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Review
. 2021 Aug 31;13(8):e17601.
doi: 10.7759/cureus.17601. eCollection 2021 Aug.

Effectiveness of Manual Therapy and Acupuncture in Tension-Type Headache: A Systematic Review

Arifa Turkistani  1 , Arpita Shah  2 , Arunima Mariya Jose  3   4 , Joao Pedro Melo  5 , Kanita Luenam  2 , Patricia Ananias  2 , Sayma Yaqub  6   7 , Lubna Mohammed  7
Affiliations
Review

Effectiveness of Manual Therapy and Acupuncture in Tension-Type Headache: A Systematic Review

Arifa Turkistani et al. Cureus. .

Abstract

Tension-type headache is one of the most prevalent types of headache. The common presentation is a mild-to-moderate dull aching pain around the temporal region, like a tight band around the forehead, neck, shoulder, and sometimes behind eyes. It can occur at any age but most commonly in the adult female population. The exact underlying mechanism is not clear but muscle tension is one of the main causes, which can be due to stress and anxiety. There are several non-pharmacologic treatment options suggested for tension-type headaches, such as cognitive behavioral therapy, relaxation, biofeedback, acupuncture, exercise, manual therapy, and even some home remedies. This systematic review was performed to evaluate the effectiveness of acupuncture and manual therapy in tension-type headaches. The literature search was primarily done on PubMed. Eight articles involving 3846 participants showed evidence that acupuncture and manual therapy can be valuable non-pharmacological treatment options for tension-type headaches. Acupuncture was compared to routine care or sham intervention. Acupuncture was not found to be superior to physiotherapy, exercise, and massage therapy. Randomized controlled trials done in various countries showed manual therapy also significantly decreased headache intensity. Manual therapy has an efficacy that equals prophylactic medication and tricyclic antidepressants in treating tension-type headaches. The available data suggests that both acupuncture and manual therapy have beneficial effects on treating symptoms of tension-type headache. However, further clinical trials looking at long-term benefits and risks are needed.

Keywords: acupuncture; chronic daily headache; chronic headache; manual therapy; non-pharmacologic treatment; tension-type headache.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Areas involved in tension type-headache are (1) upper eyes, (2) ears, (3) occipital, (4) trapezius, (5) sternocleidomastoid
The image is adapted from Muscles of the Head: http://www.musclesused.com/muscles-facial-expression/ (Public domain).
Figure 2
Figure 2. PRISMA flow diagram
PRISMA: Preferred Reporting Items for Systematic Review and Meta-Analysis
Figure 3
Figure 3. Example of common acupuncture points on the head
The image is adapted from Facial acupuncture by Mscaprikell (2005): https://www.flickr.com/photos/mscaprikell/10972762/sizes/l/. CC BY-SA 2.0.
See this image and copyright information in PMC

References

    1. Guideline for primary care management of headache in adults. Becker WJ, Findlay T, Moga C, Scott NA, Harstall C, Taenzer P. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4541429/ Can Fam Physician. 2015;61:670–679. - PMC - PubMed
    1. 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 E, Lee S. Med Sci Monit. 2019;25:9572–9584. - PMC - PubMed
    1. Effectiveness of dry needling for improving pain and disability in adults with tension-type, cervicogenic, or migraine headaches: protocol for a systematic review. Pourahmadi M, Mohseni-Bandpei MA, Keshtkar A, Koes BW, Fernández-de-Las-Peñas C, Dommerholt J, Bahramian M. Chiropr Man Therap. 2019;27 - PMC - PubMed
    1. Evaluating influential factors of acupuncture for tension-type headache: a protocol for systematic review and meta-analysis. Hao X, Shi Y, Zhu J, et al. Medicine (Baltimore) 2020;99 - PMC - PubMed
    1. Migraine and tension-type headache triggers in a Greek population. Constantinides V, Anagnostou E, Bougea A, Paraskevas G, Kapaki E, Evdokimidis I, Kararizou E. Arq Neuropsiquiatr. 2015;73:665–669. - PubMed

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