ObjectiveHeadaches are one of the commonest neurological disorders with a global lifetime prevalence of 66 percent (1), and 82.7 percent in Singapore (2). Tension type headache (TTH) is the commonest primary headache with a lifetime prevalence of 30-78 percent globally (1). TTH is related to muscular factors (17) thus treatment directed toward muscular factors such as manual therapy can be considered (18). This review is aimed at evaluating the use of manual therapy for TTH. MethodsPubMed and CENTRAL databases were searched in November 2015 with keywords 'tension-type headache' and 'manual therapy' or 'massage' or 'physiotherapy' or 'spinal manipulation' or 'trigger point therapy'. The search was limited to randomised control trials which studied the use of manual therapy in the treatment of TTH.Results 8 articles were selected for review. The studies included showed improvement in headache frequency, intensity and Headache Impact Test (HIT-6) scores in favour of manual therapy but not headache duration and Headache Disability Index (global) scores. One study also found an improvement in sick leave days taken. ConclusionManual therapy reduces headache frequency and intensity of attacks and reduces sick leave days resulting from TTH. There is also a positive effect on the quality of life related to headaches (HIT-6). However, manual therapy does not reduce the duration of a TTH episode. Due to the heterogeneity of manual therapy technique used, it is difficult to recommend a particular regime over another. There is a need for further study of manual therapy as an option for TTH.
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