Skip to main content

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

Current Pain and Headache Reports volume 23, Article number: 78 (2019) Cite this article

Abstract

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.

Summary

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Becker WJ. Assessing health-related quality of life in patients with migraine. Can J Neurol Sci. 2002;29(Suppl 2):S16–22.

    Article  Google Scholar 

  2. Vos T, Abajobir AA, Abbafati C, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1211–59.

    Article  Google Scholar 

  3. Abu Bakar N, Tanprawate S, Lambru G, Torkamani M, Jahanshahi M, Matharu M. Quality of life in primary headache disorders: a review. Cephalalgia. 2016;36:67–91.

    Article  Google Scholar 

  4. Allena M, Steiner TJ, Sances G, Carugno B, Balsamo F, Nappi G, et al. Impact of headache disorders in Italy and the public-health and policy implications: a population-based study within the Eurolight project. J Headache Pain. 2015;16:100.

    CAS  Article  Google Scholar 

  5. Kristoffersen ES, Grande RB, Aaseth K, Lundqvist C, Russell MB. Management of primary chronic headache in the general population: the Akershus study of chronic headache. J Headache Pain. 2012;13:113–20.

    Article  Google Scholar 

  6. Sinclair AJ, Sturrock A, Davies B, Matharu M. Headache management: pharmacological approaches. Pract Neurol. 2015;15:411–23.

    Article  Google Scholar 

  7. Linde M, Gustavsson A, Stovner LJ, Steiner TJ, Barré J, Katsarava Z, et al. The cost of headache disorders in Europe: the Eurolight project. Eur J Neurol. 2012;19:703–11.

    CAS  Article  Google Scholar 

  8. Sertel M, Bakar Y, Simsek TT. The effect of body awareness therapy and aerobic exercises on pain and quality of life in the patients with tension type headache. Afr J Tradit Complement Altern Med. 2017;14:288–310.

    Article  Google Scholar 

  9. Day MA, Thorn BE, Rubin NJ. Mindfulness-based cognitive therapy for the treatment of headache pain: a mixed-methods analysis comparing treatment responders and treatment non-responders. Complement Ther Med. 2014;22:278–85.

    Article  Google Scholar 

  10. Sun-Edelstein C, Mauskop A. Alternative headache treatments: nutraceuticals, behavioral and physical treatments. Headache J Head Face Pain. 2011;51:469–83.

    Article  Google Scholar 

  11. Koushede V, Hansen EH, Andersen A, Holstein BE. Young adults’ medicine use for headache: the combined effect of socioeconomic position and perceived stress, and the contribution of sense of coherence. Res Soc Adm Pharm. 2012;8:533–41.

    Article  Google Scholar 

  12. Bronfort G, Nilsson N, Haas M, Evans R, Goldsmith CH, Assendelft WJ, et al. Non-invasive physical treatments for chronic/recurrent headache. Cochrane Database Syst Rev. 2004;(3):CD001878. Review. Update in: Cochrane Database Syst Rev. 2014;8:CD001878.

  13. Lenssinck MLB, Damen L, Verhagen AP, Berger MY, Passchier J, Koes BW. The effectiveness of physiotherapy and manipulation in patients with tension-type headache: a systematic review. Pain. 2004;112:381–8.

    Article  Google Scholar 

  14. Bodes-Pardo G, Pecos-Martín D, Gallego-Izquierdo T, Salom-Moreno J, Fernández-de-las-Peñas C, Ortega-Santiago R. Manual treatment for cervicogenic headache and active trigger point in the sternocleidomastoid muscle: a pilot randomized clinical trial. J Manip Physiol Ther. 2013;36:403–11.

    Article  Google Scholar 

  15. Fernández-de-Las-Peñas C, Alonso-Blanco C, Cuadrado ML, et al. Are manual therapies effective in reducing pain from tension-type headache?: a systematic review. Clin J Pain. 2006;22:278–85.

    Article  Google Scholar 

  16. Chaibi A, Tuchin PJ, Russell MB. Manual therapies for migraine: a systematic review. J Headache Pain. 2011;12:127–33.

    Article  Google Scholar 

  17. Chaibi A, Russell MB. Manual therapies for primary chronic headaches: a systematic review of randomized controlled trials. J Headache Pain. 2014;15(1):67.

  18. Posadzki P, Ernst E. Spinal manipulations for cervicogenic headaches: a systematic review of randomized clinical trials. Headache. 2011;51:1132–9.

    Article  Google Scholar 

  19. Chaibi A, Russell MB. Manual therapies for cervicogenic headache: a systematic review. J Headache Pain. 2012;13:351–9.

    Article  Google Scholar 

  20. Lozano López C, Mesa Jiménez J, de la Hoz Aizpurúa JL, et al. Efficacy of manual therapy in the treatment of tension-type headache. A systematic review from 2000-2013. Neurologia. 2016;31(6):357–69.

    Article  Google Scholar 

  21. Bendtsen L, Evers S, Linde M, Mitsikostas DD, Sandrini G, Schoenen J, et al. EFNS guideline on the treatment of tension-type headache—report of an EFNS task force. Eur J Neurol. 2010;17:1318–25.

