Tension-type headache is the everyday headache most of us know, that tight, pressing band around the head. It is incredibly common, and a lot of people manage it with painkillers alone. This review asked whether physical and manual therapy can help, and which techniques have the best evidence behind them.
The authors reviewed fifteen randomised controlled trials covering a range of hands-on approaches, and looked at their effect on headache intensity, how often headaches came, how long they lasted, and how much they interfered with life.
Tension headache responds to muscle and joint tension in the head, neck and jaw, which is squarely the kind of thing hands-on treatment can influence. This review helps show what actually works.
The trials tested things like neck and upper-back mobilisation with posture retraining, myofascial release, suboccipital release at the base of the skull, upper-neck manipulation, massage and trigger point work.
A common thread was that the effective techniques all worked around the cranio-cervical-mandibular region, in other words the head, neck and jaw acting as one connected system.
The overall picture was positive, especially in the short and medium term.
Techniques targeting the head, neck and jaw region reduced headache intensity across the short and medium term.
Several trials showed a drop in how often headaches occurred after treatment.
The benefit came from treating the whole head-neck-jaw region rather than any single magic technique.
Only one study looked closely at headache duration, so that effect is harder to be sure about.
Hands-on treatment aimed at the head, neck and jaw reduced how intense and how frequent tension headaches were, at least in the short to medium term. There was no single best technique, but treating the whole region helped.
This supports a hands-on, whole-region approach to tension headache rather than chasing one specific method. For us, that means assessing the neck, upper back and jaw together and choosing the techniques that suit each person.
It also fits with offering a drug-free option alongside whatever a person is already doing. Fewer and less intense headaches, even for a few weeks to a few months, can make a real difference to daily life.
Supports soft-tissue, trigger point and mobilisation work across the head, neck and jaw for tension headache.
Backs mobilisation and posture retraining as part of tension headache care.
Reinforces massage and myofascial release of the neck and upper back.
Complements needling of trigger points in the neck and jaw muscles within a broader plan.
The studies used quite different methods and techniques, which makes them hard to combine into one tidy number. Most benefits were shown in the short to medium term, and long-term evidence was thin, with only one study following people out to 26 weeks.
The authors also noted there is no single standard protocol yet, so treatment is best tailored to the individual. If headaches are severe, sudden or changing in pattern, it is important to see a doctor.
Across fifteen trials, hands-on therapy for the head, neck and jaw reduced the intensity and frequency of tension-type headaches in the short to medium term. It is a solid, drug-free option to sit alongside a person’s wider care.
Physical Therapy in Tension-Type Headache: A Systematic Review of Randomized Controlled Trials. Repiso-Guardeno A, and colleagues. Int. J. Environ. Res. Public Health, 2023. Please confirm the full citation at the source before publishing.
