Manual Therapy and Quality of Life in People with Headache: Systematic Review and Meta-analysis of Randomized Controlled Trials

Maistrello, Luca Falsiroli; Rafanelli, Marco; Turolla, Andrea

doi:10.1007/s11916-019-0815-8

Cited by 45 publications

(17 citation statements)

References 53 publications

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“…19) and migraine (MD −1.94, −2.61 to −1.27), and also headache duration in migraine (MD −22.4 h, −33.9 to −10.9) and CeH (MD −1.7 h per day, −2.1 to −1.2) [14]. Finally, a recent meta-analysis has concluded that manual therapies are effective for increasing health-related quality of life (MD −2.47, −3.27 to −1.68) and related-disability (MD −5.62, −10.69 to −0.54) in TTH and migraine, while its effects on CeH were inconsistent [15]. This evidence supports the effectiveness of non-pharmacological manual therapy interventions for the treatment of headache; however, these assumptions should be considered with caution due to the heterogeneity in study designs and manual therapy approaches applied [16].…”

Section: Introductionmentioning

confidence: 99%

Clinical Reasoning Behind Non-Pharmacological Interventions for the Management of Headaches: A Narrative Literature Review

Fernández‐de‐las‐Peñas

Plaza-Manzano

Arias-Buría

2020

IJERPH

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Headache is the clinical syndrome most commonly observed by neurologists in daily practice. Pharmacological and non-pharmacological treatments are commonly used for the management of headaches; however, the clinical reasoning behind these interventions is not properly applied. We conducted a narrative literature review using as data sources for academic PubMed, MEDLINE, EMBASE, AMED, CINAHL, EBSCO, PEDro, Cochrane Database of Systematic Reviews, Cochrane Collaboration Trials Register, and SCOPUS. This narrative literature review mainly considered systematic reviews, meta-analyses, randomised clinical trials, and expert opinions published after the year 2000 discussing clinical reasoning for application of non-pharmacological interventions in individuals with tension-type, migraine, and cervicogenic headaches. After the data extraction, we organized the literature thematically as follows: (1) mapping of theoretical aspects of non-pharmacological interventions; (2) summarizing most updated literature about effectiveness of non-pharmacological interventions grouped by targeted tissue and headache; (3) identifying research gaps in the existing literature and proposing hypotheses for better understanding of current clinical reasoning. We found that there are many non-pharmacological treatment strategies used for headaches, including beyond the tissue-based impairment treatments (bottom-up) and strategies targeting the central nervous system (top down). Bottom-up strategies include joint-biased, soft-tissue biased, or needling interventions, whereas top-down strategies include exercise and cognitive interventions. Evidence shows that the effectiveness of these interventions depends on the application of proper clinical reasoning, since not all strategies are effective for all headaches. For instance, evidence of non-pharmacological interventions is more controversial for migraines than for tension-type or cervicogenic headaches, since migraine pathogenesis involves activation of sub-cortical structures and the trigemino- vascular system, whereas pathogenesis of tension-type or cervicogenic headaches is most associated to musculoskeletal impairments of the cervical spine. We conclude that current literature suggests that not all non-pharmacological interventions are effective for all headaches, and that multimodal, not isolated, approaches seem to be more effective for patients with headaches. Most published studies have reported small clinical effects in the short term. This narrative literature review provides some hypotheses for discrepancies in the available literature and future research. Clinical reasoning should be applied to better understand the effects of non-pharmacological interventions.

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Section: Introductionmentioning

confidence: 99%

Clinical Reasoning Behind Non-Pharmacological Interventions for the Management of Headaches: A Narrative Literature Review

Fernández‐de‐las‐Peñas

Plaza-Manzano

Arias-Buría

2020

IJERPH

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“…From this guideline one relevant RCT [ 32 ], concerning manual joint mobilisation techniques, was identified. This was followed by a search for existing systematic reviews; 11 relevant reviews were identified [ 14 , 16 , 17 , 19 , 22 – 27 , 49 ], and rated using the AMSTAR tool. From the included systematic reviews, ten relevant RCTs were identified (six concerning manual joint mobilisation techniques [ 31 – 36 ]; three concerning psychological treatment [ 39 – 41 ]; one concerning acupuncture [ 42 ].…”

Section: Resultsmentioning

confidence: 99%

“…Previous systematic reviews, published after the release of ICHD-2 [ 13 ] have evaluated the effectiveness of manual therapy compared to conservative or conventional treatments [ 14 , 15 ], effectiveness of trigger point manual therapy [ 16 ], several modalities [ 17 , 18 ] or a solely focus on quality of life [ 19 ]. We need a focus on modalities that used manual joint mobilisation techniques rather than including manual therapies as massage, trigger point therapy or cranio-sacral therapy.…”

