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

  • Hot Topics in Pain and Headache (N Rosen, Section Editor)
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Purpose of Review

People with headache usually experienced significantly lower health-related quality of life (HRQoL) than the healthy subjects. The goal of this systematic review was to evaluate the effectiveness of manual therapy on HRQoL in patients with tension-type headache (TTH), migraine (MH) or cervicogenic headache (CGH).

Recent Findings

We searched randomized controlled trials (RCTs) on MEDLINE, COCHRANE and PEDro databases. Treatment was manual therapy compared to usual care or placebo. The outcome was the HRQoL that could be measured by Headache Impact Test (HIT-6), Headache Disability Inventory (HDI), Migraine Disability Assessment Questionnaire (MIDAS) and Short Form Health Survey 12/36 (SF-12/36). For the RCT internal validity, we used the Cochrane risk of bias (RoB) tool. For the level of evidence, we used the Grading of Recommendations, Assessment, Development and Evaluation approach (GRADE). We identified a total of 10 RCTs, 7 of which were included into the meta-analysis. For HIT-6 scale, meta-analysis showed statistically significant differences in favour to manual therapy both after treatment (mean difference (MD) − 3.67; 95% CI from − 5.71 to − 1.63) and at follow-up (MD − 2.47; 95% CI from − 3.27 to − 1.68). For HDI scale, meta-analysis showed statistically significant differences in favour to manual therapy both after treatment (MD − 4.01; 95% CI from − 5.82 to − 2.20) and at follow-up (MD − 5.62; 95% CI from − 10.69 to − 0.54). Other scales provided inconclusive results.


Manual therapy should be considered as an effective approach in improving the quality of life in patients with TTH and MH, while in patients with CGH, the results were inconsistent. Those positive results should be considered with caution due to the very low level of evidence. Researchers should in future design primary studies using valid and reliable disease-specific outcome measures.

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Special thanks to Dr. Andrea Dell’Isola for his precious help and for his contribution in the finalization phase of the present review.

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Correspondence to Luca Falsiroli Maistrello.

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Luca Falsiroli Maistrello, Marco Rafanelli and Andrea Turolla declare no conflict of interest.

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Falsiroli Maistrello, L., Rafanelli, M. & Turolla, A. Manual Therapy and Quality of Life in People with Headache: Systematic Review and Meta-analysis of Randomized Controlled Trials. Curr Pain Headache Rep 23, 78 (2019).

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