    CAS  Article  Google Scholar 

  22. NICE Clinical Guideline (CG150) Headaches in over 12s: diagnosis and management. Natl Inst Heal Care Excell. 2012;1–30.

  23. Falsiroli Maistrello L, Geri T, Gianola S, Zaninetti M, Testa M. Effectiveness of trigger point manual treatment on the frequency, intensity, and duration of attacks in primary headaches: a systematic review and meta-analysis of randomized controlled trials. Front Neurol. 2018;9(APR).

  24. Luedtke K, Allers A, Schulte LH, et al. Efficacy of interventions used by physiotherapists for patients with headache and migraine—systematic review and meta-analysis. Cephalalgia. 2015;0:1–19.

    Google Scholar 

  25. Fernández-de-Las-Peñas C, Cuadrado ML. Physical therapy for headaches. Cephalalgia. 2015;0:0333102415596445.

  26. Andrasik F, Lipchik GL, McCrory DC, et al. Outcome measurement in behavioral headache research: headache parameters and psychosocial outcomes. Headache. 2005;45:429–37.

    Article  Google Scholar 

  27. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7).

    Article  Google Scholar 

  28. Falsiroli Maistrello L, Rafanelli M, Turolla A. Do manual therapy techniques have more positive effect compared to usual care on quality of life in people with headaches? A systematic review and meta-analysis of randomized controlled trials. PROSPERO. 2018:CRD42018106999. Available from: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018106999. Accessed 30 Aug 2018.

  29. Berggreen S, Wiik E, Lund H. Treatment of myofascial trigger points in female patients with chronic tension-type headache—a randomized controlled trial. Adv Physiother. 2012;14:10–7.

    Article  Google Scholar 

  30. Castien RF, van der Windt DAWMWM, Grooten A, et al. Effectiveness of manual therapy for chronic tension-type headache: a pragmatic, randomised, clinical trial. Cephalalgia. 2011;31:133–43.

    Article  Google Scholar 

  31. Voigt K, Liebnitzky J, Burmeister U, Sihvonen-Riemenschneider H, Beck M, Voigt R, et al. Efficacy of osteopathic manipulative treatment of female patients with migraine: results of a randomized controlled trial. J Altern Complement Med. 2011;17:225–30.

    Article  Google Scholar 

  32. Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions. Version 5.1.0. In: Higgins JP, Green S, editors. The Cochrane Collaboration; 2011.

  33. Schünemann HJ, Oxman AD, Brozek J, et al. GRADE: assessing the quality of evidence for diagnostic recommendations. Evid Based Med. 2008;13:162–3.

    Article  Google Scholar 

  34. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924–6.

    Article  Google Scholar 

  35. Schünemann HJ BJ. GRADEpro Guideline Development Tool. 2015.

  36. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88.

    CAS  Article  Google Scholar 

  37. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ Br Med J. 2003;327:557–60.

    Article  Google Scholar 

  38. Higgins JP, Altman DG, Sterne J. Chapter 8: assessing risk of bias in included studies. In: Higgins JP, Green S, editors. Cochrane Handb. Syst. Rev. Interv. version 5.1.0. The Cochrane Collaboration; 2011.

  39. • Ferragut-Garcías A, Plaza-Manzano G, Rodríguez-Blanco C, et al. Effectiveness of a treatment involving soft tissue techniques and/or neural mobilization techniques in the management of the tension-type headache: a randomized controlled trial. Arch Phys Med Rehabil. 2016;98:211–219.e2 A very well conducted RCT that used quality of life as primary outcome.

    Article  Google Scholar 

  40. Espí-López GV, Gómez-Conesa A, Gómez AA, Martínez JB, Pascual-Vaca ÁO, Blanco CR. Treatment of tension-type headache with articulatory and suboccipital soft tissue therapy: a double-blind, randomized, placebo-controlled clinical trial. J Bodyw Mov Ther. 2014;18:576–85.

    Article  Google Scholar 

  41. Espí-López GV, Rodriguez-Blanco C, Oliva-Pascual-Vaca A, et al. Effect of manual therapy techniques on headache disability in patients with tension-type headache. Randomized controlled trial. Eur J Phys Rehabil Med. 2014;50:641–7.

    PubMed  Google Scholar 

  42. Moraska AF, Stenerson L, Butryn N, Krutsch JP, Schmiege SJ, Mann JD. Myofascial trigger point-focused head and neck massage for recurrent tension-type headache. Clin J Pain. 2015;31:159–68.

    Article  Google Scholar 

  43. Higgins JP, Deeks JJ, Altman DG. Chapter 16: special topics in statistics. In: Higgins JP, Green S, editors. Handb. Syst. Rev. Interv. Version 5.1.0. The Cochrane Collaboration; 2011.

  44. The Cochrane Collaboration. Review Manager (RevMan) V.5.3. Copenhagen: the Nordic Cochrane Center; 2014.

  45. Espi-Lopez GV, Rodríguez-Blanco C, Oliva-Pascual-Vaca Á, et al. Do manual therapy techniques have a positive effect on quality of life in people with tension-type headache? A randomized controlled trial. Eur J Phys Rehabil Med. 2016;52:447–56.

