inclusion criteria and were included in the meta-analysis.

In Pooled analyses, we found that, manual therapies were more effective than pharmacological care in reducing frequency (weighted mean difference –0.8036, 95% confidence interval –1.66 to –0.44; three trials), intensity (weighted mean difference –0.5974, 95% confidence interval –0.8875 to –0.3073; five trials) and duration (weighted mean difference –0.5558, 95% confidence interval –0.9124 to –0.1992; three trials) of the headache immediately after treatment. No differences were found at longer follow-up for headache intensity (weighted mean difference –0.3498, 95% confidence interval –1.106 to 0.407; three trials).

 

Conclusion: 

Manual therapies were associated with moderate effectiveness at short term, but similar effectiveness at longer follow-up for reducing headache frequency, intensity and duration in tension-type headache than pharmacological medical drug therapy.

However, due to the heterogeneity of the medications, these results should be considered with caution at this stage.

Cephalalgia 2015 Mar 6