Physical therapy in tension-type headache: a systematic review of randomized controlled trials

<p><strong>Background:</strong> Tension-type headache (TTH) is the most prevalent neurological disorder globally, affecting over 2 billion individuals and posing a substantial public health and socioeconomic burden. Although pharmacological treatments, such as non-steroidal anti-inflammatory drugs, offer symptomatic relief, concerns regarding long-term efficacy and medication overuse have driven interest in physical therapy as an alternative or adjunctive intervention.<br /><strong>Methods:</strong> In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search from inception to December 2024 was conducted in the following electronic databases: PubMed, Google Scholar, Web of Science, the Cochrane Library, and DOAJ. Randomized controlled trials investigating the effect of physiotherapy on TTH were included.<br /><strong>Results:</strong> Fifty-one randomized controlled trials involving 3,404 participants were included in this review. The studies investigated various physical therapy interventions, including manual therapy, therapeutic exercise, and multimodal approaches. The majority of the included studies demonstrated statistically significant improvements in headache intensity, frequency, and duration compared to control groups. Adverse events, when reported, were minor and transient. No serious complications were associated with the physical therapy interventions.<br /><strong>Conclusion:</strong> Physical therapy interventions can be safe with minimal adverse effects in managing patients with TTH. Various physical therapy interventions are effective in reducing pain intensity, frequency, and duration of TTH, both chronic and episodic. However, the lack of long-term outcome data highlights the need for future high-quality randomized controlled trials with extended follow-up.</p>