Section: Introductionmentioning

confidence: 99%

Manual joint mobilisation techniques, supervised physical activity, psychological treatment, acupuncture and patient education for patients with tension-type headache. A systematic review and meta-analysis

et al. 2021

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Background Tension-type headache (TTH) has been ranked the second most prevalent health condition worldwide. Non-pharmacological treatments for TTH are widely used as a supplement or an alternative to medical treatment. However, the evidence for their effects are limited. Therefore, the aim of this study was to review the evidence for manual joint mobilisation techniques, supervised physical activity, psychological treatment, acupuncture and patient education as treatments for TTH on the effect of headache frequency and quality of life. Methods A systematic literature search was conducted from February to July 2020 for clinical guidelines, systematic reviews, and individual randomised controlled trials (RCT). The primary outcomes measured were days with headache and quality of life at the end of treatment along with a number of secondary outcomes. Meta-analyses were performed on eligible RCTs and pooled estimates of effects were calculated using the random-effect model. The overall certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach (GRADE). In addition, patient preferences were included in the evaluation. Results In all, 13 RCTs were included. Acupuncture might have positive effects on both primary outcomes. Supervised physical activity might have a positive effect on pain intensity at the end of treatment and headache frequency at follow-up. Manual joint mobilisation techniques might have a positive effect on headache frequency and quality of life at follow-up. Psychological treatment might have a positive effect on stress symptoms at the end of treatment. No relevant RCTs were identified for patient education. The overall certainty of evidence was downgraded to low and very low. No serious adverse events were reported. A consensus recommendation was made for patient education and weak recommendations for the other interventions. Conclusion Based on identified benefits, certainty of evidence, and patient preferences, manual joint mobilisation techniques, supervised physical activity, psychological treatment, acupuncture, and patient education can be considered as non-pharmacological treatment approaches for TTH. Some positive effects were shown on headache frequency, quality of life, pain intensity and stress symptoms. Few studies and low sample sizes posed a challenge in drawing solid conclusions. Therefore, high-quality RCTs are warranted.

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“…Headache is a very common condition that most people experience at least once in their lifetimes. Headache refers to the pain accompanied by discomfort in the face, neck and the head [1]. Approximately 80% of patients with headaches experience difficulty engaging in daily activities, and research has indicated that the incidence of headache accompanied by sleep disorders, depression, or anxiety continues to increase [2].…”

Section: Introductionmentioning

confidence: 99%

“…Among the representative types of headaches, tension-type headache (TTH) is the most common type in adults, with a reported prevalence between 36% to 78% [3]. Approximately 14% of adults experience TTH at least once per week, although symptoms occur almost every day in 3% of adult patients [1]. In affected patients, TTH occurs at a frequency of at least once per month and may be accompanied by moderate-to-severe sensations of pressure, with pain persisting from 30 minutes to 7 days [4].…”

Section: Introductionmentioning

confidence: 99%

Impact of Cervical Sensory Feedback for Forward Head Posture on Headache Severity and Physiological Factors in Patients with Tension-type Headache: A Randomized, Single-Blind, Controlled Trial

Lee

2019

Med Sci Monit

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BackgroundTension-type headache (TTH) decreases the ability to concentrate and function during daily activities in affected patients. As most patients with TTH exhibit forward head posture (FHP). Various interventions have been proposed to resolve TTH. However, research regarding the efficacy of these interventions remains lacking. The present study aimed to investigate the association between FHP and TTH, and to evaluate the efficacy of various intervention methods on headache symptoms and other clinical variables in patients with TTH induced by FHP.Material/MethodsParticipants were randomly allocated to 3 groups: biofeedback (BF, n1=21), manual therapy (MT, n2=20) and, stretching (ST, n3=21). Interventions were conducted 3 times per week for 4 weeks. Craniovertebral angle (CVA), electroencephalographic findings for attention, stress, and pressure-pain threshold (PPT), headache on activities of daily living (Henry Ford Headache Disability Inventory, HDI), and quality of life (QoL) assessments were obtained pre-intervention, post-intervention, and at the 2-week follow-up.ResultsThe correlation between CVA and HDI after intervention (R2=0.324, P<0.001), and at 2-week follow-up (R2=0.115, P<0.01) are significant. BF was associated with significant improvements in CVA (F2,59=3.393, P<0.001, normalηP2=0.130), attention (F2,59=5.186, P<0.01, normalηP2=0.150), stress [skin temperature (F2,59=6.005, P<0.001, normalηP2=0.169) and skin conductance (F2,59=4.900, P<0.01, normalηP2=0.142)], PPT (F2,59=5.050, P<0.01, normalηP2=0.146), HDI (F2,59=3.303, P<0.01, normalηP2=0.101), and QoL (F2,59=3.409, P<0.05, normalηP2=0.104).ConclusionsOur findings indicate that BF was more effective than MT and ST in the treatment of TTH due to FHP. Such findings highlight the need to develop and promote a controlled exercise program to facilitate a return to normal daily activities in patients with TTH due to FHP.

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Manual Therapy and Quality of Life in People with Headache: Systematic Review and Meta-analysis of Randomized Controlled Trials

Cited by 45 publications

References 53 publications

Clinical Reasoning Behind Non-Pharmacological Interventions for the Management of Headaches: A Narrative Literature Review

Clinical Reasoning Behind Non-Pharmacological Interventions for the Management of Headaches: A Narrative Literature Review

Manual joint mobilisation techniques, supervised physical activity, psychological treatment, acupuncture and patient education for patients with tension-type headache. A systematic review and meta-analysis

Impact of Cervical Sensory Feedback for Forward Head Posture on Headache Severity and Physiological Factors in Patients with Tension-type Headache: A Randomized, Single-Blind, Controlled Trial

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