    PubMed  Google Scholar 

  46. Uthaikhup S, Assapun J, Watcharasaksilp K, Jull G. Effectiveness of physiotherapy for seniors with recurrent headaches associated with neck pain and dysfunction: a randomized controlled trial. Spine J. 2017;17:46–55.

    Article  Google Scholar 

  47. Cerritelli F, Ginevri L, Messi G, Caprari E, di Vincenzo M, Renzetti C, et al. Clinical effectiveness of osteopathic treatment in chronic migraine: 3-armed randomized controlled trial. Complement Ther Med. 2015;23:149–56.

    Article  Google Scholar 

  48. Vincent M, Wang S. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38:1–211.

    Google Scholar 

  49. Espí-López GV, Rodríguez-Blanco C, Oliva-Pascual-Vaca A, Benítez-Martínez JC, Lluch E, Falla D. Effect of manual therapy techniques on headache disability in patients with tension-type headache. Randomized controlled trial. Eur J Phys Rehabil Med. 2014 ;50(6):641–7.

  50. Ailani J. Tension-type headache and women: do sex hormones influence tension-type headache? Curr Pain Headache Rep. 2010;14:436–40.

    Article  Google Scholar 

  51. Burch RC, Loder S, Loder E, Smitherman TA. The prevalence and burden of migraine and severe headache in the United States: updated statistics from government health surveillance studies. Headache J Head Face Pain. 2015;55:21–34.

    Article  Google Scholar 

  52. Smelt AFH, Assendelft WJJ, Terwee CB, Ferrari MD, Blom JW. What is a clinically relevant change on the HIT-6 questionnaire? An estimation in a primary-care population of migraine patients. Cephalalgia. 2014;34:29–36.

    Article  Google Scholar 

  53. Castien RF, Blankenstein AH, van der Windt DA, et al. Minimal clinically important change on the Headache Impact Test-6 questionnaire in patients with chronic tension-type headache. Cephalalgia. 2012;32:710–4.

    Article  Google Scholar 

  54. Coeytaux RR, Kaufman JS, Chao R, Mann JD, DeVellis RF. Four methods of estimating the minimal important difference score were compared to establish a clinically significant change in Headache Impact Test. J Clin Epidemiol. 2006;59:374–80.

    Article  Google Scholar 

  55. Kamper SJ. Blinding: linking evidence to practice. J Orthop Sport Phys Ther. 2018;48:825–6.

    Article  Google Scholar 

  56. Rossettini G, Carlino E, Testa M. Clinical relevance of contextual factors as triggers of placebo and nocebo effects in musculoskeletal pain. BMC Musculoskelet Disord. 2018;19:27.

    Article  Google Scholar 

  57. Rossettini G, Testa M. Manual therapy RCTs: should we control placebo in placebo control? Eur J Phys Rehabil Med. 2018;54(3):500–501.

  58. •• Testa M, Rossettini G. Enhance placebo, avoid nocebo: how contextual factors affect physiotherapy outcomes. Man Ther. 2016;24:65–74 The first article that analyses the importance of contextual factors in physiotherapy.

    Article  Google Scholar 

  59. •• Haywood KL, Mars TS, Potter R, Patel S, Matharu M, Underwood M. Assessing the impact of headaches and the outcomes of treatment: a systematic review of patient-reported outcome measures (PROMs). 2018;38(7):1374–86. A good systematic review focused on the different methods available to measure the impact of headaches on quality of life.

  60. Lipton R, Kolodner K, Bigal M, Valade D, Láinez MJA, Pascual J, et al. Validity and reliability of the migraine-treatment optimization questionnaire. Cephalalgia. 2009;29:751–9.

    CAS  Article  Google Scholar 

  61. De Diego EV, Lanteri-Minet M. Recognition and management of migraine in primary care: influence of functional impact measured by the Headache Impact Test (HIT). Cephalalgia. 2005;25:184–90.

    Article  Google Scholar 

  62. Magnusson JE, Riess CM, Becker WJ. Modification of the SF-36 for a headache population changes patient-reported health status. Headache. 2012;52:993–1004.

    Article  Google Scholar 

Download references

Acknowledgements

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

Author information

Authors and Affiliations

  1. Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy

    Luca Falsiroli Maistrello

  2. Cosenza, Italy

    Marco Rafanelli

  3. Laboratory of Neurorehabilitation Technologies, Fondazione Ospedale San Camillo IRCCS, Venice, Italy

    Andrea Turolla

Authors
  1. Luca Falsiroli Maistrello
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marco Rafanelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrea Turolla
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luca Falsiroli Maistrello.

Ethics declarations

Conflict of Interest

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

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Hot Topics in Pain and Headache

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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). https://doi.org/10.1007/s11916-019-0815-8

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11916-019-0815-8

Keywords

  • Tension-type
  • Migraine
  • Cervicogenic headache
  • Manual treatment
  • Physical therapy
  • HRQoL