Effectiveness of Hands-Off Therapy in the Management of Primary Headache: A Systematic Review and Meta-Analysis

Abstract

A number of hands-off therapies have been widely reported and are used in the management of headache. This systematic review and meta-analysis aimed to assess evidence supporting these therapies on selected headache outcomes. A systematic literature search for randomized clinical trials reporting on the effects of hands-off therapies for headache was performed in two electronic databases; PubMed and Web of Science (PROSPERO: CRD42018093559). Risk of bias was assessed using the Cochrane risk of bias tool. Meta-analysis was performed using Review Manager v5.4. Thirty-five studies, including 3,403 patients with migraine, tension-type or chronic headaches were included in the review. Methodological quality of the studies ranged from poor to good. Result-synthesis revealed moderate evidence for aerobic exercises, relaxation training and pain education for reducing pain intensity and disability. Other hands-off interventions were either weak or limited in evidence. Meta-analysis of 22 studies indicated that the effect of hands-off therapies significantly differed from one another for pain intensity, disability and quality of life (p < 0.05). Relaxation training, aerobic and active/stretching exercises had significant effect on pain intensity and disability (p < 0.05). To conclude, few hands-off therapies were effective on selected headache outcomes. Evidence to support other hands-off therapies is limited by paucity of studies.

Pilot study on the effects of a culturally-sensitive and standard pain neuroscience education for Hausa-speaking patients with chronic neck pain

“…Nevertheless, substantial heterogeneity among epidemiological studies exists, thereby making generalized conclusions and/or recommendations difficult. Presently, the use of hands-off therapies, patients education and simple aerobic exercises are intervention options with variable level of evidence that have been recommended for managing patients with nonspecific neck pain, especially those with normal recovery patterns [8,9,10].…”